Psychological challenges of patients starting peritoneal dialysis: a single-center qualitative pilot study.

BACKGROUND: Psychological challenges are common among patients starting peritoneal dialysis (PD), yet studies specifically exploring psychological well-being during PD initiation are limited. This qualitative pilot study aimed to identify the most frequent reasons prompting psychological referral among patients initiating PD at our center. METHODS: We conducted a thematic analysis of the twice-monthly psychological support sessions involving 12 patients who were referred within the first 3 months of PD initiation due to symptoms of anxiety and insomnia. Among them, 7/12 were male, with a median age at PD initiation of 54 years (Interquartile range [IQR] 43-61). PD was initiated because of stage V chronic kidney disease in 8/12 patients, kidney transplant failure in 2/12, and due to a switch from hemodialysis in 2/12 patients. RESULTS: The most frequently reported themes causing psychological suffering included non-acceptance of chronic disease, altered body image perception after peritoneal catheter placement, managing fluid restrictions, and travel-related anxiety (12/12). Seven patients also expressed struggles with dietary adherence and the emotional burden of preparing for transplant evaluation. Additional concerns included non-acceptance of PD, task-anxiety, and fear of PD-related peritonitis. CONCLUSIONS: In conclusion, this study highlights the range of psychological difficulties experienced during the early phase of PD. These findings underscore the importance of proactively addressing these aspects during pre-dialysis counseling to better support the patients' emotional adaptation and treatment engagement.