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.

BACKGROUND

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.

METHODS

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.

RESULTS

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<0.001), with a large effect size (Cohen's d = 1.16). Plasma serotonin levels were significantly higher in the intervention at post-intervention (p=0.028; r=0.30). However, no significant differences were observed in HRV (SDNN) either between groups (p=0.805) or within groups over time (p>0.05).

CONCLUSION

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.