Loneliness and its influencing factors in patients on maintenance hemodialysis comorbid with anemia：an analysis based on machine learning

Zhou Zumu; Li Fanghe; Ye Shushi; Zhou Yiwei

doi:10.13406/j.cnki.cyxb.004050

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Loneliness and its influencing factors in patients on maintenance hemodialysis comorbid with anemia：an analysis based on machine learning

Frontiers in brain science and neuropsychiatric disorders | 更新时间：2026-04-15

- Loneliness and its influencing factors in patients on maintenance hemodialysis comorbid with anemia：an analysis based on machine learning
- Journal of Chongqing Medical University Vol. 51, Issue 4, Pages: 459-466(2026)
- 作者机构：
  
  1.温州医科大学附属康宁医院临床研究中心/浙江省精神心理疾病临床医学研究中心，温州 325007
  2.温州医科大学附属第一医院神经内科，温州 325000
  3.温州医科大学附属第一医院产科，温州 325000
  4.上海理工大学管理学院，上海 200093
- 作者简介：
- 基金信息：
- DOI：10.13406/j.cnki.cyxb.004050
  CLC： R395
- Received：15 October 2025，
  
  Revised：2025-12-15，
  
  Accepted：05 January 2026，
  
  Published：28 April 2026
- 稿件说明：
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周祖木，李芳河，叶淑施，等.基于机器学习的维持性血液透析并发贫血患者的孤独感及影响因素研究[J].重庆医科大学学报，2026，51（4）：459-466.

Zhou Zumu,Li Fanghe,Ye Shushi,et al.Loneliness and its influencing factors in patients on maintenance hemodialysis comorbid with anemia：an analysis based on machine learning[J].Journal of Chongqing Medical University,2026,51(4):459-466.
周祖木，李芳河，叶淑施，等.基于机器学习的维持性血液透析并发贫血患者的孤独感及影响因素研究[J].重庆医科大学学报，2026，51（4）：459-466. DOI： 10.13406/j.cnki.cyxb.004050.

Zhou Zumu,Li Fanghe,Ye Shushi,et al.Loneliness and its influencing factors in patients on maintenance hemodialysis comorbid with anemia：an analysis based on machine learning[J].Journal of Chongqing Medical University,2026,51(4):459-466. DOI： 10.13406/j.cnki.cyxb.004050.

摘要

目的

探讨维持性血液透析（maintenance hemodialysis，MHD）并发贫血患者孤独感的发生情况，分析其影响因素，并通过机器学习［卡方自动交互检测（Chi-squared automatic interaction detector，CHAID）决策树分析］与logistic回归模型相结合的方法，识别关键预测变量，为临床干预提供依据。

方法

本研究为多中心横断面调查，纳入2024年上半年在5家医院接受MHD治疗且并发贫血的患者共389例。采用加州大学洛杉矶分校（University of California，Los Angeles，UCLA）孤独量表评估孤独感，使用Connor-Davidson心理弹性量表（Connor-Davidson resilience scale，CD-RISC）评估心理弹性水平。收集患者的人口学特征、疾病相关资料及实验室指标。采用SPSS 26.0进行统计分析，运用单因素分析筛选变量，进一步采用二元logistic回归和CHAID决策树分析孤独感的影响因素。

结果

389例患者中，272例（69.9%）存在孤独感。logistic回归分析表明，职业（与工人相比，农民

=5.862，95%CI=2.033~16.900；离退休者

=37.085，95%CI=2.135~64.037；无职业者

=29.482，95%CI=7.704~112.830）、婚姻（

=10.474，95%CI=1.322~8.983）、参保类型（

=0.090，95%CI=0.023~0.356）、乙型肝炎（

=9.880，95%CI=2.612~37.372）、失眠（

=3.416，95%CI=1.508~7.736）、糖尿病（

=49.741，95%CI=1.943~273.427）、心理弹性（

=0.016，95%CI=0.003~0.097）为MHD并发贫血患者出现孤独感的影响因素（均

0.05）。CHAID决策树分析显示，参保类型是MHD并发贫血患者出现孤独感的最重要影响因素，其中医保患者孤独感发生率（51.6%）明显低于农保/社保患者（93.0%）。进一步分析发现，在医保患者中，工人和非工人的孤独感发生率分别为19.2%和69.8%，工人的孤独感发生率低于非工人（

=51.13，

0.001）。而在拥有医保并且是非工人的患者中，有失眠和无失眠的孤独感发生率分别为87.0%和58.8%（

=12.47，

0.001）。

结论

MHD并发贫血患者的孤独感发生率较高，且与社会人口学（如职业、婚姻、参保类型）、慢性疾病（如乙型肝炎、糖尿病、失眠）和心理因素（如心理弹性）等密切相关。建议临床针对该人群的高危特征（如农保/社保、非工人、伴失眠）开展分层心理干预。

Abstract

Objective

To investigate the prevalence of loneliness and its influencing factors in patients on maintenance hemodialysis （MHD） comorbid with anemia，to identify key predictive variables by integrating machine learning（Chi-squared Automatic Interaction Detector［CHAID］ decision tree） with the logistic regression model，and to provide a basis for clinical intervention.

Methods

A multicenter cross-sectional study was conducted among 389 patients comorbid with anemia who underwent MHD in five hospitals during the first half of 2024. The UCLA Loneliness Scale was used to assess loneliness，and the Connor-Davidson Resilience Scale（CD-RISC） was used to assess psychological resilience. The data on demographic features，disease profiles，and laboratory markers were collected. SPSS 26.0 was used to perform statistical analyses，a univariate analysis was used for variable screening，and then binary logistic regression analysis and CHAID decision tree analysis were used to investigate the influencing factors for loneliness.

