Vascular access status strongly linked with demoralization syndrome in Elderly maintenance hemodialysis Patients: Study

Vascular access is the lifeblood of hemodialysis patients. Yet, VA complication, pain, and functional impairment can impact not only physical well-being, but emotional resilience as well. Demoralization syndrome—a psychological condition characterized by helplessness, hopelessness, and loss of purpose—is particularly common in older MHD patients, yet its relationship to VA satisfaction has not been well researched.

This research, carried out from April 2024 to October 2024, sought to fill this gap by assessing the relationship between satisfaction with vascular access (VAS) and demoralization among a sample of 350 older MHD patients. With the use of trusted instruments—the Short Form Vascular Access Questionnaire (VAQ) and the Chinese Version of the Demoralization Syndrome Scale—the research provides new information on how bodily treatment experiences affect mental health outcomes.

Participants were recruited from three tertiary hospitals and consisted of patients 60 years and older who were on long-term hemodialysis. Patients were classified into two groups according to their vascular access satisfaction scores:

VA dissatisfaction group (n = 220)

VA satisfaction group (n = 130)

Data gathered consisted of social demographics, laboratory values (hemoglobin and PTH levels), and the duration of dialysis. Binary logistic regression models were employed to determine independent predictors of dissatisfaction with vascular access, while independent t-tests were utilized to compare between the two groups the demoralization syndrome scores.

Results

• The comparison revealed a substantial difference in DS scores between the low and high VA satisfaction patients.

• The average DS score for the VA dissatisfaction group was 73.6 ± 8.7, whereas it was 51.2 ± 6.9 in the VA satisfaction group (p < 0.01), strongly reflecting increased psychological distress among those dissatisfied with their vascular access.

Multivariate logistic regression identified several independent risk factors for VA dissatisfaction:

• Solitary living made dissatisfaction more likely (OR = 2.1; 95% CI, 1.4–3.2).

• Increased dialysis time was also an independent predictor (OR = 1.8; 95% CI, 1.2–2.7).

• Higher PTH levels were associated with more dissatisfaction (OR = 1.5; 95% CI, 1.1–2.0).

• Higher hemoglobin levels, on the other hand, was a protective factor (OR = 0.6; 95% CI, 0.4–0.9), indicating that adequately treated anemia can be a factor in better patient satisfaction with vascular access.

This study finds a strong and clinically relevant correlation between satisfaction with vascular access and demoralization syndrome among elderly hemodialysis patients. Interventions for anemia, control of PTH, and social isolation alone or living with others can increase satisfaction and reduce psychological distress. These modifiable risk factors offer the opportunity for multidisciplinary teams to include vascular access assessments and emotional well-being screening in regular MHD treatment to achieve improved patient quality of life.

Reference:

Lv, X., Zhang, H., Yang, L. et al. Correlation between vascular access satisfaction and demoralization syndrome in elderly patients with maintenance hemodialysis: a multi-center study. BMC Nephrol 26, 265 (2025). https://doi.org/10.1186/s12882-025-04191-3