“If you can’t change it, don’t fight it” Coping with automated peritoneal dialysis for end-stage kidney disease: A qualitative study

Ms Emily Duncanson1,2,3, Prof Anna Chur-Hansen3, Associate Professor Shilpanjali Jesudason2,4,5

1ANZDATA Registry, Adelaide, Australia, 2Central and Northern Adelaide Renal and Transplantation Service (CNARTS) Clinical Research Group, Royal Adelaide Hospital, Adelaide, Australia, 3School of Psychology, University of Adelaide, Adelaide, Australia, 4Kidney Health Australia, , Australia, 5Adelaide Medical School, University of Adelaide, Adelaide, Australia

Introduction: People receiving peritoneal dialysis (PD) for end-stage kidney disease (ESKD) experience poorer quality of life than healthy individuals. Whilst the prevalence of psychosocial difficulties in dialysis cohorts is well documented, further investigation into how patients adjust to and cope with the challenges imposed by ESKD and dialysis is needed.

Methods: Qualitative study. Participants were recruited purposively through the renal unit of a public hospital in South Australia. Ten people receiving automated PD (APD) (5 females, 5 males) aged 31 to 77 years (M = 59.3) participated in a one-on-one qualitative interview. Interviews were audio recorded and transcribed verbatim. Transcripts were analysed thematically.

Results: Five main themes representing participants’ experiences and perspectives of the psychosocial challenges resulting from ESKD and APD and coping with these were identified: 1) Resigned Acceptance, 2) Means to an End, 3) Navigating Emotional Impacts at Milestones and Transitions 4) Professional Support and 5) Social Support. Participants described increased psychological burden at CKD and end-stage kidney disease diagnoses, dialysis initiation, and during theatment decision-making. Themes demonstrate the various cognitive, behavioural and social factors that promote adaptive coping, treatment adherence and patient wellbeing.

Conclusions: People receiving APD for ESKD face daily and chronic psychosocial challenges. Psychological distress and poor coping may be heightened at key disease milestones and transition periods, or among individuals without a caregiver in the home. Further research may evaluate the role of education and psychosocial support interventions at dialysis initiation and other transitions periods throughout the trajectory of chronic kidney disease.


Emily is a registered psychologist who works as a research officer at the Central and Northern Adelaide Renal and Transplantation Service (CNARTS) Clinical Research Group at the Royal Adelaide Hospital and the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA). Her area of interest, health psychology, involves addressing the psychological aspects of physical illness and chronic disease from a biopsychosocial approach. Her clinical and research interests are in the psychological wellbeing and quality of life of people undergoing renal replacement therapies and that of their caregivers and family members. In her research, she is interested in exploring people’s lived experiences using qualitative methods, with an aim of improving psychosocial wellbeing and  care for people with kidney disease.


The ASM is hosted by Australian and New Zealand Society of Nephrology.

The aims of the Society are to promote and support the study of the kidney and urinary tract in health and disease, and to ensure the highest professional standards for the practice of nephrology in Australia and New Zealand.

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