caught between two threats with no safe choice
Em Porto, investigadores acompanharam vinte doentes renais crónicos durante os primeiros meses da pandemia e documentaram aquilo que a razão intui mas a ciência precisa de nomear: quando uma doença já exige uma reestruturação radical da vida, e uma pandemia se sobrepõe, o peso psicológico torna-se esmagador. Estes doentes, obrigados a sair de casa três vezes por semana para fazer diálise, viram-se apanhados entre dois perigos — o vírus e a ausência de tratamento — sem que nenhuma das escolhas fosse segura. A investigação, publicada na revista Seminars in Dialysis, não se limita a registar o sofrimento: defende que o apoio psicológico é parte integrante do cuidado clínico, não um complemento opcional.
- Doentes que já viviam sob a pressão constante da doença renal crónica viram a pandemia transformar cada saída de casa num dilema entre sobreviver ao vírus ou sobreviver sem tratamento.
- A ansiedade traduziu-se em consequências clínicas concretas: aumento do consumo de líquidos, abandono do exercício físico e menor adesão à dieta — fatores que comprometem diretamente a eficácia da diálise.
- A adequação dialítica do grupo estudado deteriorou-se durante o período analisado, mantendo-se ainda dentro dos limites de referência, mas com uma trajetória preocupante caso nada seja feito.
- A investigadora Daniela Figueiredo, do CINTESIS e da Universidade de Aveiro, defende que o suporte psicológico deve ser integrado no protocolo de cuidados essenciais, com impacto direto na gestão da doença.
- A equipa prepara-se agora para alargar o estudo aos familiares destes doentes, reconhecendo que o dano pandémico se estende muito além do próprio paciente.
Investigadores do CINTESIS, centro de investigação em saúde sediado no Porto, acompanharam vinte doentes em hemodiálise durante os primeiros meses da pandemia de COVID-19 e publicaram conclusões que desafiam os hospitais a repensar o que conta como cuidado essencial. A investigação foi liderada por Daniela Figueiredo, que também leciona na Universidade de Aveiro, e parte de uma realidade que precede qualquer pandemia: a doença renal crónica já é, por si só, uma condição que transforma profundamente a vida de quem a vive.
A hemodiálise exige deslocações a clínicas três vezes por semana, durante horas. Impõe restrições severas na alimentação e na ingestão de líquidos. Reorganiza rotinas, relações familiares e a própria identidade. Muitos destes doentes apresentam sintomas depressivos significativos antes de qualquer crise externa. Quando chegou março de 2020, este grupo já fragilizado deparou-se com uma nova ameaça: sair de casa para fazer diálise significava exposição ao vírus; ficar em casa significava perder o tratamento. O estudo documentou o que os doentes descreveram como uma emboscada emocional — medo, isolamento e um stress particular que nasce de estar preso entre dois perigos.
As consequências não ficaram apenas no plano emocional. Um doente, incapaz de gerir a pressão psicológica, começou a sentir a boca e a garganta permanentemente secas devido à ansiedade e passou a beber mais água — comprometendo diretamente a eficácia da diálise. Outros abandonaram o exercício físico. Muitos alteraram a dieta por receio de ir às compras. A adequação dialítica do grupo deteriorou-se, embora se mantivesse dentro dos intervalos de referência internacionais. Figueiredo foi direta na sua recomendação: estes doentes precisam de apoio psicológico não como um luxo, mas como parte do cuidado clínico — porque a saúde mental e a gestão da doença são, neste caso, inseparáveis.
A equipa prepara agora uma segunda fase do estudo, voltada para os familiares destes doentes — as pessoas que gerem medicação, preparam refeições dentro de limites dietéticos estritos e absorvem o peso emocional de viver ao lado de alguém com uma doença crónica grave. Esse próximo capítulo promete revelar outra camada de dano pandémico, que se estende muito além do próprio paciente.
Researchers at a Porto-based health research center have published findings that should reshape how hospitals think about treating people with chronic kidney disease during a pandemic. The study, small but precise, followed twenty dialysis patients through the early months of COVID-19 and found something that might seem obvious in hindsight but was worth documenting: when you're already managing a disease that demands radical restructuring of your life, and then a pandemic arrives, the psychological weight becomes crushing.
