Mental health and quality of life in dialysis and transplant patients in Vietnam: a call for integrated care models

Le résumé fourni par la source

Chronic kidney disease represents a significant global health burden, affecting over 850 million individuals worldwide (1,2). Among these, the progression to end-stage renal disease (ESRD) necessitates renal replacement therapies, including dialysis or kidney transplantation, to sustain life. While these treatments address the physiological needs of kidney failure, the psychological toll is profound (3)(4)(5)(6)(7). Studies report that approximately 30-40%30% to 40% of dialysis patients suffer from clinically significant depression and anxiety, underscoring the substantial mental health burden associated with ESRD (8)(9)(10). In Vietnam and similar resource-constrained settings, financial stress, limited psychological care, and social stigma further heighten patients' vulnerability (11,12). Despite evidence highlighting the interconnectedness of physical symptoms and HRQOL in ESRD (13), healthcare models remain siloed, particularly in low-and middle-income countries (LMICs). Current approaches often neglect the multidimensional burden of symptoms, from pain and fatigue to emotional distress, that define patients' lived experiences. Lessons from integrated mental healthprimary care models demonstrate that collaborative frameworks can improve outcomes for chronic conditions, though their adaptation to nephrology care, especially in LMICs, remains underexplored (14). This viewpoint critiques this fragmentation through a Vietnamese context, advocating for integrated care models that address both nephrological and mental health needs. By synthesizing global insights (e.g., symptom assessment frameworks) with local realities, we propose scalable strategies to bridge this gap, emphasizing interdisciplinary collaboration and patient-centered outcomes.Current healthcare models predominantly separate physical and mental health services, a division that neglects the holistic needs of patients undergoing long-term dialysis or post-transplant care. This viewpoint seeks to illuminate the mental health disparities faced by renal patients and advocates for the adoption of integrated care models that bridge nephrology and mental health disciplines. By leveraging Vietnam as a case study, we aim to highlight universal challenges and propose pragmatic, scalable strategies that can inform global health policy and practice.Patients undergoing dialysis or recovering from kidney transplantation experience a complex interplay of physical and psychological challenges. Patients receiving dialysis or kidney transplants face intertwined physical and psychological challenges. Clinical evidence reveals disproportionately high rates of depression, anxiety, and sleep disturbances in this population, with pooled prevalence estimates reaching ~50% across studiesClinical evidence reveals that rates of depression, anxiety, and sleep disturbances are disproportionately high among this population, with prevalence estimates averaging around 50% (15)(16)(17). These figures, however, reflect methodological variations in assessment tools (e.g., PHQ-9 vs. BDI) and cultural adaptations across study populations. In resource-limited settings like Vietnam, these conditions are further exacerbated by financial strain on patients and families (18), including costs of lifelong dialysis/post-transplant medications and inadequate insurance coverage (19). This economic burden perpetuates a vicious cycle of mental health risks and caregiver burnout. These conditions are further exacerbated in resource-limited countries like Vietnam, where financial burdens place significant strain on patients and their families. (17) The cost of lifelong dialysis or posttransplant medications, compounded by insufficient insurance coverage, contributes to chronic economic stress and caregiver burnout. (18) This financial pressure often leads to psychological exhaustion, intensifying the risk of mental health deterioration.Cultural factors also play a pivotal role. Social stigma associated with chronic illness and mental health issues can deter patients from seeking psychological support, perpetuating feelings of isolation and distress (20). In Vietnam, traditional beliefs regarding illness causation and healing may conflict with modern mental health approaches, creating additional barriers to accessing care.ESRD severely limits daily functioning. Beyond psychological distress, ESRD significantly impairs patients' physical and social functioning. Dialysis schedules and post-transplant regimens often impose rigid constraints on daily life, though the degree of impact may vary by individual circumstances and treatment modalitiesimpose rigid constraints on daily life, limiting employment opportunities and participation in social activities. Fatigue, physical discomfort, and dietary restrictions further diminish quality of life, making routine tasks burdensome (21)(22)(23).Interpersonal relationships are similarly affected. While strong family support can be a protective factor, it may also become a source of tension if caregiving demands are overwhelming or inadequately shared (24,25). Marital and familial dynamics often undergo substantial strain, influencing both mental health outcomes and overall well-being (26). Addressing these multifaceted impacts requires a holistic approach that integrates psychological and social dimensions into routine nephrology care.Healthcare System Constraints Vietnam's healthcare infrastructure struggles with a critical shortage of healthcare professionals trained simultaneously in nephrology and psychiatry. The specialized expertise required to address both the physical and psychological aspects of chronic kidney disease is fragmented, with nephrology and mental health services operating as separate, siloed disciplines. This division hampers comprehensive care and prevents the holistic management of patients' complex needs.Additionally, a lack of interdisciplinary collaboration further exacerbates the disconnect. Referral pathways between nephrologists and mental health practitioners are often unclear or non-existent, leaving patients without timely psychological support. This systemic fragmentation poses significant barriers to the integration of care that addresses both mind and body.Economic challenges compound the difficulties faced by renal patients in Vietnam (18,27,28). The cost of dialysis, transplantation, and long-term immunosuppressive therapies is substantial, placing enormous financial strain on households (27)(28)(29). Psychological services, when available, are often excluded from standard health insurance plans, making them inaccessible to most patients.The absence of comprehensive insurance coverage for mental health care creates a significant gap in treatment. Without adequate financial support, both patients and caregivers endure chronic stress, contributing to a vicious cycle of deteriorating mental and physical health outcomes. Addressing these financial inequities is critical to building a sustainable, integrated model of care that prioritizes both mental health and nephrological outcomes.Addressing the dual burdens of ESRD requires a holistic and patient-centered approach that integrates mental health with routine nephrology care. A multidisciplinary care model that encompasses nephrologists, mental health professionals, and social workers is essential to provide comprehensive support. First, embedding psychological counseling and mental health screening as routine components of dialysis and transplant care is imperative. Mental health interventions should be standardized, ensuring that patients receive regular assessments for depression, anxiety, and other psychosocial challenges (30). Specialized mental health professionals should collaborate closely with nephrology teams to develop personalized care plans. Second, establishing dedicated mental health services within dialysis centers can reduce stigma and improve accessibility. Group therapy sessions and peer support

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.