Association Between Hemoglobin Levels, Duration of Hemodialysis, and Mental Health Outcomes in CKD Patients: A Cross-Sectional Study
DOI:
https://doi.org/10.55018/janh.v8i1.339Keywords:
Chronic Kidney Disease, Mental Health, Quality of Life, AnemiaAbstract
Background: Chronic kidney disease (CKD) is a global health problem that can progress to end-stage renal failure requiring hemodialysis. Patients on long-term hemodialysis often experience anemia and mental health problems, yet evidence from Indonesia and other LMICs on the relationship between clinical factors and mental health remains limited. This study aims to analyze the association between hemodialysis duration and hemoglobin levels with mental health and emotional role functioning in hemodialysis patients.
Methods: This quantitative study used a cross-sectional design. A consecutive sampling method was used, involving 75 patients undergoing hemodialysis from hospitals across Bangka Island between June and August 2024. Inclusion criteria are undergoing hemodialysis twice a week, and exclusion criteria are experiencing sudden shortness of breath and being in unstable or emergency conditions during data collection. Independent variables are years on hemodialysis and hemoglobin; dependent variables are the Mental Health and Role Emotional domains of the SF-36. The SF-36 questionnaire is a valid instrument used in patients undergoing hemodialysis to study physical activity and rehabilitation. Data analysis included univariate analysis to determine the mean and standard deviation, as well as bivariate analysis using the Pearson correlation test using SPSS Version 26.
Results: The mean score for the Mental Health (MH) domain was 59.22, and for the Role Emotional (RE) domain, it was 30.67, indicating that patients undergoing hemodialysis had relatively low scores in both domains. A significant correlation was found between years on hemodialysis and hemoglobin levels with mental health and role emotional scores (P =0,0001) (P value < 0,05).
Conclusion: Mental health and role emotional issues in patients with CKD undergoing hemodialysis are still understudied, which negatively affects their quality of life. Healthcare professionals need to conduct comprehensive assessments that consider not only the physical but also the mental health and emotional role aspects of these patients. Many patients undergoing hemodialysis have poor mental health and emotional functioning. Factors such as years on hemodialysis and hemoglobin levels are associated with improvements in these domains.
Downloads
References
Ahsan, M. N., Asif, N., Khanzada, S. W., Asghar, M. S., Yasmin, F., Khalid, F., Fareed, S., & Irshad, S. G. (2021). Comparative effectiveness of erythropoietin alpha and beta in hemodialysis patients: a single-center prospective observational study. Journal of Community Hospital Internal Medicine Perspectives, 11(6), 782–786. https://doi.org/10.1080/20009666.2021.1983980
Alshelleh, S., Alhawari, H., Alhouri, A., Abu-Hussein, B., & Oweis, A. (2023). Level of Depression and Anxiety on Quality of Life Among Patients Undergoing Hemodialysis. International Journal of General Medicine, 16, 1783–1795. https://doi.org/10.2147/IJGM.S406535
Alshogran, O. Y., Shatnawi, E. A., Altawalbeh, S. M., Jarab, A. S., & Farah, R. I. (2021). Predictors of poor health-related quality of life among hemodialysis patients with anemia in Jordan. Health and Quality of Life Outcomes, 19(1). https://doi.org/10.1186/s12955-021-01905-7
Andhika, R., Afiatin, Supriyadi, R., Bandiara, R., Sukesi, L., Sudarmadi, A. P., Wahyudi, K., & Sofiatin, Y. (2025). One-year Survival of End-Stage Kidney Disease Patients Undergoing Hemodialysis in Indonesia. International Journal of Nephrology and Renovascular Disease, 18, 87–101. https://doi.org/10.2147/IJNRD.S508012
Badura, K., Janc, J., Wąsik, J., Gnitecki, S., Skwira, S., Młynarska, E., Rysz, J., & Franczyk, B. (2024). Anemia of Chronic Kidney Disease—A Narrative Review of Its Pathophysiology, Diagnosis, and Management. In Biomedicines (Vol. 12, Number 6). Multidisciplinary Digital Publishing Institute (MDPI). https://doi.org/10.3390/biomedicines12061191
Boima, V., Agyekum, A. B., Ganatra, K., Agyekum, F., Kwakyi, E., Inusah, J., Ametefe, E. N., & Adu, D. (2025). Advances in kidney disease: pathogenesis and therapeutic targets. In Frontiers in Medicine (Vol. 12). Frontiers Media SA. https://doi.org/10.3389/fmed.2025.1526090
Dasgupta, I., Bagnis, C. I., Floris, M., Furuland, H., Zurro, D. G., Gesualdo, L., Heirman, N., Minutolo, R., Pani, A., Portolés, J., Rosenberger, C., Alvarez, J. E. S., Torres, P. U., Vanholder, R. C., Wanner, C., & Sánchez Alvarez, J. E. (2024). Anaemia and quality of life in chronic kidney disease: A consensus document from the European Anaemia of CKD Alliance. In Clinical Kidney Journal (Vol. 17, Number 8). Oxford University Press. https://doi.org/10.1093/ckj/sfae205
Ganu, V. J., Boima, V., Adjei, D. N., Yendork, J. S., Dey, I. D., Yorke, E., Mate-Kole, C. C., & Mate-Kole, M. O. (2018). Depression and quality of life in patients on long-term hemodialysis at a nationalhospital in Ghana: a cross-sectional study. Ghana Medical Journal, 52(1), 22–28. https://doi.org/10.4314/gmj.v52i1.5
Goyal, E., Chaudhury, S., & Saldanha, D. (2018). Psychiatric comorbidity in patients undergoing hemodialysis. Industrial Psychiatry Journal, 27(2), 206. https://doi.org/10.4103/ipj.ipj_5_18
Guerra, F., Di Giacomo, D., Ranieri, J., Tunno, M., Piscitani, L., & Ferri, C. (2021). Chronic kidney disease and its relationship with mental health: Allostatic load perspective for integrated care. Journal of Personalized Medicine, 11(12). https://doi.org/10.3390/jpm11121367
joshi. (n.d.).
