The lived experience of late midlife hemodialysis patients with diabetic nephropathy

Background: Diabetic nephropathy is the primary reason that patients receive hemodialysis (HD), a frequent and lifelong treatment. However, HD is burdensome for middle–aged individuals, who still have personal and professional responsibilities, and can have a significant and disruptive impact on their lives. Aim: This study seeks to better understand the daily life experiences of middle-aged patients with diabetic nephropathy who are receiving HD. Methods: This qualitative study used purposive sampling to recruit participants from a teaching hospital in southern Taiwan from November 2014 to May 2015. The data was collected through in-depth interviews from 12 middle-aged diabetic nephropathy patients receiving HD. Data analysis was performed using Colaizzi’s phenomenological method. Results : The significant statements were categorized into four themes and 10 subthemes: (1) Mental and physical suffering: shock and refusing HD, loss of control in certain aspects of life, burdened with complications from diabetes and HD conditions. (2) Social isolation: barriers to normal life and leisure activities, financial hardship resulting in reduced self-esteem. (3) Moving toward a new adjusted lifestyle: acknowledging illness and accepting HD, changing their perspective towards HD, learning to improve their own health, and (4) End-of-life evaluation: appreciation of life and death, coming to terms with mortality, and increased time spent with their families. Conclusions: The findings of this study showed that middle-aged patients receiving HD typically underwent a process of mental and physical suffering to adaptation and end-of-life reflection. These findings can help health care providers and family members better understand the experiences and hardships of patients receiving HD, which allows for better support and improved nursing care.