Cent Eur J Nurs Midw 2025, 16(1):2111-2118 | DOI: 10.15452/cejnm.2025.16.0006

Resilience, pain self-efficacy and health-related quality of life of people on hemodialysis: a cross-sectional study

Michail Tsanasidis1, Theodora Kafkia2, Dimitrios Papoutsis1, Michael Kourakos3
1 Department of Midwifery, University of Western Macedonia, Ptolemaida, Greece
2 Department of Nursing, International Hellenic University, Thessaloniki, Greece
3 Department of Nursing, University of Ioannina, Greece

Aim: The study aimed to assess the connection of psychological resilience, pain self-efficacy and quality of life in people with chronic kidney disease (CKD) on hemodialysis.

Design: A cross-sectional study design was chosen.

Methods: Data were collected from 361 adults receiving hemodialysis in hospital and private settings in a Southern European country over six months. This was done in a semi-structured interview using the Connor-Davidson Resilience Scale (CD-RISC), the Pain Self-Efficacy Questionnaire (PSEQ), and the Kidney Disease Quality of Life (KDQOL-36) questionnaire.

Results: The results indicated that the higher the resilience, the higher the pain self-efficacy. In addition, pain self-efficacy was found to have a positive effect on minimising both the symptoms and burden of the disease, leading to better quality of life.

Conclusion: The present study showed that the level of resilience was proportional to pain self-efficacy with limited effect of demographic parameters. In addition, both resilience and pain self-efficacy affected health-related quality of life in people on hemodialysis. Using up-to-date assessment tools and implementing appropriate pharmacological and non-pharmacological interventions in everyday clinical practice can improve the quality of life of people on hemodialysis.

Keywords: health-related quality of life, hemodialysis, pain self-efficacy, resilience

Received: August 5, 2024; Revised: January 26, 2025; Accepted: February 12, 2025; Prepublished online: February 19, 2025; Published: March 6, 2025  Show citation

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Tsanasidis M, Kafkia T, Papoutsis D, Kourakos M. Resilience, pain self-efficacy and health-related quality of life of people on hemodialysis: a cross-sectional study. Central European Journal of Nursing and Midwifery. 2025;16(1):2111-2118. doi: 10.15452/cejnm.2025.16.0006.
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    References

