How counselling can support kidney patients
Healthcare Counselling and Psychotherapy Journal, October 2026

Chronic kidney disease (CKD) is relentless, unforgiving and takes a huge toll on patients’ lives. There is no cure – and the treatment options when kidneys fail include disruptive dialysis that requires three hospital visits a week, each lasting four hours, or a transplant that comes with the risk of rejection.

In my view, psychological and counselling interventions need to be an integral part of care, as patients can find it challenging to juggle hospital visits, treatment, side effects of medication, associated diseases, ability to work and the impact on relationships. And yet there are only about twenty-eight counsellors across the UK with any renal specialism.¹

CKD is a progressive disease and is often explained in terms of five stages. At stage one, kidneys show early signs of damage; by stage five, either dialysis or a kidney transplant is usually required to stay alive. About three and a quarter million people in the UK are in stages three to five. Every day, twenty more patients reach end-stage kidney failure and two patients out of the six-thousand-nine-hundred waiting for a transplant will die before a transplant is found.²

Over the past ten years, I have worked as the lead renal counsellor in an NHS Trust, taking referrals for counselling from nephrologists and other members of the multidisciplinary team (MDT). Many patients have talked to me about feeling overwhelmed, living in fear, losing any sense of self-identity, feeling angry and at a loss, as their lives have been turned upside down. I believe that, with effective emotional support and interventions, it is possible to improve a patient’s wellbeing and quality of life.

In his seminal paper, The Need for a New Medical Model: a challenge for biomedicine, published in 1977, George Engel argued that sticking rigidly to a medical model of care was like treating the body as a machine, at the expense of the social, psychological and behavioural aspects of illness.³ Engel’s work helped to shape holistic and patient-centred care in hospitals. But, in my experience, not every member of every medical team has been trained to think and work holistically.

CKD is a risk factor for poor mental health and, in turn, poor mental health is a risk factor for poorer kidney disease outcomes.⁴

In January 2022, Kidney Research UK carried out a patient survey of more than one-thousand people living with kidney disease. Almost seventy per cent (sixty-seven per cent) had experienced symptoms of depression; twenty-seven per cent had considered self-harm or suicide and thirty-six per cent couldn’t fully take care of their physical health because of their mental health problems. Yet sixty-eight per cent had been offered no mental health support.⁵

People living with kidney disease are significantly more likely to experience depression and anxiety than the general population, with prevalence varying according to factors such as the stage of the kidney disease, age of the patient and perception of their illness. Depression is linked to poorer quality of life, increased symptom burden, reduced adherence to treatment, faster disease progression and increased mortality.⁴

Furthermore, people who have experienced adversity in childhood are at higher risk of a range of long-term medical conditions, including kidney disease.⁴ There is also evidence, and I have seen it in my practice, that treatments such as dialysis and transplantation can lead to post-traumatic stress disorder (PTSD) in this patient population.⁴

In addition, older adults with kidney disease are at risk of poorer psychological outcomes, as they are often living with more than one health condition, and are more likely to be frail and socially isolated.⁴

Health inequality

Adults living in areas of high deprivation are more likely to develop kidney disease, progress faster to the need for intervention and experience worse outcomes, such as early death.⁶

In the report, Addressing the Mental Health Challenges of Life with Kidney Disease: the case for change, the author reminds researchers and clinicians ‘to hold the concept of race in mind, not only because there are well-defined biological differences and genetic susceptibility, but also because there is a degree of social construct that can feed into a person’s likelihood of experiencing discrimination, deprivation and marginalisation and how likely they are to seek medical advice and use the health services available.’⁴

The burden of managing symptoms for kidney disease is among the highest of all long-term conditions.⁴ Symptoms include fatigue, chronic pain, itching and sleep disturbance. In addition, there may be diet and fluid restrictions. Dialysis, whether at home or in hospital, is demanding.

It can also be difficult to fit work around treatment and hospital appointments, which can lead to financial hardship. CKD can also alter relationship dynamics. Frustrations can build up if a patient is unable to attend family events or go on holiday, due to health and treatment constraints.

