This multicenter longitudinal study evaluated how psychological resilience evolves during the early transition to maintenance hemodialysis (MHD) and which baseline characteristics are associated with different longitudinal patterns. The authors aimed to identify heterogeneous resilience trajectories among patients newly initiating MHD and to examine baseline psychological, clinical, and sociodemographic correlates of trajectory membership.
The cohort comprised 693 patients who were newly initiating MHD and were followed for 6 months. Resilience was measured repeatedly across seven assessment points using the Chinese Connor-Davidson Resilience Scale. Baseline data included psychological measures (depressive symptoms, anxiety symptoms, sleep disturbance), clinical information (comorbidity burden, hospitalizations, physical activity), and sociodemographic variables (age, marital status, income). The study was conducted across multiple centers; full author and affiliation information is reported in the original publication.
The investigators used latent growth mixture modeling (LGMM) to identify distinct longitudinal trajectories of resilience in the sample. After trajectory identification, multinomial logistic regression analysis was performed to examine baseline factors associated with membership in the identified trajectories. To address classification uncertainty and potential bias due to missing data or attrition, the authors conducted sensitivity analyses that included the R3STEP procedure and a complete-case LGMM.
Three distinct resilience trajectories were identified among the 693 patients:
High-level rapidly decreasing: 12.8% of participants followed this trajectory.
Low-stable: 35.5% of participants followed a persistently low resilience trajectory.
High-level stable: 51.7% of participants maintained a high level of resilience across the follow-up period.
These trajectories indicate heterogeneity in early psychological adaptation to initiating MHD: the majority retained high resilience, a substantial subgroup remained at low resilience, and a smaller subgroup began with high resilience but experienced a rapid decline.
When compared with the high-level stable trajectory (reference group), the high-level rapidly decreasing trajectory was associated at baseline with:
The low-stable trajectory was associated with the same psychological and clinical features listed above and additionally with several sociodemographic and health-utilization factors, specifically:
These associations were derived from multinomial logistic regression following trajectory assignment and were tested for robustness using the reported sensitivity analyses.
The study documents that psychological resilience among patients newly initiating dialysis does not follow a single course: some patients maintain high resilience, some remain persistently low, and a minority with initially high resilience can experience rapid declines. The distinct baseline profiles associated with the declining and low-stable trajectories suggest different mechanisms and intervention targets. In particular, baseline depressive and anxiety symptoms, sleep disturbance, and higher comorbidity burden appear to mark risk for early resilience decline, while additional sociodemographic vulnerabilities (older age, unmarried, lower income), greater prior hospital use, and lower physical activity characterize those in the persistently low group.
From a clinical standpoint, these findings support the value of early psychosocial assessment at or before dialysis initiation, systematic monitoring of resilience and mental health during early dialysis adaptation, and development of targeted supportive care strategies for patients at higher risk of decline or sustained low resilience.
The abstract and bibliographic record provide key results and methods but do not report detailed information on some aspects that would aid interpretation, including: recruitment and retention rates at each assessment point, effect sizes or adjusted odds ratios for baseline predictors, the absolute resilience score ranges for each trajectory, and whether interventions or standard-of-care psychosocial supports were in place during follow-up. These details were not reported in the source abstract and would require consultation of the full text for comprehensive appraisal.
This multicenter, longitudinal analysis of 693 patients starting MHD identified three heterogeneous resilience trajectories over the first 6 months: high-level stable, low-stable, and high-level rapidly decreasing, with different baseline psychological, clinical, and sociodemographic correlates. The authors conclude that psychological resilience can change dynamically during early dialysis adaptation and emphasize the importance of early psychosocial screening, ongoing monitoring, and targeted supportive care for patients initiating MHD. The study reports no competing interests and is published under a CC0 public domain dedication.