Page 20 - JCBP-2-4

Journal of Clinical and
Basic Psychosomatics Stigma in maintenance hemodialysis patients

patients face significant life changes such as economic influence how individuals receive, filter, edit, and process
burdens, interpersonal relationships, and modifications information obtained from objective environments. Such
in social and family status. A review suggested that stigma negative cognition and emotion may distort information
affects marriage, interpersonal relationships, mobility, from others, leading to misunderstanding others’ attitudes
employment, access to treatment and care, education, as prejudice or discrimination.
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leisure activities, and social and religious participation, There are several limitations to our study. First,
all of which contribute to a diminished quality of life. there is currently no established norm or standard
Uremic pruritus is a common and distressing symptom value for assessing stigma specifically related to ESRD,
in patients with ESRD, affecting up to 46% of hemodialysis so a quantitative comparison could not be conducted.
patients. 24,25 Moreover, it is associated with multiple health- Second, although the various scales we used have been
related complications and is independently associated with proven to be very effective, they may not capture stigma
mortality. Our study suggested that uremic pruritus was as comprehensively as a structured clinical interview.
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associated with both internalized and enacted stigma in Therefore, clinical trials with larger, multi-center samples
hemodialysis patients. Uremic pruritus, which is a chronic and more refined psychological assessments are warranted
stressor, can significantly impact one’s mental well-being in the future.
and may contribute to the experience of stigma. On the other
hand, systemic inflammation is a common characteristic of 5. Conclusion
brain and kidney lesions in ESRD patients, making it quite Stigma is prevalent among maintenance hemodialysis patients,
reasonable to hypothesize that inflammatory mediators significantly impairing their quality of life. Internalized stigma
may contribute to the cross-talk between the kidneys appears to be associated with uremic pruritus and duration
and brain. Systemic inflammations may be a common of hemodialysis, whereas enacted stigma correlates with
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pathogenesis of uremic pruritus and neuropsychiatric uremic pruritus, depression, and anxiety. Therefore, timely
disorders, which is probably associated with stigma. The identification and effective intervention by nephrologists
well-identified role of cytokines in mediating peripheral are crucial for enhancing the quality of life among patients
and central nervous system communication reinforces this undergoing maintenance hemodialysis.
hypothesis. 28
Our study suggested that internalized stigma was Acknowledgments
negatively associated with the duration of hemodialysis. None.
For patients with ESRD, the initiation of dialysis itself can
be regarded as an acute stressor that produces a series of Funding
psychosocial reactions, which may manifest as emotional,
cognitive, and behavioral disturbances. Higher BDI scores None.
were noted in patients at the initiation of hemodialysis. 29,30 Conflict of interest
However, individuals may gradually adapt to this stressor
through adaptive coping strategies, leading to an alleviation The authors have no potential conflicts of interest to
of adverse psychological reactions over time. Therefore, a disclose.
methodological, thorough, and comprehensive evaluation
should be conducted before the initiation of hemodialysis, Author contributions
and psychological conditions should be identified and Conceptualization: All authors
addressed as soon as possible. 31 Formal analysis: All authors
Previous findings on neurological and psychiatric Investigation: Wei Ye
disorders suggested that depression and anxiety are related Methodology: Wei Ye
to stigma. 32,33 Our study also found that depression and Writing-original draft: Wei Ye
anxiety are related to enacted stigma. Enacted stigma Writing-review & editing: Wei Ye
involves experiences of prejudice, discrimination, Ethics approval and consent to participate
and stereotyping directed at individuals by others. In
essence, it still belongs to an individual’s subjective This study was conducted in compliance with local
perception, influenced by one’s cognitive and emotional regulations and the revised established principles of
x
patterns. Aaron Beck , the founder of cognitive therapy, the Declaration of Helsinki (2013). The Medical Ethics
believes that patients with depression and anxiety have Committee of Jinshan Hospital affiliated with Fudan
negative cognitive and emotional patterns. These patterns University (approval no.: JIEC2022-S83) approved the

Volume 2 Issue 4 (2024) 5 doi: 10.36922/jcbp.2181