Kalantar-Zadeh, K., Jafar, T. H., Nitsch, D., Neuen, B. L., & Perkovic, V. (2021). Chronic kidney disease. In The Lancet (Vol. 398, Number 10302, pp. 786–802). Elsevier B.V. https://doi.org/10.1016/S0140-6736(21)00519-5
Khan, A., Ghulam Hussain, S., Mushtaq, S., Abbas, S., Dong, Y., Feng, W., & Fang, Y. (2024). Prevalence and management of anemia and impact of treatment burden on health-related quality of life in chronic kidney disease and dialysis patients. Journal of Pharmaceutical Policy and Practice , 17(1). https://doi.org/10.1080/20523211.2024.2427779
Kim, D. S., Kim, S. W., & Gil, H. W. (2022). Emotional and cognitive changes in chronic kidney disease. In Korean Journal of Internal Medicine (Vol. 37, Number 3, pp. 489–501). Korean Association of Internal Medicine. https://doi.org/10.3904/kjim.2021.492
Kim, Y. H., Lee, W., Kim, K. Y., Kim, Y., Ko, A., Weon, B., Lee, J., Jin, W., Kim, D. K., Kim, Y. S., Lim, C. S., Lee, J. P., Kim, S. G., Ko, G. J., Park, J. T., Chang, T. I., Chung, S., Lee, S. H., Choi, B. S., … Jung, W. K. (2024). The estimated mediating roles of anemia-related variables in the association between kidney function and mortality: a National Health and Nutrition Examination Survey (NHANES) study. Scientific Reports, 14(1). https://doi.org/10.1038/s41598-024-56877-7
Legrand, K., Speyer, E., Stengel, B., Frimat, L., Ngueyon Sime, W., Massy, Z. A., Fouque, D., Laville, M., Combe, C., Jacquelinet, C., Durand, A. C., Edet, S., Gentile, S., Briançon, S., & Ayav, C. (2020). Perceived Health and Quality of Life in Patients With CKD, Including Those With Kidney Failure: Findings From National Surveys in France. American Journal of Kidney Diseases, 75(6), 868–878. https://doi.org/10.1053/j.ajkd.2019.08.026
Lin, P. Y., Li, L. C., Wang, L. J., Yang, Y. H., & Hsu, C. W. (2021). Lack of association between erythropoietin treatment and risk of depression in patients with end-stage kidney disease on maintenance dialysis: a nationwide database study in Taiwan. Therapeutic Advances in Chronic Disease, 12. https://doi.org/10.1177/2040622321995690
Ma, S. J., Wang, W. J., Tang, M., Chen, H., & Ding, F. (2021a). Mental health status and quality of life in patients with end-stage renal disease undergoing maintenance hemodialysis. Annals of Palliative Medicine, 10(6), 6112–6121. https://doi.org/10.21037/apm-20-2211
Ma, S. J., Wang, W. J., Tang, M., Chen, H., & Ding, F. (2021b). Mental health status and quality of life in patients with end-stage renal disease undergoing maintenance hemodialysis. Annals of Palliative Medicine, 10(6), 6112–6121. https://doi.org/10.21037/apm-20-2211
Machaca-Choque, D., Palomino-Guerra, G., Flores-Cohaila, J., Parihuana-Travezaño, E., Taype-Rondan, A., Gomez-Colque, S., & Copaja-Corzo, C. (2024). Quality of life and its associated factors in chronic kidney disease patients undergoing hemodialysis from a Peruvian city: A cross-sectional study. PLoS ONE, 19(5 MAY). https://doi.org/10.1371/journal.pone.0300280
Mardiyah, A., & Johan, A. (n.d.). FUNCTIONAL STATUS IN PATIENTS WITH CHRONIC KIDNEY DISEASE BEING TREATED WITH HEMODIALYSIS IN PKU MUHAMMADIYAH HOSPITAL, YOGYAKARTA, INDONESIA. Belitung Nursing Journal, 3(4), 426–431. Retrieved http://belitungraya.org/BRP/index.php/bnj/
Mohamed, N. A., Eraslan, A., & Kose, S. (2023). The impact of anxiety and depression on the quality of life of hemodialysis patients in a sample from Somalia. BMC Psychiatry, 23(1). https://doi.org/10.1186/s12888-023-05312-8