It can be especially challenging for younger patients. As Sophie, twenty-two, said: ‘I feel I’m getting so left behind in life. It feels like I’m held back from doing so many things and I’m in limbo waiting for a possible transplant.’

Access to NHS renal psychosocial support is not guaranteed. In my experience, it often depends on whether local consultants or budget holders understand the value of psychosocial practitioners within their MDT.

A 2017 study of the renal psychosocial workforce across the eighty-four renal units in the UK showed inequalities and variations in the number and type of psychosocial staff available to support kidney patients. There was no psychosocial support at all in fourteen per cent of units; there were units with a social worker and no counsellor, two psychologists and no social worker, and just one counsellor – and these were not always whole-time equivalent posts.¹

It is important to remember that many renal patients could also be managing other conditions, such as diabetes, heart disease, arthritis or cancer.⁶ So, many counsellors in the NHS and private practice might find themselves working with kidney patients, even if CKD is not the presenting issue. An understanding of the complexity of the disease can therefore be helpful in providing appropriate support.

Provision of psychosocial support is not the only variable across renal units. The delivery, style and method will often depend on local resources and the individual psychological practitioners.

Therapy is generally short term, usually only six sessions. And these sessions can take place behind a hospital curtain, with dialysis machines bleeping loudly and intermittently, or in a cramped medical consultation room, with two plastic chairs and no windows. Sessions are often conducted over the phone, as it’s too difficult to arrange hospital transport. They are also frequently cancelled due to illness or clashes with hospital appointments.

Identifying psychosocial needs

Guidance from the National Psychosocial Working Group suggests that kidney patients should be assessed for their psychological needs at diagnosis, when they change treatment and at times of distress.⁷ But this remains an aspiration within the NHS. Kidney patients remain woefully underserved by psychological support across the UK.

I work in an integrative, humanistic way that is collaborative, validating, empathic and non-judgmental. Each patient arrives with their unique set of life circumstances, alongside their unique physical and mental health challenges.

My fundamental aim is to support patients with their emotional health and management of treatment and symptoms, through improved understanding, adjustment and acceptance. During six sessions, we focus on finding some level of emotional equilibrium, by building coping techniques and supporting the patient’s ability to live around the disease.

Patients might never have told their family how they feel, never talked about their fear of dying or their fear of letting their family down. They might never have spoken about the difficulty of asking a family member to donate a kidney, or how daunting it is to accept a cadaveric kidney from a deceased donor – and the guilt of living with a new kidney. They might find it hard to explain that they feel anxious about managing the side effects of the anti-rejection medication and worry the kidney will fail, even though everyone now believes they’re ‘mended’.

Jane was referred to me by her consultant for renal counselling. In her fifties and a teacher by training, she was struggling with panic attacks when on dialysis and had started to miss treatment sessions. Jane had been active on the transplant waiting list for two years and had received a call once during this time. She went into hospital in the middle of the night, only to be told the kidney was not suitable. As a direct result of her CKD, she had lost her teaching job, and her relationship with her partner was becoming fractured. ‘I feel I’m existing and not living anymore. My panic attacks are horrible, and life feels out of control. I’m no use to anyone,’ she said when we met.

For Jane, the counselling sessions were a chance to be heard, a chance to understand that her anxiety and low mood were not ‘abnormal’, as she feared, and that she could make some changes that would help her to manage her anxiety. ‘I’ve finally shared my inner secrets and fears, which is such a weight off me. I’m managing my anxiety better and I’m now starting to look at the way ahead again, knowing I do still have something to offer in life.’

Good psychosocial intervention can support better adherence to treatment, increased ability to self-manage, improved medical outcomes and better quality of life. It is always a privilege to work alongside patients as they navigate the ups and downs of living with CKD. Many patients come with humour, resilience and courage. It is my hope that they receive appropriate emotional support, alongside their medical care.