Nephrology · Medical Literature
The Role of Group Supportive Psychotherapy on Quality of Life and Its Relationship with Heart Rate Variability and Blood Serotonin Levels in End-Stage Renal Disease (ESRD) Patients Undergoing Chronic Hemodialysis.
Abstract
Patients with end-stage renal disease (ESRD) undergoing chronic hemodialysis often experience reduced quality of life and autonomic dysregulation. Group supportive psychotherapy may improve psychological well-being through biopsychosocial mechanisms. This study evaluated the effects of group supportive psychotherapy on quality of life and its association with heart rate variability (HRV) and blood serotonin levels. This randomized, parallel-group, single-blind controlled trial was conducted at the Hemodialysis Unit of Dr. Cipto Mangunkusumo National General Hospital, Jakarta, from November 2024 to January 2025. Fifty-two eligible patients were randomly assigned to an intervention group receiving group supportive psychotherapy plus standard care (n = 26) or a control group receiving standard care alone (n = 26). Outcomes were assessed at baseline and post-intervention using Kidney Disease Quality of Life-36 (KDQOL-36), HRV measured by standard deviation of normal-to-normal intervals (SDNN), and plasma serotonin levels measured using enzyme-linked immunosorbent assay (ELISA). Statistical analyses included an independent t-test or Mann-Whitney test, with effect size calculation and ANCOVA adjustment for baseline values. The intervention group demonstrated significantly greater improvement in KDQOL-36 scores compared with control (mean change 8.46-16.92 vs 0.27-11.36; p=0.046). After adjustment, the between-group difference remained statistically significant (p 0.05). Group supportive psychotherapy significantly improves quality of life and is associated with higher plasma serotonin levels in ESRD patients undergoing chronic hemodialysis. However, no significant autonomic modulation, as measured by HRV, was demonstrated.
Clinical relevance
Does group supportive psychotherapy added to standard care improve quality of life, heart rate variability (HRV), and plasma serotonin levels in ESRD patients undergoing chronic hemodialysis, compared with standard care alone? __SNAPSHOT__ {"studyDesign":"Randomized, parallel-group, single-blind controlled trial","setting":"Hemodialysis Unit, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia; November 2024 – January 2025","sampleSize":"n = 52 (intervention: n = 26, control: n = 26)","population":"Eligible adult ESRD patients undergoing chronic hemodialysis; detailed inclusion/exclusion criteria not fully reported in abstract","intervention":"Group supportive psychotherapy plus standard hemodialysis care","comparator":"Standard hemodialysis care alone","primaryOutcome":"Quality of life assessed via Kidney Disease Quality of Life-36 (KDQOL-36); secondary outcomes included HRV (SDNN) and plasma serotonin levels (ELISA)","followUp":"Assessed at baseline and post-intervention; duration of follow-up beyond intervention not explicitly reported","fundingSource":"Not reported"}
Key findings
The intervention group demonstrated significantly greater improvement in KDQOL-36 scores compared with the control group (mean change 8.46–16.92 vs. 0.27–11.36; p = 0.046). After ANCOVA adjustment for baseline values, the between-group difference remained statistically significant (p 0.05). The magnitude of the KDQOL-36 mean change ranges (8.46–16.92 in the intervention arm) likely spans multiple KDQOL-36 subscales rather than a single composite score, as the abstract does not clarify a single primary subscale; this should be interpreted with caution. NNT is not calculable from the data as reported. No adverse events from the psychotherapy intervention were reported in the abstract.
Practice implications
This trial establishes that group supportive psychotherapy significantly improved kidney disease–specific quality of life (KDQOL-36) with a large effect size in ESRD patients on chronic hemodialysis at a single Indonesian tertiary center. The association with higher post-intervention plasma serotonin levels (small-to-medium effect, r = 0.30) supports a plausible biopsychosocial mechanism, though this is associative and not proof of a causal serotonergic pathway. The hypothesis that psychotherapy modulates autonomic function (HRV/SDNN) was not supported; SDNN did not differ between or within groups, suggesting the intervention's benefit does not operate detectably through autonomic modulation within this study's timeframe and sample. The findings apply to ESRD patients receiving chronic hemodialysis in a tertiary academic center in Indonesia; generalizability to diverse healthcare settings, different ethnic populations, or patients with severe psychiatric comorbidities is uncertain, as these populations were likely underrepresented. The statistical significance of KDQOL-36 improvement is clear, but clinical importance requires contextualizing the mean change against established minimal clinically important differences (MCID) for the KDQOL-36, which are not discussed in the abstract. Single-blind design (blinding of assessors only) and the short intervention window are additional interpretive constraints. Note: This summary is based on the published abstract only; full-text review may reveal additional methodological detail, session structure, randomization procedures, and subscale-level outcomes. __LIMITATIONS__ Small sample size (n = 52 total) substantially limits statistical power for secondary outcomes and subgroup analyses, and increases risk of Type II error for HRV.,Single-blind design: patient blinding to group assignment is inherently infeasible in psychotherapy trials, introducing performance and detection bias.,Single-center, single-country (Indonesian tertiary hospital) setting limits generalizability to other healthcare systems and patient populations.,Short study duration (November 2024 – January 2025, approximately 2–3 months) precludes conclusions about durability of QoL benefit or serotonin changes.,No long-term follow-up reported; it is unknown whether gains are sustained after psychotherapy cessation.,The KDQOL-36 mean change ranges reported (8.46–16.92 vs. 0.27–11.36) span a wide interval, suggesting possible reporting across multiple subscales without a clearly pre-specified single primary endpoint, raising concerns about multiple comparisons.,Plasma serotonin association is correlational within a small sample; no causal mechanistic inference is warranted.,HRV measurement limited to SDNN (time-domain only); frequency-domain and nonlinear HRV indices were not reported, potentially undercharacterizing autonomic modulation.,Funding source not reported; potential conflicts of interest cannot be assessed.,Detailed information on session structure, therapist training, fidelity monitoring, and concomitant psychotropic medication use is not available from the abstract. __BOTTOM_LINE_CATEGORY__ promising_but_preliminary __BOTTOM_LINE__ In this small single-center RCT, group supportive psychotherapy added to standard care significantly improved KDQOL-36 quality of life scores with a large effect size (Cohen's d = 1.16) and was associated with higher post-intervention plasma serotonin levels in ESRD hemodialysis patients; however, no effect on HRV was detected. These findings are clinically encouraging but require replication in larger, multicenter trials with longer follow-up before routine implementation can be recommended. Clinicians managing ESRD patients should view adjunctive psychological support as a low-risk, potentially beneficial intervention warranting further rigorous evaluation.