Exploring Caregiver Burden in Hemodialysis Patients in Pakistan: Variations Across Different Age Groups

Chronic kidney disease is a condition where the body's filters, the kidneys, slowly stop working. When they fail completely, a person needs a treatment called hemodialysis to survive. This process uses a machine to clean the blood, a task that must be repeated regularly for the rest of the patient's life. While the patient undergoes this exhausting treatment, they rely heavily on a family member to drive them, manage their schedule, and provide daily support. This person is the caregiver. In many parts of the world, and particularly in Pakistan, this role falls to relatives rather than paid professionals. The emotional and physical weight of this duty is known as caregiver burden. It is a heavy load that can lead to stress, exhaustion, and sadness. For years, doctors and researchers have known that caring for someone with a serious illness is difficult, but they have not fully understood how the age of the sick person changes the experience for the person helping them.

A team of researchers in Pakistan set out to explore this specific question. They wanted to know if the age of a patient on hemodialysis made a difference in how much strain their family caregiver felt. The study took place between September 2025 and January 2026 across three large hospitals in Peshawar. The researchers spoke with 246 family members who were caring for patients on dialysis. These caregivers were all adults, and they had been helping their relatives for at least three months. To measure the burden, the team used two standard questionnaires. One asked about the stress and challenges of caregiving, while the other checked for signs of depression. The researchers grouped the patients into three age categories: those 25 years or younger, those between 26 and 50, and those older than 50. They then compared the scores of the caregivers in each group to see if a pattern emerged.

The results revealed a surprising trend that challenges common assumptions. Usually, people might expect that caring for an elderly person is the most difficult task, perhaps because older patients are frailer or have more complex medical needs. However, this study found the opposite. Caregivers looking after the youngest patients, those aged 25 or under, reported significantly higher levels of stress and depression than those caring for older adults. On average, the caregivers of the young patients scored higher on the burden scale, indicating a heavier load, and also showed higher scores for depressive symptoms. Specifically, 35.7 percent of all caregivers in the study reported a moderate to severe burden, and 11 percent reported moderate to severe depression. But when the data was broken down by age, the group caring for the youngest patients stood out as the most distressed.

The researchers suggest that this emotional strain comes from the unique nature of caring for a young person. When a child or young adult needs lifelong dialysis, it disrupts the natural expectations of life. A family member might worry about the patient's entire future, their ability to work, or their independence, creating a deep sense of uncertainty. In contrast, caring for an older relative, while still demanding, may feel more like a natural part of the life cycle that families are culturally prepared to handle. The study also noted that most of the caregivers were living in rural areas, many had limited formal education, and they were often providing care for more than 13 hours a day. Despite these challenging conditions, the data clearly showed that the age of the patient was a key factor in the caregiver's mental health.

This finding matters because it highlights that support for families cannot be one-size-fits-all. The study concludes that caregivers of younger patients need specific attention and screening for depression, as they are facing a unique kind of emotional pressure. By recognizing that the age of the patient changes the nature of the burden, doctors and support workers can better target their help. The research does not claim to have solved the problem of caregiver stress, but it provides a clear map of where the pain is greatest. It shows that in the context of kidney failure in Pakistan, the youngest patients place the heaviest emotional weight on the shoulders of their families.