    1. Alikari, V., Matziou, V., Tsironi, M., Kollia, N., Theofilou, P., Aroni, A., Fradelos, E., & Zyga, S. (2017). A modified version of the Greek Simplified Medication Adherence Questionnaire for hemodialysis patients. Health Psychology Research, 5(1), 6647-6659. https://doi.org/10.4081/hpr.2017.6647 Go to original source... Go to PubMed...
    2. Aljawadi, M. H., Babaeer, A. A., Alghamdi, A. S, Alhammad, A.M., Almuqbil, M. S., & Alonazi, K. F. (2024). Quality of life tools among patients on dialysis: a systematic review. Saudi Pharmaceutical Journal, 32(3), 101958. https://doi.org/10.1016/j.jsps.2024.101958¨ Go to original source... Go to PubMed...
    3. Bello, A. K., Levin, A., Lunney, M., Osman, M. A., Ye, F., Ashuntantang, G. E., ... Johnson, D. W. (2019). Status of care for end stage kidney disease in countries and regions worldwide: international cross sectional survey. BMJ, 367(8220), l5873. https://doi.org/10.1136/bmj.l5873 Go to original source... Go to PubMed...
    4. Bikbov, B., Purcell, C.A., Levey, A.S., Smith, M., Abdoli, A., Abebe, M., ... Vos, T., & for GBD Chronic Kidney Disease Collaboration (2020). Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet, 395(10225), 709-733. https://doi.org/10.1016/S0140-6736(20)30045-3 Go to original source... Go to PubMed...
    5. Budhram, B., Sinclair, A., Komenda, P., Severn, M., & Sood, M. M. (2020). A comparison of patient-reported outcome measures of quality of life by dialysis modality in the treatment of kidney failure: a systematic review. Canadian Journal of Kidney Health and Disease, 7. https://doi.org/10.1177/2054358120957431 Go to original source... Go to PubMed...
    6. Casteleijn, N. F., Gansevoort, R. T., & Leliveld, A. M. (2016). Nephrectomy in patients with autosomal dominant polycystic kidney disease, does size matter? World Journal of Urology, 34(7), 907-908. https://doi.org/10.1007/s00345-016-1799-1 Go to original source... Go to PubMed...
    7. Cohen, D. E., Lee, A., Sibbel, S., Benner, D., Brunelli, S. M., & Tentori, F. (2019). Use of the KDQOL-36™ for assessment of health-related quality of life among dialysis patients in the United States. BMC Nephrology, 20, 112. https://doi.org/10.1186/s12882-019-1295-0 Go to original source... Go to PubMed...
    8. Connor, K. M., & Davidson, J. R. (2003). Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC). Depression & Anxiety, 18(2), 76-82. https://doi.org/10.1002/da.10113 Go to original source... Go to PubMed...
    9. Cox, K. J., Parshall, M. B., Hernandez, S. H. A., Parvez, S. Z., & Unruh, M. L. (2017). Symptoms among patients receiving in-center hemodialysis: a qualitative study. Hemodialysis International, 21(4), 524-533. https://doi.org/10.1111/hdi.12521 Go to original source... Go to PubMed...
    10. European Renal Association (ERA). (2022). ERA Registry Annual Report 2022. Amsterdam UMC.
    11. Fidan, C., & Ağirbaº, İ. (2023). The effect of renal replacement therapy on health-related quality of life in end-stage renal disease: a meta-analysis. Clinical and Experimental Nephrology, 27(10), 829-846. https://doi.org/10.1007/s10157-023-02377-3 Go to original source... Go to PubMed...
    12. Flach, F. F. (1980). Psychobiologic resilience, psychotherapy, and the creative process. Comprehensive Psychiatry, 21(6), 510-518. https://doi.org/10.1016/0010-440X(80)90054-1 Go to original source... Go to PubMed...
    13. García-Martínez, P., Temprado-Albalat, M. D., Ballester-Arnal, R., Gandhi-Morar, K., Castro-Calvo, J., & Collado-Boira, E. (2020). Predictive model of variables associated with health-related quality of life in patients with advanced chronic kidney disease receiving hemodialysis. Quality of Life Research, 29(2), 1817-1827. https://doi.org/10.1007/s11136-020-02454-0 Go to original source... Go to PubMed...
    14. González-Flores, C. J., García-García, G., Lerma, A., Pérez-Grovas, H., Meda-Lara, R. M., Guzmán-Saldaña, R. M. E., & Lerma, C. (2021). Resilience: a protective factor from depression and anxiety in Mexican dialysis patients. International Journal of Environmental Research and Public Health, 18(22), 11957. https://doi.org/10.3390/ijerph182211957 Go to original source... Go to PubMed...
