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December 1972

Problems in Adaptation to Maintenance Hemodialysis: A Four-Year Study of 25 Patients

Author Affiliations

New York

From the departments of medicine and psychiatry, State University of New York, Downstate Medical Center College of Medicine, and the Medical Service of Kings County Hospital Center, Brooklyn, New York.

Arch Intern Med. 1972;130(6):859-865. doi:10.1001/archinte.1972.03650060051009

Before acceptance for center maintenance hemodialysis, all 25 patients were significantly depressed—helplessness being the dominant affect. Eighteen patients had suffered meaningful losses and nine of these felt helpless prior to becoming uremic. Three successive periods of adaptation to hemodialysis were observed: the "honeymoon," disenchantment and discouragement, and long-term adaptation. Of 16 patients who experienced a clear-cut "honeymoon," this period ended in 12 patients at the time when they were expected to resume an active and productive role at work or in the household. This was accompanied by depressive affects, helplessness in particular, and by complications at the shunt site, most notably clotting of the shunt.

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