Comparative Analysis of Caregivers’ Perspective from Patients under Hemodialysis versus Conservative Kidney Management

Abstract

Introduction: Elderly patients with advanced chronic kidney disease (CKD) experience a significant physical and emotional burden, regardless of treatment choice. However, little is known about the challenges faced by their families throughout the disease. This study aimed to evaluate how caregivers of patients over 75 years‑old with advanced CKD perceive and cope with the disease.
Methods: A qualitative study was conducted through semi‑structured telephone interviews with 22 caregivers [11 of hemodialysis (HD) patients and 11 of conservative kidney management (CKM) patients]. Thematic analysis was performed to identify key themes related to communication, quality of life, caregiver burden, and advance care planning.
Results: Caregivers of CKM patients reported greater involvement in decision‑making and better awareness of prognosis, while HD caregivers felt less included in patient management. Symptom control concerns were common in both groups, but HD caregivers experienced more uncertainty in communication with the medical team. Loss of personal freedom was noted in both groups ‑ HD caregivers linked it to treatment constraints, while CKM caregivers attributed it to mobility loss. Although caregivers reported emotional and physical burden, many were reluctant to acknowledge it explicitly. HD caregivers were more open to discussing advanced care planning, whereas CKM caregivers preferred ongoing informal discussions.
Conclusion: Caregivers play a critical role in CKD management but often lack adequate support. The palliative approach in CKM facilitates structured communication and shared decision‑making, while its inconsistent integration in HD may contribute to caregiver distress. These findings highlight the need for enhanced caregiver support through multidisciplinary strategies.