Giornale di Clinica Nefrologica e Dialisi

In-center hemodialysis transportation: an Italian citizens’ committee point of view

2026-02-03T13:38:04+00:00

Introduction: Transportation insecurity is a problem for people fighting against chronic diseases, and the organization of transportation for in-center hemodialysis (HD) is a complex challenge and long travel times to dialysis centers have been associated with increased mortality risk and poorer health-related quality of life.
Methods: We carried out a cross-sectional survey with the aim of identifying and understanding the transportation
options available to in-center HD patients and to describe their experiences from their perspective.
Results: We investigated 132 out of 166 patients treated with HD in the province of Ferrara (mean age 68.6 ±
13.9 years, 65% males). An investigation was performed by using a questionnaire. The average distance from
residence to the dialysis center was 20 ± 14.7 km. 48.5% of users used their own vehicle, while 41.7% used an
ambulance. A minority of the population used social services vehicles. The average travel time was 29 ± 15 minutes,
and when the vehicle was not personal, it was shared with 2.6 passengers in 85% of cases. Transportation
fee was reimbursed in 48.5% of cases. Users were dissatisfied or very dissatisfied in 7.5-15.1% of cases. Duration
of the journey was the main determinant of patients’ satisfaction, independently of age, gender, and receiving
financial support for transportation.
Conclusion: Although the majority of investigated subjects were satisfied with their transportation arrangements,
the burden of traveling to HD is an issue, and its organization should consider economic resources and patients’
needs. A validated instrument is needed to understand this complex phenomenon, which is not a logistic item.

Education and training of home hemodialysis patients in Europe: a scoping review

2026-02-10T13:33:05+00:00

Introduction: Home hemodialysis (HHD) began in the 1960s; it has largely moved to the dialysis centers in recent
decades, particularly across Europe. HHD patients account for <2% of the dialysis patient population. Training
programs aimed at addressing the benefits, enablers and obstacles of home hemodialysis may therefore be relevant
when considering this modality of renal replacement therapy (RRT). The aim was to conduct a scoping
review of studies about training in HHD patients.
Methods: Using Arksey and O’Malley’s framework, three databases were searched on CINAHL, PubMed and
Scopus. The search included studies published in English from August 2013 to August 2023.
Results: Five studies met the scoping review criteria (two observational, two qualitative and one narrative review).
Three education themes were identified: technique and management of the dialysis machine, self-cannulation
of arterio-venous fistulas and safety.
Conclusion: The educational fields described represent a systematic approach to foster the growing use of home
hemodialysis, but to date, further research is needed to investigate the feasibility and effects of educational
training to understand if they meet the educational needs of patients. Finally, in Europe, there are obstacles to
the implementation of home hemodialysis concerning health costs, logistics, but above all, the lack of specialized
and dedicated medical and nursing staff.

The health psychology: an integrated approach

2026-02-09T13:48:27+00:00

In contemporary nephrology and dialysis care, oriented toward developing care more closely connected to the person’s resources, needs, beliefs, and opinions, it is important to adopt a comprehensive, systemic approach useful for advancing care in nephrology and dialysis from a personalized, patient-oriented perspective: health psychology. Health psychology aims to promote an integrated understanding of health and illness and to facilitate the integration of biomedical and psychological knowledge through research, education, and professional activities in nephrology and dialysis care. It considers not only integrated aspects of disease state, types of thoughts, emotions, and behaviors, but also factors related to social, cultural, gender, and socioeconomic inequalities.
Another systemic variable is health and well-being in the workplace as an element influencing a person’s psychosomatic balance. In a vision of care based on the biopsychosocial and systemic model, health psychology connects, in a circular way with feedback dynamics, modern lifestyles with people’s mental health, where stress-management processes are central in the genesis and disruption of mind–body balance. Health psychology also regards the health and psychological well-being of healthcare providers as determinants strongly influencing the quality of care. It brings elements for reflection, comparison, and design in nephrology and dialysis care, integrating psychological, physical, technological, and social components. By considering these dimensions, health psychology strengthens patient-centered practice and offers a systemic perspective that supports both patients and providers. It provides tools to understand complex interactions, guide interventions, and promote holistic care that addresses biological, psychological, and social factors in modern nephrology and dialysis settings.

Effects of guided imagery on patients in hemodialysis: study protocol

2026-01-13T13:34:18+00:00

Introduction: Patients undergoing hemodialysis can show anxiety, depression, poor sleep and a reduction in the
quality of life. Non-pharmacological interventions could be used to combine with conventional treatments to
improve these outcomes. Guided imagery is a mind-body technique that uses mental images to promote relaxation
and well-being. This is the first international research protocol that studies the effects of guided imagery in
hemodialysis patients on various subjective and objective outcomes.
Methods: The aim is to evaluate the impact of guided imagery on the level of anxiety, depression, sleep, quality
of life, systolic blood pressure, diastolic blood pressure, heart rate and respiratory rate. The study design is
a randomized controlled trial, prospective, with two parallel groups (guided imagery vs standard care), with 1:1
balanced allocation, pre-posttest, in a calculated sample of 30 patients diagnosed with chronic kidney disease
(CKD) undergoing hemodialysis. The intervention requires that each patient be treated with guided imagery for
30 minutes, three times a week, for 4 weeks. Expected results. The research hypotheses on the results are that
the guided imagery, compared to the control group, reduces anxiety levels, reduces depression levels, improves
sleep, improves quality of life, improves systolic blood pressure, improves diastolic blood pressure, improves
heart rate and improves respiratory rate.
Conclusion: If the effects show a statistically significant efficacy, guided imagery could be used during the daily
care of hemodialysis patients.