Family functionality and social support in Brazilian older people with chronic kidney disease in hemodialysis: a cross-sectional study
Keywords:
Validation Study, Caregivers, Dementia, Mental Health, Psychometric Properties, Family Caregivers, Positive Aspects of Caregiving, Major Neurocognitive DisorderAbstract
BACKGROUND: End-stage chronic kidney disease (CKD) requires hemodialysis, which carries significant biopsychosocial impact.
OBJECTIVES: This study aimed to investigate the relationship between family functionality and social support among older individuals undergoing hemodialysis.
DESIGN AND SETTING: This cross-sectional and correlational study was conducted at a renal replacement therapy unit located in São Paulo State.
METHODS: A total of 118 participants aged ≥ 60 years undergoing hemodialysis were interviewed individually using the Family adaptability, partnership, growth, affection, and resolve (APGAR), and the Medical Outcomes Study Social Support Scale. All ethical principles were duly respected.
RESULTS: Majority of participants were male (69.5%), aged between 60–69 years (50.8%), white ethnicity (63.6%), with a stable partner (54.2%), and had an income of one to three times the minimum wage (55.9%). Regarding the domains of social support, affective support (AS) had the highest mean score (93.44 ± 12.97), whereas informational support (IS) had the lowest (81.69 ± 24.60). Overall, 83.9% reported good family functioning, 9.3% moderate family dysfunction, and 6.8% severe dysfunction. A statistically significant positive correlation with a moderate magnitude was confirmed between APGAR with all support domains. Material support (MS, r = 0.327), AS (r = 0.425), emotional support (ES, r = 0.518), positive social interaction support (PSIS, r = 0.466), and IS (r = 0.421).
CONCLUSION: Social support was positively associated with family functioning, indicating that patients with CKD undergoing hemodialysis who reported better family functioning also perceived higher levels of social support.
Downloads
References
1. World Health Organization. Noncommunicable diseases. Available from: https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases. Accessed in 2025 (September 15).
2. Brazil. Boletim Epidemiológico. Cenário da doença renal crônica no Brasil no período de 2010 a 2023. Ministério da Saúde. 2024;55(12):119. Available from: https://www.gov.br/saude/pt-br/assuntos/noticias/2024/outubro/divulgado-boletim-epidemiologico-sobredoenca-renal-cronica-no-brasil. Accessed in 2025 (October 7).
3. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int. 2024;105(4S):S117-S314. PMID: 38490803; https://doi.org/10.1016/j.kint.2023.10.018.
4. Sułkowski L, Matyja A, Matyja M. Social support and quality of life in hemodialysis patients: a comparative study with healthy controls. Medicina. 2024;60(11):1732. PMID: 39596917; https://doi.org/10.3390/ medicina60111732.
5. Safi F, Namdar Areshtanab H, Ghafourifard M, Ebrahimi H. The association between self-efficacy, perceived social support, and family resilience in patients undergoing hemodialysis: a cross-sectional study. BMC Nephrol. 2024;25(1):207. PMID: 38918709; https://doi.org/10.1186/s12882-024-03629-4.
6. Kisomi ZS, Taherkhani O, Mollaei M, et al. The moderating role of social support in the relationship between death anxiety and resilience among dialysis patients. BMC Nephrol. 2024;25(1):100. PMID: 38493124; https:// doi.org/10.1186/s12882-024-03533-x.
7. Hulu T, Budi NP, Sari RP. Relationship of family support with quality of life of hemodialyzed patients using study literature review method. J Vocat Nurs. 2021;2(2):132-41. https://doi.org/10.20473/jovin.v2i2.30720.
8. Pratiwi WN, Gayatri PR, Astutik WS, Pratama YG, Ayyaroh FA. The role of family support in stress and anxiety conditions in the elderly with chronic kidney disease underwent hemodialysis therapy. Adi Husada Nurs J. 2023;9(1):20-9. https://doi.org/10.37036/ahnj.v9i1.392.