Muxunov, A., Almazan, J., Kalinina, D., Kuanshaliyeva, Z., Gaipov, A., Makhadiyeva, D., Kabibulatova, A., Madikenova, M., Nabiyev, A., & Sarria-Santamera, A. (2026). Health-related quality of life in chronic kidney disease patients in low- and lower-middle income countries: a systematic review and meta-analysis. In Quality of Life Research (Vol. 35, Number 2). Springer Science and Business Media Deutschland GmbH. https://doi.org/10.1007/s11136-025-04154-z
Nasution, S. A., Ginanjar, E., Lydia, A., Sukrisman, L., Alwi, I., Wijaya, I. P., Limantoro, C., Rasyid, H., Nugroho, P., Putranto, W., Suastika, K., Soelistijo, S. A., Tarigan, T. J. E., & Faratisha, I. F. D. (2026). Cardiovascular-kidney-metabolic syndrome in Indonesia: a commentary on the need for integrated management and policy action. Frontiers in Public Health, 13. https://doi.org/10.3389/fpubh.2025.1707551
Pollock, C., Carrero, J. J., Kanda, E., Ofori-Asenso, R., Palmer, E., Niklasson, A., Linder, A., Woodward, H., Pentakota, S., Garcia Sanchez, J. J., Kashihara, N., Fishbane, S., Pecoits-Filho, R., & Wheeler, D. C. (2024). The Lived Experience of Patients with Chronic Kidney Disease: Insights From DISCOVER CKD. American Journal of Nephrology, 55(6), 618–628. https://doi.org/10.1159/000541064
Pretto, C. R., Winkelmann, E. R., Hildebrandt, L. M., Barbosa, D. A., Colet, C. de F., & Stumm, E. M. F. (2020). Quality of life of chronic kidney patients on hemodialysis and related factors. Revista Latino-Americana de Enfermagem, 28, 1–11. https://doi.org/10.1590/1518-8345.3641.3327
Profil-Kesehatan-Indonesia-2019. (n.d.).
Riskesdas Kepulauan Bangka Belitung 2018. (n.d.).
Rosyanti, L., Hadi, I., & Ibrahim, K. (2018). Eksplorasi Perubahan Fisik dan Gejolak Emosional pada Pasien Gagal Ginjal Kronis yang Menjalani Hemodialisis: Pendekatan Kualitatif. Health Information : Jurnal Penelitian, 10(2), 98–112. https://doi.org/10.36990/hijp.v10i2.83
Smeltzer, S.C., Bare, B.G., Hinkle, J.L., Cheever, K. H. (2010). Brunner and Suddarth’s Text Book of Medical Surgical nursing ((!!th ed)). Lippincolt Williams & Wilkins.
Wen, J., Fang, Y., Su, Z., Cai, J., & Chen, Z. (2023). Mental health and its influencing factors of maintenance hemodialysis patients: a semi-structured interview study. BMC Psychology, 11(1). https://doi.org/10.1186/s40359-023-01109-2
Wilk, A. S., Hu, J. C., Chehal, P., Yarbrough, C. R., Ji, X., & Cummings, J. R. (2022). National Estimates of Mental Health Needs Among Adults With Self-Reported CKD in the United States. Kidney International Reports, 7(7), 1630–1642. https://doi.org/10.1016/j.ekir.2022.04.088
Xue, J., Li, H., Zhou, Q., Wen, S., Zhou, Q., & Chen, W. (2019). Comparison of peritoneal dialysis with hemodialysis on survival of diabetic patients with end-stage kidney disease: a meta-analysis of cohort studies. Renal Failure, 41(1), 521–531. https://doi.org/10.1080/0886022X.2019.1625788
Ye, W., Wang, L., Wang, Y., Wang, C., & Zeng, J. (2022). Depression and anxiety symptoms among patients receiving maintenance hemodialysis: a single center cross-sectional study. BMC Nephrology, 23(1). https://doi.org/10.1186/s12882-022-03051-8
Zulfan Efendi, M. I. R. I. Z. Y. R. (2021). Faktor-Faktor yang Berhubungan dengan Kualitas Hidup Pasien Dengan Gagal Ginjal Kronik yang Menjalani Hemodialisa. Jurnal Maharatu, 2(2).
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Adiyati Mardiyah, Erna Julianti, Zulkifli Zulkifli, Lyah Giovana, Dian Tri Raharjo
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
