Bridging the Gap: A Cross-Sectional Study of Hemodialysis Services and Patient Psychosocial Burden in Semi-urban Punjab, Pakistan.

Background Chronic kidney disease progressing to end-stage renal disease (ESRD) poses a significant public health challenge, particularly in resource-constrained settings. This clinical audit aimed to evaluate patient satisfaction, clinical practices, and the psychosocial burden among hemodialysis patients at secondary care facilities in Pakistan, benchmarking against Kidney Disease Outcomes Quality Initiative (KDOQI) and Kidney Disease: Improving Global Outcomes (KDIGO) standards. Methods A cross-sectional clinical audit was conducted among 100 ESRD patients receiving maintenance hemodialysis. Data regarding demographic profiles, clinical care standards, patient education, and psychosocial experiences were collected using a validated, interviewer-administered questionnaire. Patient satisfaction was assessed using a standardized five-point Likert scale. Results The cohort (mean age: 42.4 ± 8.2 years; 65.0% male) demonstrated high satisfaction with technical care. Arteriovenous fistulas were utilized by 100% (n = 100) of patients. Maximum satisfaction scores (5/5) were reported by 90% (n = 90) for cannulation technique and overall care. Safety protocol adherence was strict, with 100% confirming the use of dedicated machines for hepatitis B/hepatitis C-positive cases. However, a severe psychosocial and economic burden was observed: 100% of the cohort reported current unemployment, and 100% reported experiencing severe treatment-related stress, anxiety, or depression. Conclusions Secondary care hemodialysis centers in this cohort demonstrated high technical proficiency and strict adherence to biomedical safety protocols. However, this clinical excellence contrasts with universal patient psychosocial distress and economic vulnerability, highlighting an urgent need to integrate routine mental health and socioeconomic support into the standard renal care model.