Pain, Anxiety, and Depression in Hemodialysis Patients Undergoing Different Types of Vascular Access: A...

Chronic hemodialysis (HD) patients experience various psychological burdens including pain, anxiety, and depression which are often under-recognized in routine clinical care. While the vascular access (VA) modality is a crucial factor in dialysis adequacy and patient outcomes, its participation in the psychosocial distress remains insufficiently assessed.

To assess the association between the VA types, arteriovenous fistula and central venous catheter (CVC), and the prevalence of pain, anxiety, and depression in chronic HD patients.

This multicentered cross-sectional study included 415 adult patients undergoing HD for at least 1 year in six Lebanese hospitals. Participants with a documented diagnosis of psychological disorders or receiving antidepressants prior to dialysis initiation were excluded. Anxiety and depression were assessed through Hospital Anxiety and Depression Scale (HADS) while pain was evaluated using Numeric Rating Scale and Short-Form McGill Pain Questionnaire.

The incidence of symptomatic anxiety was higher with arteriovenous fistula (75%) than with CVC (25%). Similarly, detection of depressive symptoms was higher with arteriovenous fistula (81%) than with CVC (19%). Some degree of pain has been reported by 54.5% of studied patients. Statistically, there was no significant difference between the type of VA and the psychosocial factors mentioned (p  > 0.05). In contrast, higher pain score and psychosocial distress were associated with dialysis and VA related complications (p = 0.018).

These findings highlight the importance of routine systematic symptom assessment, complications management and prevention, and the integration of a multidisciplinary support team in HD care.