Symptom network structure across stigma subgroups in maintenance hemodialysis: a latent profile and network analysis

BACKGROUND: Maintenance hemodialysis (MHD) patients commonly experience stigma during long-term treatment, yet the characteristics of their subgroups and the associated patterns with symptom burden remain unclear. This study aimed to identify latent subgroups of stigma among MHD patients and depict the symptom network structure of each subgroup. METHODS: This cross-sectional study enrolled 558 MHD patients from two hospitals between March and December 2024. Stigma was assessed using the Social Impact Scale (SIS), symptom burden was assessed using the Modified Dialysis Symptom Index (DSI), subgroups of stigma were identified using latent profile analysis, and complex relationships between symptoms were explored using network analysis. Network comparison tests were performed to evaluate between-group differences in network connectivity. RESULTS: The study found that there were three subgroups of MHD patients with stigma: low stigma group (38.5%), moderate stigma group (49.6%), and high stigma group (11.8%). The network analysis showed that muscle pain, sadness, and chest pain were the core symptom nodes in the overall sample. Stable symptom networks were observed in the low and moderate stigma groups, with core symptoms differing by subgroup (physical symptoms in the low stigma group vs. emotional symptom in the moderate stigma group), though no significant difference in global network strength was found between these two groups. CONCLUSIONS: Stigma among MHD patients presents distinct heterogeneous subgroup characteristics, and there are core symptoms with high connection strength in the symptom network. The difficulty in recruiting patients with high stigma reflects the concealment of this population. Future studies should adopt longitudinal designs and expand the sample size of the high stigma subgroup to verify the value of core symptoms in symptom management. CLINICAL TRIAL NUMBER: Not applicable.