Psychological burden and existential well-being in advanced kidney disease: a comparative analysis of end-stage renal disease (ESRD) patients, transplant recipients and healthy controls

Abstract

Introduction: Chronic kidney disease (CKD), and particularly end-stage renal disease (ESRD), is associated with substantial psychological burden, including elevated rates of depression, anxiety and somatic distress, while kidney transplantation improves physical outcomes but does not eliminate psychological vulnerability. Previous research has shown that personality traits, coping styles, hope and meaning in life significantly influence the emotional adjustment of patients undergoing renal replacement therapies.

Aim: The aim of this study was to compare psychopathology, personality traits, burnout, depersonalization, hope and meaning in life among three groups: ESRD patients on hemodialysis, kidney transplant recipients and healthy controls.

Materials and Methods: The sample consisted of 100 patients (50 ESRD patients on hemodialysis and 50 kidney transplant recipients) and 50 healthy controls matched for key sociodemographic characteristics. Data collection included sociodemographic questionnaires and validated psychometric tools: SCL-90-R, Cambridge Depersonalization Scale (CDS), Maslach Burnout Inventory (MBI), Eysenck Personality Questionnaire (EPQ), Meaning in Life Questionnaire (MLQ), and Adult Hope Scale (AHS). Participation was voluntary, anonymity was ensured, informed consent was obtained, and institutional ethical approval was granted. Statistical analysis included descriptive measures, group comparisons and p-values with 95% confidence intervals.

Results: Patients scored higher than healthy controls on most SCL-90-R subscales, with psychoticism showing a statistically significant difference (p=0.019). ESRD patients recorded higher levels of psychopathology, emotional exhaustion, personal accomplishment deficits and depersonalization compared with transplant recipients, though only the MLQ “search for meaning” subscale differed significantly (p=0.007). Transplant patients showed higher hope levels on both AHS subscales but without statistical significance. Gender analyses revealed that women in both clinical groups exhibited significantly higher somatization, anxiety and obsessive-compulsive symptoms, while men scored higher in hope and meaning domains.

Conclusions: ESRD and transplant patients demonstrate substantial psychological burden relative to healthy controls, with notable gender-specific patterns. ESRD patients appear more engaged in existential search, whereas transplant recipients show stronger hopeful thinking. These findings highlight the importance of integrating structured psychological screening and personalized psychosocial interventions into routine nephrology care to improve emotional resilience and overall quality of life.