Psychological resilience trajectories and baseline factors associated with trajectory membership among patients newly initiating maintenance hemodialysis: A multicenter longitudinal study

BACKGROUND: Psychological resilience may change substantially during the early transition to maintenance hemodialysis (MHD), but its heterogeneous trajectories remain unclear. This study aimed to identify longitudinal trajectories of psychological resilience and examine baseline factors associated with trajectory membership among patients newly initiating maintenance hemodialysis. METHODS: In this multicenter longitudinal study, 693 patients newly initiating MHD were followed for 6 months across seven assessments. Resilience was measured using the Chinese Connor-Davidson Resilience Scale, and latent growth mixture modeling followed by multinomial logistic regression was used to identify resilience trajectories and examine associated baseline factors. Sensitivity analyses using the R3STEP procedure and a complete-case LGMM were conducted to account for classification uncertainty and potential attrition bias, respectively. RESULTS: Among 693 patients, three resilience trajectories were identified: high-level rapidly decreasing (12.8%), low-stable (35.5%), and high-level stable (51.7%). Compared with the high-level stable trajectory, the high-level rapidly decreasing trajectory was associated with depressive symptoms, anxiety symptoms, sleep disturbance, and higher comorbidity burden, whereas the low-stable trajectory was additionally associated with older age, unmarried status, lower income, more frequent hospitalizations, and lower physical activity. CONCLUSION: Psychological resilience among patients newly initiating MHD showed heterogeneous trajectories during the early dialysis period. The declining and low-stable trajectories were associated with different baseline psychological, clinical, and sociodemographic characteristics. These findings suggest that psychological resilience may change dynamically during early adaptation to dialysis and highlight the importance of early psychosocial assessment, ongoing monitoring, and targeted supportive care.