    15. Hanspal, I., Fathima, F. N., & Kedlaya P. G. (2021). Social impact of end-stage renal disease requiring hemodialysis among patients with type-2 diabetes and their caregivers in Bengaluru, Karnataka. Indian Journal of Community Medicine, 46(4), 626-630. https://doi.org/10.4103/ijcm.IJCM_995_20 Go to original source... Go to PubMed...
    16. Hill, N. R., Fatoba, S. T., Oke, J. L., Hirst, J. A., O'Callaghan, C. A., Lasserson, D. S., & Hobbs, F. D. R. (2016). Global prevalence of chronic kidney disease-a systematic review and meta-analysis. PloS One, 11(7), e0158765. https://doi.org/10.1371/journal.pone.0158765 Go to original source... Go to PubMed...
    17. Hsu, H. J., Wu, I. W., Hsu, K. H., Sun, C. Y., Hung, M. J., Chen, C. Y., Tsai, C. J., Wu, M. S., & Lee, C. C. (2019). The association between chronic musculoskeletal pain and clinical outcome in chronic kidney disease patients: a prospective cohort study. Renal Failure, 41(1), 257-266. https://doi.org/10.1080/0886022X.2019.1596817 Go to original source... Go to PubMed...
    18. IBMCorp IBM, SPSS. (2017). Statistics for Windows (version 25.0) [Computer software]. Armonk, NY. https://hadoop.apache.org
    19. Keskin, G. (2022). Resilience in patients with dialysis-dependent renal failure: evaluation in terms of depression, anxiety, traumatic growths. Applied Nursing Research, 65, 151575. https://doi.org/10.1016/j.apnr.2022.151575 Go to original source... Go to PubMed...
    20. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. (2024). KDIGO 2024 Clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney International, 105(4S), S117-S314. https://doi.org/10.1016/j.kint.2023.10.018 Go to original source... Go to PubMed...
    21. Kontodimopoulos, N., & Niakas, D. (2005). Determining the basic psychometric properties of the Greek KDQOL-SFTM. Quality of Life Research, 14(8), 1967-1975. https://doi.org/10.1007/s11136-005-3868-6 Go to original source... Go to PubMed...
    22. Kukihara, H., Yamawaki, N., Ando, M., Nishio, M., Kimura, H., & Tamura, Y. (2020). The mediating effect of resilience between family functioning and mental well-being in hemodialysis patients in Japan: a cross-sectional design. Health and Quality of Life Outcomes, 18, 233. https://doi.org/10.1186/s12955-020-01486-x Go to original source... Go to PubMed...
    23. Liu, Y. M., Chang, H. J., Wang, R. H., Yang, L. K., Lu, K. C., & Hou, Y. C. (2018). Role of resilience and social support in alleviating depression in patients receiving maintenance hemodialysis. Therapeutics and Clinical Risk Management, 14, 441-451. https://doi.org/10.2147/TCRM.S152273 Go to original source... Go to PubMed...
    24. Malindretos, P., Sarafidis, P., Spaia, S., Sioulis, A., Zeggos, N., Raptis, V., Kitos, V., Koronis, C., Kabouris, C., Zili, S., & Grekas, D. (2010). Adaptation and validation of the Kidney Disease Quality of Life - short form questionnaire in the Greek language. American Journal of Nephrology, 31(1), 9-14. https://doi.org/10.1159/000252926 Go to original source... Go to PubMed...
    25. Moura, A., Madureira, J., Alija, P., Fernandes, J. C., Oliveira, J. G., Lopez, M., Filgueiras, M., Amado, L., Sameiro-Faria, M., Miranda, V., Mesquita, E., Santos-Silva, A., & Costa, E. (2015). Predictors of health-related quality of life perceived by end-stage renal disease patients under online hemodiafiltration. Quality of Life Research, 24(6), 1327-1335. https://doi.org/10.1007/s11136-014-0854-x Go to original source... Go to PubMed...
    26. Mousa, I., Ataba, R., Al-ali, K., Alkaiyat, A., & Zyoud, S. H. (2018). Dialysis-related factors affecting self-efficacy and quality of life in patients on hemodialysis: a cross-sectional study from Palestine. Renal Replacement Therapy, 4, 21. https://doi.org/10.1186/s41100-018-0162-y Go to original source...
    27. Nicholas, M. K. (2007). The pain self-efficacy questionnaire: taking pain into account. European Journal of Pain, 11(2), 153-163. https://doi.org/10.1016/j.ejpain.2005.12.008 Go to original source... Go to PubMed...
    28. Pecoits-Filho, R., Okpechi, I. G., Donner, J. A., Harris, D. C., Aljubori, H. M., Bello, A. K., ... Johnson, D. W. (2020). Capturing and monitoring global differences in untreated and treated end-stage kidney disease, kidney replacement therapy modality, and outcomes. Kidney International Supplements, 10(1), E3-E9. https://doi.org/10.1016/j.kisu.2019.11.001 Go to original source... Go to PubMed...
