{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T14:19:24Z","timestamp":1786544364160,"version":"build-2736575974"},"reference-count":70,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T00:00:00Z","timestamp":1762992000000},"content-version":"unspecified","delay-in-days":12,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,10,29]]},"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The prevalence of chronic kidney disease (CKD) is increasing at an alarming rate worldwide, leading to a growing number of patients developing kidney failure and requiring haemodialysis (HD). HD prolongs life and improves health, but it imposes substantial physical, nutritional, psychological and financial demands on patients. Patients on HD often endure a high symptom burden, which significantly impairs their lives.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The study aimed to explore and describe the lived experiences of patients residing in rural areas of Pakistan receiving HD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A transcendental phenomenology.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Dialysis unit of a tertiary care hospital in Mirpur, AJK, Pakistan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Twenty village-based patients with CKD receiving HD were recruited through a purposive sampling technique.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data collection and analysis<\/jats:title>\n                    <jats:p>The data were collected through unstructured, in-depth, face-to-face interviews using an interview guide, as well as observation and document analysis. Thematic analysis used a Colaizzi seven-step method to derive key themes from the data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Five major themes emerged after the data analysis, reflecting the complex symptom burden experienced by patients: (1) Physical manifestations and loss of independence due to persistent pain and fatigue, leading to increased dependency in daily activities. (2) Emotional and cognitive impact characterised by emotional distress, including anxiety, helplessness and cognitive disturbances such as poor concentration and mental fatigue. (3) Challenges with dietary management and lifestyle adaptation due to difficulties in adhering to dietary and fluid restrictions, further complicated by limited resources, lack of individualised guidance and cultural dietary practices. (4) Financial and logistical hardships, including out-of-pocket expenses, loss of income due to reduced work capacity and geographic barriers, significantly affecting treatment adherence and continuity of care. (5) Post-dialysis experiences and side effects. Patients expressed diverse experiences: some mentioned transient relief after HD, while others described ongoing side effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Patients with CKD on HD may face multiple symptoms that impact physical, emotional, cognitive, dietary, financial and social domains, which potentially contribute to reduced quality of life. Persistent symptoms and limited support highlight the need for holistic, patient-centred care strategies that address their physical, emotional, psychosocial and financial challenges, particularly in rural and underserved populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-106937","type":"journal-article","created":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T06:25:23Z","timestamp":1763101523000},"page":"e106937","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Lived realities of symptom burden among haemodialysis patients: a phenomenological study from rural Pakistan"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-4577-9079","authenticated-orcid":false,"given":"Tazeem","family":"Akhtar","sequence":"first","affiliation":[{"name":"Faculty of Nursing & Midwifery, Shifa Tameer-e-Millat University, Islamabad, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abel J","family":"Pienaar","sequence":"additional","affiliation":[{"name":"Faculty of Nursing & Midwifery, Shifa Tameer-e-Millat University, Islamabad, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0576-2066","authenticated-orcid":false,"given":"Kainat","family":"Asmat","sequence":"additional","affiliation":[{"name":"Faculty of Nursing & Midwifery, Shifa Tameer-e-Millat University, Islamabad, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siham","family":"Sikander","sequence":"additional","affiliation":[{"name":"Faculty of Nursing & Midwifery, Shifa Tameer-e-Millat University, Islamabad, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,11,13]]},"reference":[{"key":"2025120413271596000_15.11.e106937.1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0287510","article-title":"Health inequity associated with financial hardship among patients with kidney failure","volume":"18","author":"Ng","year":"2023","journal-title":"PLoS One"},{"key":"2025120413271596000_15.11.e106937.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30045-3"},{"key":"2025120413271596000_15.11.e106937.3","doi-asserted-by":"publisher","DOI":"10.1053\/j.jrn.2021.11.007"},{"key":"2025120413271596000_15.11.e106937.4","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1003954","article-title":"Symptom burden and health-related quality of life in chronic kidney disease: A global systematic review and meta-analysis","volume":"19","author":"Fletcher","year":"2022","journal-title":"PLoS Med"},{"key":"2025120413271596000_15.11.e106937.5","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0230512","article-title":"The impact of chronic kidney disease on developed countries from a health economics perspective: A systematic scoping review","volume":"15","author":"Elshahat","year":"2020","journal-title":"PLoS One"},{"key":"2025120413271596000_15.11.e106937.6","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.17.206441"},{"key":"2025120413271596000_15.11.e106937.7","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2369-15-90","article-title":"Prevalence, determinants, and management of chronic kidney disease in Karachi, Pakistan - a community based cross-sectional study","volume":"15","author":"Jessani","year":"2014","journal-title":"BMC Nephrol"},{"key":"2025120413271596000_15.11.e106937.8","doi-asserted-by":"crossref","first-page":"184","DOI":"10.4103\/0971-4065.111842","article-title":"General practitioners\u2019 knowledge and approach to chronic kidney disease in Karachi, Pakistan","volume":"23","author":"Yaqub","year":"2013","journal-title":"Indian J Nephrol"},{"key":"2025120413271596000_15.11.e106937.9","doi-asserted-by":"crossref","unstructured":"Rehman IU , Khan TM . 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