Integration of Clinical Psychology into Hemodialysis Programs

Abstract

What would happen to your life if your physician told you that you had end-stage renal disease (ESRD) or, in more common parlance, complete kidney failure? Your doctor would explain that, in order for you to survive, your blood must be cleansed of waste products by a mechanical device of some sort. The vast majority of the 100,000 or so ESRD patients use hemodialysis, a process in which the blood is circulated through an artificial kidney and then returned to the patient’s bloodstream via a fistula (a connection between an artery and a vein created surgically in the arm). Unfortunately, hemodialysis requires 4 to 7 hours per day (including transportation time if it is done outside the home) three times per week. The use of hemodialysis brings with it the constant threat of death and a substantial dependency on medical personnel and machinery for survival. Also, this process is far from equivalent to the manner in which people with functional kidneys have their blood cleansed. Bodily impurities and poisons remain in the bloodstream (uremia) at levels that can often produce severe reductions in physical energy, strength, and motivation. Dialysis also produces substantial reductions in sexual activities and a variety of more minor, but still rather troublesome, difficulties, such as headaches, nausea, cramping in the legs, sleep disturbances, skin irritations, and problems with access to the blood supply or other technical difficulties that pose considerable personal threat (Nichols & Springford, 1984).