Financial Toxicity and Psychosocial Burden Among Adults Receiving Maintenance Hemodialysis

Maintenance hemodialysis is a life-sustaining therapy for individuals with end-stage renal disease but is frequently associated with substantial financial and psychosocial burdens that may compromise treatment adherence. This study examined the direct and indirect costs of hemodialysis, the financial and psychosocial factors hindering adherence, and the challenges encountered by patients undergoing long-term treatment. A descriptive quantitative design was employed using anonymized, patient-reported data collected through a structured questionnaire. The findings revealed considerable direct costs related to medications, transportation, food, and hospitalization, alongside significant indirect economic impacts, including employment disruption, caregiver work loss, and reliance on loans. Financial strain was identified as a meaningful barrier to adherence, despite the presence of insurance coverage and government assistance, with patients reporting dependence on external financial support and missed dialysis sessions due to economic constraints. Psychosocial implications were also prominent, with patients experiencing persistent fatigue, social isolation, emotional distress, and perceived disruption of daily life and family roles. Despite these challenges, patients demonstrated strong motivation to adhere to treatment, supported by positive perceptions of healthcare facilities and medical personnel. Overall, the findings underscore the multidimensional burden of maintenance hemodialysis and highlight the need for integrated financial and psychosocial interventions to support sustained treatment adherence and improve patient well-being.