Elucidating issues stressful for patients in predialysis and dialysis: from symptom to context.

Biopsychosocial problems experienced by renal disease patients were studied within a contextual framework the patients themselves defined, the findings being related to sociodemographic and medical data. Participants were 72 predialysis patients and 73 patients being treated by haemodialysis or peritoneal dialysis (106 men and 39 women, aged 18-84 years). Both stress-related global and situational measures of biopsychosocial problems were assessed by questionnaire. Factor analyses revealed five factors--Bodily problems; Work and leisure time; Sleep, cramps and itching complaints; Financial problems; and Dependence-- explaining 71.1 per cent of the total variance. Fatigue loaded both on Bodily problems and Work and leisure time. Sleep disturbances, itching of the skin and muscle cramps were more stressful for the dialysis than the predialysis patients. Also, fatigue, inability to work and limitation on vacation activities appeared more stressful for the dialysis group. The study supports the usefulness of a contextual approach for gaining a better general understanding of renal disease patients' problems.