Abstract
BackgroundThe highly burdensome effects of kidney failure and its management impose many life-altering changes on patients. Better understanding of successful coping strategies will inform patients and help health care providers support patients’ needs as they navigate these changes together.MethodsA qualitative, cross-sectional study involving semi-structured telephone interviews including open- and closed-ended questions, with 179 U.S. patients with advanced chronic kidney disease (CKD), either not yet on dialysis ([CKD-ND], n = 65), or on dialysis (hemodialysis [HD], n = 76; or peritoneal dialysis [PD], n = 38) recruited through social media and in-person contacts from June to December 2013. Themes identified through content analysis of interview transcripts were classified based on the Coping Strategies Index (CSI) and compared across groups by demographics, treatment modality, and health status.ResultsOverall, more engagement than disengagement strategies were observed. “Take care of myself and follow doctors’ orders,” “accept it,” and “rely on family and friends” were the common coping themes. Participants often used multiple coping strategies. Various factors such as treatment modality, time since diagnosis, presence of other chronic comorbidities, and self-perceived limitations contributed to types of coping strategies used by CKD patients.ConclusionsThe simultaneous use of coping strategies that span different categories within each of the CSI subscales by CKD patients reflects the complex and reactive response to the variable demands of the disease and its treatment options on their lives. Learning from the lived experience of others could empower patients to more frequently use positive coping strategies depending on their personal context as well as the stage of the disease and associated stressors. Moreover, this understanding can improve the support provided by health care systems and providers to patients to better deal with the many challenges they face in living with kidney disease.
Highlights
The highly burdensome effects of kidney failure and its management impose many life-altering changes on patients
Demographics Chronic kidney disease (CKD)-ND patients tended to be older, had more female respondents, were more frequently diagnosed within the last year, more often felt they were in poor health, more frequently expressed limitations in daily life, and more often had three or more chronic conditions compared to HD and Peritoneal dialysis (PD) patients
Patients with kidney failure often feel better after starting dialysis and this is reflected in our patient cohort where Not yet on dialysis (CKD-ND) patients more often felt they were in poor health than those on dialysis
Summary
The highly burdensome effects of kidney failure and its management impose many life-altering changes on patients. CKD patients often have to deal with several other chronic comorbidities, especially diabetes, hypertension, and cardiovascular diseases [3, 4]. These patients face the challenge and burden of the intrusive and irreversible consequences of kidney failure on their physical and mental health, as well as on their quality of life, including the impact on their family, lifestyle, relationships, and employment [5, 6]. The effects of kidney failure and its treatment, the lack of a cure, and the impact of treatment options on lifestyle and well-being contribute to a sustained source of stressors in the lives of these patients [2]
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