9. Santos DGM, Pallone JM, Manzini CSS, Zazzetta MS, Orlandi FS. Relationship between frailty, social support and family functionality of hemodialysis patients: a cross-sectional study. Sao Paulo Med J. 2021;139(6):570-5. PMID: 34706049; https://doi.org/10.1590/15163180.2021.0089.r1.0904221.
10. Wang Y, Qiu Y, Ren L, et al. Social support, family resilience and psychological resilience among maintenance hemodialysis patients: a longitudinal study. BMC Psychiatry. 2024;24(1):76. PMID: 38279114; https://doi.org/10.1186/s12888-024-05526-4.
11. Ajzen I, Fishbein M. Understanding attitudes and predicting social behavior. Englewood Cliffs: Prentice-Hall; 1980.
12. Sherbourne CD, Stewart AL. The MOS social support survey. Soc Sci Med. 1991;32(6):705-14. PMID: 2035047; https://doi.org/10.1016/02779536(91)90150-b.
13. Andrade CR, Chor D, Faerstein E, et al. Social support and breast self-examination in the Pró-Saúde Study. Rev Saude Publica.
2005;21(2):379-86. PMID: 15905900; https://doi.org/10.1590/s0102311x2005000200004.
14. Smilkstein G. The family APGAR: a proposal for a family function test and its use by physicians. J Fam Pract. 1978;6(6):1231-9. PMID: 660126.
15. Duarte YAO. Família: rede de suporte ou fator estressor – a ótica de idosos e cuidadores familiares [doctoral thesis]. São Paulo: Escola de Enfermagem, Universidade de São Paulo; 2001.
16. Levin J, Fox JA. Elementary statistics in social research. 9th ed. São Paulo: Pearson Prentice Hall; 2004.
17. Paula EA, Roth JM, Schwartz E, Lima Spagnolo LM, Lise F. Perfil sociodemográfico e clínico de usuários em hemodiálise no sul do Rio Grande do Sul, Brasil. Enferm Actual Costa Rica. 2022;(43):51375. http://dx.doi.org/10.15517/enferm.actual.cr.v0i43.45296.
18. Instituto Brasileiro de Geografia e Estatística (IBGE). Demographic Census 2022: population and households: preliminary results. Available from: https://biblioteca.ibge.gov.br/visualizacao/livros/liv102011.pdf. Accessed in 2025 (October 7).
19. Alatawi AA, Alaamri M, Almutary H. Social support and adherence to treatment regimens among patients undergoing hemodialysis. Healthcare. 2024;12(19):1958. PMID: 39408138; https://doi.org/10.3390/healthcare12191958.
20. Moradi M, Amiri M, Daneshi S, et al. Investigating the effectiveness of a virtual family-centered support intervention on the mental health of hemodialysis patients and their family caregivers during the COVID-19 pandemic. Open Public Health J. 2024;17:e18749445271736. http:// dx.doi.org/10.2174/0118749445271736231123110235.
21. Supriati L, Sunarto M, Ulya I, et al. The role of peer social support on family psychological resilience in caring for chronic kidney disease patients receiving hemodialysis. Healthcare Low-Resour S. 2024;12(s1):1-10. https://doi.org/10.4081/hls.2024.13048.
22. Anita DC, Alfrizki ES, Suprayitno E, Fadlilah S, Wantonoro W. Family support, depression, and health-related quality of life of hemodialysis patients. Turk J Nephrol. 2025;34(3):195-200. https://doi.org/10.5152/turkjnephrol.2025.25991.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Ana Beatriz Murari Thomazini, Diana Gabriela Mendes dos Santos, Yngrid Larisse Teodoro de Souza, Daiane Baldo Apolinário, Ana Luiza Barbosa, Marisa Silvana Zazzetta, Fabiana Souza Orlandi

This work is licensed under a Creative Commons Attribution 4.0 International License.