Peritoneal Dialysis: Support, Beliefs & Fluid Management

The complexities of managing chronic kidney disease (CKD) extend far beyond the mechanics of dialysis. A growing body of research, synthesized from recent publications (Flythe & Watnick, 2024; Cozzolino et al., 2018), highlights the critical interplay between physiological demands, psychological well-being, and adherence to treatment protocols – particularly fluid and dietary restrictions. This isn’t simply a medical challenge; it’s a holistic one demanding a patient-centered approach that acknowledges the significant burden placed on individuals and their support systems.

For patients requiring dialysis, maintaining proper fluid balance is paramount. As Danziger & Hoenig (2016) explain, the kidneys play a vital role in volume regulation, and their failure necessitates careful management. However, adherence to fluid restrictions is notoriously difficult, often influenced by factors beyond a patient’s control. Recent studies (Zheng & Auguste, 2023; Yi et al., 2013) demonstrate the challenges of volume management in peritoneal dialysis, while highlighting the need for tailored prescriptions (Auguste & Bargman, 2023). Dietary adherence presents similar hurdles, with patients often struggling to navigate complex nutritional requirements. Padial et al. (2024, forthcoming) further emphasize the importance of understanding both patient and caregiver needs in this area.

The psychological toll of CKD and dialysis is substantial. Feroze et al. (2010) first established a strong link between mental health and outcomes, a connection consistently reinforced by subsequent research (Shafi & Shafi, 2017; Sheng et al., 2023). Depression and anxiety not only diminish quality of life but also directly contribute to non-adherence (Gebrie & Ford, 2019; Yu et al., 2012). The illness perception – how a patient understands their condition – significantly impacts their coping mechanisms and adherence behaviors (Leventhal et al., 1984; Broadbent et al., 2006; Weinman et al., 1996). Furthermore, social factors, including family dynamics and social support networks, play a crucial role (Wu et al., 2025; Ahrari et al., 2014; Beerendrakumar et al., 2018). The Family APGAR scale (Smilkstein, 1978, 1982) remains a valuable tool for assessing family function and identifying potential areas of support.

The Forward Look: The emerging trend is a move towards more holistic and personalized care. The recent KDIGO workshop on the nurse’s role (Bennett et al., 2025) underscores the need for expanded nursing responsibilities in symptom management and psychosocial support. We can anticipate increased emphasis on interventions that address not only the physiological aspects of CKD but also the psychological and social determinants of health. The development and validation of tools like the Chronic Kidney Disease Perception Scale (Anuar et al., 2020) will be crucial for tailoring interventions to individual patient needs. Furthermore, the growing body of evidence supporting the benefits of patient and caregiver involvement in research (Gutman et al., 2025) suggests a future where shared decision-making and collaborative care are the norm. Finally, expect to see more research focused on effective strategies to improve adherence, building on the systematic reviews and meta-analyses already underway (Murali et al., 2019, 2020; Clark et al., 2014). The challenge now lies in translating these research findings into practical, scalable interventions that can improve the lives of individuals living with CKD.