Dialyzing Steadfastly

The prospect of starting dialysis may be overwhelming, daunting, and bleak. According to the National Kidney Foundation, the average life expectancy of an individual on dialysis is 5-10 years, though some may well exceed that average. With stark changes in lifestyle and daily routines, beginning dialysis is certainly a major transition for patients and their families with challenges ahead.

Given these transitions and changes in mood or overall well-being, patients may be at increased risk of experiencing symptoms of depression, anxiety, or hopelessness. Relationships with family members may become strained with their new and perhaps unexpected role of caregiver, as well as dealing with issues of transportation and employment. This may culminate in expressing feelings of “giving up” or asking “what’s the point?”. How then, might one combat or prepare for these issues to extend quality of life for yourself and others?

Starting dialysis does not mean starting the end of your life, though it may largely be perceived as such by many. Rather, it could be viewed as the next challenge you will attempt to conquer in your healthcare and one you will not face alone. Recognition of signs or symptoms of depression from your healthcare providers, yourself, as well as others is the first step in improving quality of life and tackling dialysis head on with a brave, determined approach. Research shows depression and anxiety are some of the most common illnesses associated with higher mortality in dialysis patients, though often underrecognized or inadequately treated (Chilcot, Wellsted, Da Silva-Gane & Farrington, 2008). Often, symptoms related to starting dialysis such as loss of appetite, fatigue, and sleep disorders mimic those of depression increasing the challenges of correctly diagnosing or recognizing the illness. Effective screening tools administered by healthcare providers can aid in properly detecting symptoms. Being honest with yourself and your healthcare team is also crucial in being able to steadfastly confront dialysis and its related challenges.

Treating depression while on dialysis however proves complicated. Usually prescribed medications have a greater chance of interacting with your current medication regiment or effecting dietary restrictions. Some medications have shown to be effective, though in a small population of dialysis patients. It has been suggested that psychological rather than pharmacological interventions may prove more effective (i.e. seeing a therapist). However, the largest issue confronting treatment is the outright refusal by patients. Perhaps the stigma of depression is largely to blame, but challenging and questioning your views on this issue may prove helpful and insightful. Overcoming these obstacles to treatment may in fact significantly improve your quality of life.

Dialysis presents itself with many challenges and questions about how you may envision your life going forward. However, confronting this challenge with knowledge about what you may experience and how to correctly navigate these issues with effective treatments may in fact provide you with more control of your healthcare. Being honest and open about what is going on with your mind and body can also improve your quality of life through receiving adequate treatment. Together, your healthcare team, family, and yourself can confront these new challenges with courage and determination.

Resources:

Chilcot, J., Wellsted, D., Da Silva-Gane, M., Farrington, K. (2008). Depression on dialysis. Nephron Clinical Practice, 108 (4)