ArticleMedicine2026
Fear of disease progression as a mediator of the association between symptom clusters and social alienation among hemodialysis patients: A cross-sectional study.
Article in Medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Abstract
Patients undergoing maintenance hemodialysis often experience multiple concurrent symptoms that may affect psychosocial functioning. This study aimed to identify symptom-clusters and examine the associations among symptom-cluster severity, fear of disease progression (FoP), and social alienation, including the statistical mediating role of FoP. This analytical cross-sectional study included 321 patients receiving maintenance hemodialysis at a tertiary hospital in Shenyang, China. Symptoms, social alienation, and FoP were assessed using the Chinese versions of the Dialysis Symptom Index, General Alienation Scale, and Fear of Progression Questionnaire-Short Form, respectively. Principal component analysis with Varimax rotation was used to identify symptom-clusters. Correlation analyses and structural equation modeling were performed, and indirect effects were tested using 5000 bootstrap resamples. Five symptom-clusters were identified: water and electrolyte, sleep disorder, gastrointestinal, skin, and psychological symptom-clusters, collectively explaining 55.50% of the total variance. The severity scores of all 5 symptom-clusters were positively correlated with FoP and social alienation (all P < .01), with the sleep disorder symptom-cluster showing the strongest correlation with total social alienation (correlation coefficient = 0.703, P < .01). The partial-mediation model showed better fit than the competing full-mediation model and demonstrated acceptable model-fit (χ2/df = 2.604, root mean square error of approximation = 0.072). Symptom-clusters were positively associated with FoP (B = 4.910, β = 0.705, P < .001), and FoP was positively associated with social alienation (B = 0.112, β = 0.358, P < .001). The direct association between symptom-clusters and social alienation remained significant after FoP was included in the model (B = 1.610, β = 0.737, P < .001). The indirect effect through FoP was statistically significant (B = 0.551, β = 0.252, 95% confidence interval: 0.180-1.258), accounting for 25.5% of the total effect. Greater symptom-cluster severity was associated with greater FoP and social alienation, with FoP showing a significant statistical indirect effect. Integrated assessment of symptom-clusters, disease-related fears, and psychosocial needs may help identify patients requiring comprehensive support. Given the cross-sectional design, these findings should not be interpreted as evidence of temporal or causal relationships.
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