Psychological challenges of patients starting peritoneal dialysis: a single-center qualitative pilot study

Psychological challenges are common among patients starting peritoneal dialysis (PD), yet studies specifically exploring psychological well-being during PD initiation are limited. This qualitative pilot study aimed to identify the most frequent reasons prompting psychological referral among patients initiating PD at our center.

We conducted a thematic analysis of the twice-monthly psychological support sessions involving 12 patients who were referred within the first 3 months of PD initiation due to symptoms of anxiety and insomnia. Among them, 7/12 were male, with a median age at PD initiation of 54 years (Interquartile range [IQR] 43-61). PD was initiated because of stage V chronic kidney disease in 8/12 patients, kidney transplant failure in 2/12, and due to a switch from hemodialysis in 2/12 patients.

The most frequently reported themes causing psychological suffering included non-acceptance of chronic disease, altered body image perception after peritoneal catheter placement, managing fluid restrictions, and travel-related anxiety (12/12). Seven patients also expressed struggles with dietary adherence and the emotional burden of preparing for transplant evaluation. Additional concerns included non-acceptance of PD, task-anxiety, and fear of PD-related peritonitis.

In conclusion, this study highlights the range of psychological difficulties experienced during the early phase of PD. These findings underscore the importance of proactively addressing these aspects during pre-dialysis counseling to better support the patients' emotional adaptation and treatment engagement.