    29. Peipert, J. D., Bentler, P. M., Klicko, K., & Hays, R. D. (2018). Psychometric properties of the Kidney Disease Quality of Life 36-item Short-Form Survey (KDQOL-36) in the United States. American Journal of Kidney Diseases, 71(4), 461-468. https://doi.org/10.1053/j.ajkd.2017.07.020 Go to original source... Go to PubMed...
    30. Peipert, J. D., Nair, D., Klicko, K., Schatell, D. R., & Hays, R. D. (2019). Kidney Disease Quality of Life 36-item Short Form Survey (KDQOL-36) normative values for the United States dialysis population and new single summary score. Journal of the American Society of Nephrology, 30(4), 654-663. https://doi.org/10.1681/ASN.2018100994 Go to original source... Go to PubMed...
    31. Pradila D. A., Satiadarma M. P., & Dharmawan U. S. (2021). The resilience of elderly patients with chronic kidney disease undergoing hemodialysis. Advances in Social Science, Education and Humanities Research, 570, 1191-1196. https://doi.org/10.2991/assehr.k.210805.187 Go to original source...
    32. Pretto, C. R., Winkelmann, E. R., Hildebrandt, L. M., Barbosa, D. A., Colet, C. D. F., & Stumm, E. M. F. (2020). Quality of life of chronic kidney patients on hemodialysis and related factors. Revista Latino-Americana de Enfermagem, 28, e3327-e3338. https://doi.org/10.1590/1518-8345.3641.3327 Go to original source... Go to PubMed...
    33. Rikos, N., Kassotaki, A., Frantzeskaki, C., Fragiadaki, M., Mpalaskas, A., Vasilopoulos, G., & Linardakis, M. (2023). Investigation of perception of quality of life and psychological burden of patients undergoing hemodialysis - quality of life of hemodialysis patients. Nursing Reports, 13(3), 1331-1341. https://doi.org/10.3390/nursrep13030112 Go to original source... Go to PubMed...
    34. Stavrianou, K., & Pallikarakis, N. (2007). Quality of life of end-stage renal disease patients and study on the implementation of nocturnal home hemodialysis in Greece. Hemodialysis International, 11(2), 204-209. https://doi.org/10.1111/j.1542-4758.2007.00170.x Go to original source... Go to PubMed...
    35. Stømer, U. E., Klopstad Wahl, A., Gunnar Gøransson, L., & Hjorthaug Urstad, K. (2020). Health literacy in kidney disease: associations with quality of life and adherence. Journal of Renal Care, 46(2), 85-94. https://doi.org/10.1111/jorc.12314 Go to original source... Go to PubMed...
    36. Sundström, J., Bodegard, J., Bollmann, A., Vervloet, M. G., Mark, P. B., Karasik, A., Taveira-Gomes, T., Botana, M., Birkeland, K. I., Thuresson, M., Jäger, L., Sood, M. M., VanPottelbergh, G., Tangri, N., & CaReMe CKD Investigators. (2022). Prevalence, outcomes, and cost of chronic kidney disease in a contemporary population of 2.4 million patients from 11 countries: the CaReMe CKD study. The Lancet Regional Health-Europe, 20, 100438. https://doi.org/10.1016/j.lanepe.2022.100438 Go to original source... Go to PubMed...
    37. Theofilou, P., Aroni, A., Tsironi, M., & Zyga, S. (2013). Measuring pain self-efficacy and health related quality of life among hemodialysis patients in Greece: a cross-sectional study. Health Psychology Research, 1(3), e30. https://doi.org/10.4081/hpr.2013.e30 Go to original source... Go to PubMed...
    38. Tsigkaropoulou, E., Douzenis, A., Tsitas, N., Ferentinos, P., Liappas, I., & Michopoulos, I. (2018). Greek version of the Connor-Davidson resilience scale: psychometric properties in a sample of 546 subjects. In Vivo, 32(6), 1629-1634. https://doi.org/10.21873/invivo.11424 Go to original source... Go to PubMed...
    39. Tsirigotis, S., Polikandrioti, M., Alikari, V., Dousis, E., Koutelekos, I., Toulia, G., Pavlatou, N., Panoutsopoulos, G. I., Leftheriotis, D., & Gerogianni, G. (2022). Factors associated with fatigue in patients undergoing hemodialysis. Cureus, 14(3), e22994. https://doi.org/10.7759/cureus.22994 Go to original source... Go to PubMed...
    40. Werner, E. E., & Smith, R. S. (1982). Vulnerable but invincible: a longitudinal study of resilient children and youth. McGraw-Hill, New York.
    41. Zyga, S., Alikari, V., Sachlas, A., Fradelos, E. C., Stathoulis, J., Panoutsopoulos, G., Georgopoulou, M., Theophilou, P., & Lavdaniti, M. (2015). Assessment of fatigue in end stage renal disease patients undergoing hemodialysis: prevalence and associated factors. Medical Archives, 69(6), 376-380. https://doi.org/10.5455/medarh.2015.69.376-380 Go to original source... Go to PubMed...

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