Daniela Figueiredo, who led the work at CINTESIS and teaches at the University of Aveiro, explained the bind these patients face. Chronic kidney disease itself is relentless—a slow, progressive failure of the kidneys to filter metabolic waste from the blood. The standard treatment, hemodialysis, requires patients to visit clinics three times a week, sometimes for hours at a time. This alone reshapes everything: diet, fluid intake, daily routines, family life. Many patients already show significant depressive symptoms before any pandemic arrives.
Then came March 2020. Suddenly these same patients faced a new terror: the virus. They needed to leave their homes three times weekly for dialysis, but leaving home meant exposure. Staying home meant missing treatment. The research team documented what patients reported—a kind of emotional ambush. People described fear of going outside, isolation that deepened existing anxiety, and a particular kind of stress that comes from being caught between two threats. One patient couldn't manage the psychological pressure: anxiety made their mouth and throat feel perpetually dry, so they drank more water, which directly threatened the effectiveness of their dialysis treatment. Others stopped exercising. Many shifted to less healthy foods because they were afraid to shop.
The study, published in the journal Seminars in Dialysis, measured both the emotional toll and the clinical consequences. Researchers found that dialysis adequacy—a key marker of treatment effectiveness—declined in their cohort, though it remained within international reference ranges. But Figueiredo emphasized the trajectory: if these trends continued unchecked, the numbers would worsen. Physical activity dropped. Dietary compliance eroded. Fluid restriction, already one of the hardest parts of kidney disease management, became even harder.
What made this group particularly vulnerable was the collision of vulnerabilities. Chronic kidney disease patients, especially those with end-stage renal failure, often carry additional diagnoses: diabetes, hypertension, age. Their immune systems are already compromised. COVID-19 wasn't just another stressor—it was a threat that felt existential in a way that ordinary disease management did not.
Figueiredo's recommendation was direct: these patients need psychological support, not as a luxury but as part of essential care. The goal isn't just mental health in the abstract sense. It's practical: helping patients manage the anxiety that makes them restrict their diet or increase their fluid intake, helping them maintain the routines and discipline that keep their disease stable, helping them navigate the impossible choice between isolation and infection risk.
The research team is now expanding the work to examine how the pandemic affected the families of these patients—the people who help manage medications, prepare meals within strict dietary limits, and absorb the emotional weight of living alongside someone with a serious chronic illness. That next phase will likely reveal another layer of pandemic damage, one that extends beyond the patient to everyone in their orbit.
Citas Notables
This disease by itself is already profoundly demanding. Dialysis treatment requires an almost radical restructuring of patients' and families' lives, leading to significant depressive symptoms—and the pandemic intensified these psychological issues.— Daniela Figueiredo, CINTESIS researcher
Patients reported emotional suffering from isolation, fear of leaving home, and the stress of needing to travel to clinics three times weekly while facing infection risk.— Study findings
La Conversación del Hearth Otra perspectiva de la historia
Why does the pandemic hit kidney patients harder than the general population?
Because they're already living with a disease that demands constant, precise management. Dialysis isn't like taking a pill—it's a three-times-weekly commitment that structures your entire life. Then the pandemic adds a layer of fear on top of that existing burden.
But people with other chronic diseases faced the same pandemic. What's different about kidney disease?
The immediacy of the treatment. A diabetic can often manage at home. A kidney patient has to leave home three times a week, no exceptions. So they're caught: skip dialysis and die slowly, go to dialysis and risk the virus. That's not an abstract dilemma—it's a weekly choice.
The study mentions people drinking more water because of anxiety. How does that threaten their treatment?
Dialysis removes excess fluid from the blood. If a patient drinks too much between treatments, their body accumulates fluid that the next dialysis session has to remove. Too much fluid buildup can damage the heart. So anxiety literally undermines the treatment that keeps them alive.
Did the researchers find that psychological support actually helps, or is this just a recommendation?
This study documents the problem and makes the case for support. They're not yet showing outcomes from intervention. But the logic is clear: if anxiety is driving the behaviors that destabilize disease management, then addressing the anxiety could stabilize the disease.
What happens next with this research?
They're looking at families now. The patient isn't isolated in their illness—spouses, children, parents are all managing it too. The pandemic likely fractured those support systems in ways we haven't yet measured.