Dialysis Modality Influenced Degree of Pandemic-Related Psychological Distress in Patients With CKD

Patients with chronic kidney disease (CKD) undergoing hemodialysis experienced a greater degree of psychological distress during the COVID-19 pandemic compared with patients treated with peritoneal dialysis, investigators found.

Patients with chronic kidney disease (CKD) receiving dialysis treatment showed psychological distress during the COVID-19 pandemic, with hemodialysis (HD) patients demonstrating more severe symptoms than peritoneal dialysis (PD) patients, according to a recent study.

The cross-sectional observational study, published in PLOS One, is the first study to investigate the differences between patients undergoing HD and PD in regard to psychological distress and COVID-19–related concerns.

“Our results might offer insight into the necessities of beforehand interventions to prevent psychological distress and depression in dialysis patients who are vulnerable to pandemic infections such as COVID-19,” wrote the investigators.

The COVID-19 pandemic has affected the psychological well-being of many people, and chronic medical comorbidity may play a role in psychological impact of the crisis. Patients with chronic diseases may experience fears that a collapse of the health care system as a result of the pandemic could prevent them from having access to appropriate and timely treatment.

Although the impact of CKD on depression and anxiety is well known, and thus may be linked to COVID-19–related stress, less is known about how dialysis modality influences this risk. The implementation of infection control precautions within medical institutions can mean that patients have to delay HD treatment if they experience mild symptoms. Patients undergoing HD have to spend several hours multiple times per week at a medical institution compared with patients undergoing PD, who only require a hospital visit once a month.

Between August and September 2020, the investigators conducted a survey at Soonchunhyang University Hospital Cheonan in the Republic of Korea among patients with end-stage renal disease. Of the 224 outpatients underdoing dialysis identified, 148 were enrolled in the study, 70 of whom were receiving PD and 78 were receiving HD.

The investigators utilized several scales to assess psychological distress. The 9-item Patient Health Questionnaire was used to analyze depression. A 7-item Generalized Anxiety Disorder scale was used to measure anxiety levels. The 22-item Impact of Event Scale-Revised assessed stress and the 7-item Insomnia Severity Index provided information on insomnia.

In the HD group, 67.9% were male, the mean age was 55.32 years, and the mean dialysis vintage was about 6.77 years. In the PD group, 50.0% were male, the mean age was 51.44 years (P = .06), and the mean dialysis vintage was 4.37 years (P = .0001). The participants were matched into 52 pairs.

The HD group was found to have higher levels of psychological distress related to depression, anxiety, stress, and insomnia compared with the PD group. About 30.7% of HD patients and 15.8% of PD patients reported moderate to severe depression (P = .001).

Nearly half of HD patients and 28.5% of PD patients experienced moderate to severe anxiety, but the different was not significant (P = .081). In regard to stress and insomnia, 60.0% and 65.7% of PD patients and 25.6% and 38.5% of HD patients had normal ranges of stress and insomnia, respectively (P < .001; P = .002).

The investigators listed the cross-sectional, single-center design as a study limitation, saying that the results may not be generalizable to other populations or ethnicities. They also said that the scales used to measure aspects of psychological distress relied heavily on patient self-reporting, potentially leading to bias. Longitudinal multicenter studies with larger sample sizes are needed to confirm the results.


Yu JY, Kim JS, Hong CM, et al. Psychological distress of patients with end-stage kidney disease undergoing dialysis during the 2019 coronavirus disease pandemic: a cross-sectional study in a University Hospital. PLOS One. 2021;16(12):e0260929. doi:10.1371/journal.pone.0260929