Does the Type of Dialysis Treatment Make a Difference to the Quality of Life and Suicidal Thoughts?

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If you have End Stage Renal Disease (ESRD) then you are significantly more likely to commit suicide than a person in the general population. Short- and long-term personal adjustments to dialysis exact a very heavy toll on patients in terms of health and mortality. The increased risk for suicide associated with ESRD is seen across all demographic patient groups and tends to accentuate national suicide patterns.

A recent study investigated the differences in 84 hemodialysis (HD) and 60 peritoneal dialysis (PD) patients. The results indicated that HD patients reported lower quality of life in social relationships and environment. Less satisfactory results were also found in the areas of anxiety, insomnia and severe depression. This included sleep problems and suicidal thoughts.

Suicide and Dialysis Withdrawal were strongly associated although the pattern of risk differed somewhat between the two methods to induce death. The risk for suicide was highest in the first 3 months after dialysis initiation and diminished steadily over time, whereas the likelihood of dialysis withdrawal was relatively high for the first year of dialysis and lessened considerably thereafter. Several factors that were significantly associated with withdrawal were identified, including hemodialysis rather than peritoneal dialysis, and a number of comorbid conditions (coexisting diseases).

These findings confirmed the differences between the two treatment modalities, indicating that HD patients have poorer quality of life in several aspects of their social relationships and environment. Both groups reported elevated depression. However, HD patients reported more suicidal thoughts and sleeping problems as compared to PD patients.

Thoughts of suicide and depression can have many causes. In the case of someone who has just been diagnosed with chronic kidney disease there may be a lot of information to process about their physical health, which may lead to strong emotions about life and how it may change. Similarly, once a person reaches end stage renal disease and begins dialysis, there are lifestyle adjustments to be made that could bring up feelings of despair. However, thoughts of self-harm are treatable. Just like you get medical treatment for your renal disease, there are treatments available for severe depression.

The most dangerous feature of suicidal thoughts is that if left untreated it can lead to suicide. If you ever have thoughts that you would be better off dead than continuing to live, then tell someone. People and places you can turn to for help include: a health care professional, your caregiver, your spouse or significant other, your religious leader or pastor, a trusted friend or family member, the suicide hot line by calling 1-800-SUICIDE, and emergency response by calling 9-1-1.

Several studies have identified mental illness, especially depression, as a risk factor for suicide in many of those with ESRD. reminds you that it is exceedingly rare for someone to not get better with help over time. Severe depression requires openness with your healthcare team, trusting that things will get better, and resolving to do whatever it takes to get better.  Most importantly remember that you are not alone and that your life is important.


"Suicide in the United States End-Stage Renal Disease Program. " Journal of the American Society of Nephrology.

Theofilou, Paraskevi. "Abstract." National Center for Biotechnology Information. U.S. National Library of Medicine 

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Chronic Kidney Disease Patients' Attitude Determines Quality of Life
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