PSYCHOLOGICAL BURDEN IN RENAL REPLACEMENT THERAPY: COMPARATIVE OUTCOMES ACROSS HEMODIALYSIS, PERITONEAL DIALYSIS, AND KIDNEY TRANSPLANTATION

Damian Zienkiewicz; Gabriela Makulec; Karolina Domosud; Weronika Walendziak; Natalia Mordal; Kacper Ściebura; Wiktoria Wiśniewska; Magdalena Ostaszewska; Milena Majchrzyk; Anna Malczyk

doi:10.31435/ijitss.1(49).2026.4814

Authors

Damian Zienkiewicz Praga Hospital of the Transfiguration, Warsaw, Poland https://orcid.org/0009-0008-7263-1545
Gabriela Makulec Military Institute of Medicine - National Research Institute, Warsaw, Poland https://orcid.org/0009-0009-1357-1340
Karolina Domosud Military Institute of Medicine - National Research Institute, Warsaw, Poland https://orcid.org/0009-0007-4345-2188
Weronika Walendziak The National Medical Institute of the Ministry of the Interior and Administration, Warsaw, Poland https://orcid.org/0009-0008-9764-7324
Natalia Mordal Mazowiecki Szpital Bródnowski, Warsaw, Poland https://orcid.org/0009-0000-7494-8070
Kacper Ściebura Military Institute of Medicine - National Research Institute, Warsaw, Poland https://orcid.org/0009-0004-8279-8008
Wiktoria Wiśniewska Mazowiecki Szpital Bródnowski, Warsaw, Poland https://orcid.org/0009-0003-7401-419X
Magdalena Ostaszewska The National Medical Institute of the Ministry of the Interior and Administration, Warsaw, Poland https://orcid.org/0009-0007-6519-0449
Milena Majchrzyk The National Medical Institute of the Ministry of the Interior and Administration, Warsaw, Poland https://orcid.org/0009-0003-1054-9953
Anna Malczyk Międzyleski Szpital Specjalistyczny, Warsaw, Poland https://orcid.org/0009-0009-0206-2348

DOI:

https://doi.org/10.31435/ijitss.1(49).2026.4814

Keywords:

Dialysis, Kidney Transplantation, Depression, Cognitive Function, Quality of Life, Psychological Burden

Abstract

Chronic kidney disease affects approximately 9.5% of the global population, with end-stage kidney disease requiring renal replacement therapy (RRT). This narrative review synthesizes evidence from recent meta-analyses and landmark studies comparing psychological and psychosocial outcomes across hemodialysis (HD), peritoneal dialysis (PD), and kidney transplantation (KTx). Depression prevalence is approximately 35% in both HD and PD patients, but significantly lower (25%) in KTx recipients, a difference primarily attributable to modality rather than patient characteristics. Cognitive impairment affects 53% of HD patients versus lower rates in PD patients; intradialytic cerebral ischemia emerges as a plausible mechanism, yet paradoxically, PD patients show faster brain atrophy while maintaining better cognitive test performance. Health-related quality of life follows a consistent hierarchy: KTx provides superior outcomes, followed by PD, then HD, with effects most pronounced in kidney-disease-specific domains. Critically, immunosuppressive medication side effects, not graft function, emerge as the strongest predictor of post-transplant quality of life. Major psychosocial domains including employment, sexual function, and sleep quality remain unstudied when stratified by modality. Current modality selection relies on clinical and logistical factors without considering psychological fit. This review identifies substantial evidence gaps and proposes that future practice integrate psychological assessment into pre-dialysis education and develop validated tools to personalize modality selection based on coping capacity and psychological resilience.

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