Results

Among the 389 patients，272（69.9%） experienced loneliness. The logistic regression analysis showed that occupation（compared to workers，farmer

=5.862，95%CI=2.033-16.900；retirees

=37.085，95%CI=2.135–64.037，

0.05，and the unemployed

=29.482，95%CI=7.704–112.830，

0.05），marital status（

=10.474，95%CI=1.322-8.983，

0.05），type of health insurance，hepatitis B（

=9.880，95%CI=2.612-37.372，

0.05），insomnia（

=3.416，95%CI=1.508-7.736，

0.05），diabetes（

=49.741，95%CI=1.943-273.427，

0.05），and psychological resilience（

=0.016，95%CI=0.003-0.097，

0.05） were influencing factors for loneliness in MHD patients comorbid with anemia. The CHAID decision tree analysis showed that type of health insurance was the most important influencing factor for loneliness，and the patients with urban employee basic medical insurance had a significantly lower incidence rate of loneliness than those covered by rural resident medical insurance or social medical insurance（51.6% vs. 93.0%）. Fur

ther analysis showed that for the patients with urban employee basic medical insurance，the incidence rate of loneliness was 19.2% in workers and 69.8% in non-workers（

=51.13，

0.001），while for the non-workers with urban employee basic medical insurance，the incidence rate of loneliness was 87.0% in those with insomnia and 58.8% in those without insomnia（

=12.47，

0.001）.

Conclusion

There is a relatively high incidence rate of loneliness among MHD patients comorbid with anemia，which is closely associated with social demography （such as occupation，marital status，and type of health insurance），chronic diseases （such as hepatitis B，diabetes，and insomnia），and psychological factors（including psychological resilience）. It is recommended to implement stratified psychological interventions targeting the high-risk features（such as rural resident medical insurance/social medical insurance，non-workers，and comorbidity with insomnia） in such population.

关键词

Keywords

references

Zhao QY ， Zhu YY ， Jiang JY ， et al . Emotional changes of patients undergoing maintenance hemodialysis during the COVID-19 lockdown [J ] . Ann Med ， 2025 ， 57 （ 1 ）： 2527359 .

Wang GN ， Dong J ， Zhu N ， et al . Development and validation of a social alienation predictive model for older maintenance hemodialysis patients based on latent profile analysis：a cross-sectional study [J ] . BMC Geriatr ， 2024 ， 24 （ 1 ）： 495 .

Endrias EE ， Geta T ， Israel E ， et al . Prevalence and determinants of Anemia in chronic kidney disease patients in Ethiopia：a systematic review and meta-analysis [J ] . Front Med ， 2025 ， 12 ： 1529280 .

中国病理生理学会肾脏病专业委员会糖尿病肾脏疾病贫血共识专家组 . 糖尿病肾脏疾病肾性贫血认识与管理中国专家共识（2023年版） [J ] . 中华肾脏病杂志， 2023 ， 39 （ 3 ）： 229 - 244 .

Consensus Expert Group on Anemia in Diabetic Kidney Disease，Chinese Association of Pathophysiology，Society of Nephrology . Understanding and management of renal Anemia in diabetic nephropathy China expert consensus（2023 edition） [J ] . Chin J Nephrol ， 2023 ， 39 （ 3 ）： 229 - 244 .

Spithoven AWM ， Bijttebier P ， Goossens L . It is all in their mind：A review on information processing bias in lonely individuals [J ] . Clin Psychol Rev ， 2017 ， 58 ： 97 - 114 .

刘　玺，刘石柱，陈　羲 . 老年慢性病人群的孤独感现状及影响因素研究 [J ] . 南京医科大学学报（社会科学版）， 2022 ， 22 （ 6 ）： 558 - 564 .

Liu X ， Liu SZ ， Chen X . Status quo of loneliness among elderly people with chronic diseases and its influencing factors [J ] . J Nanjing Med Univ Soc Sci ， 2022 ， 22 （ 6 ）： 558 - 564 .

刘忆冰，张庆庆，赵　阳，等 . 维持性血液透析患者孤独感状况及影响因素分析 [J ] . 护理学杂志， 2022 ， 37 （ 18 ）： 94 - 97 .

Liu YB ， Zhang QQ ， Zhao Y ， et al . Loneliness status and its influencing factors among maintenance hemodialysis patients [J ] . J Nurs Sci ， 2022 ， 37 （ 18 ）： 94 - 97 .

张晓英，邓胜兰，卢伟，维持性血液透析患者孤独感与其社会支持的相关性分析 [J ] . 中国实用护理杂志， 2013 ， 29 （ 34 ）： 44 - 46 .

Zhang XY ， Deng SL ， Lu W . Correlation between loneliness and social support in maintenance hemodialysis patients [J ] . Chin J Pract Nurs . 2013 ， 29 （ 34 ）： 44 - 46 .

Zhou YW ， Zhang ZJ ， Xiang FL ， et al . Assessing psychological resilience and its influencing factors in the MSM population by machine learning [J ] . Sci Rep ， 2025 ， 15 ： 24022 .

Zhou YW ， Zhang ZJ ， Li Q ， et al . Construction and validation of machine learning algorithm for predicting depression among home-quarantined individuals during the large-scale COVID-19 outbreak：based on Adaboost model [J ] . BMC Psychol ， 2024 ， 12 （ 1 ）： 230 .

World Health Organization . WHO Guideline on Haemoglobin Cut-offs to Define Anaemia in Individuals and Populations [M ] . Geneva，Switzerland ： World Health Organization ， 2024 .

失眠定义、诊断及药物治疗共识专家组 . 失眠定义、诊断及药物治疗专家共识（草案） [J ] . 中华神经科杂志， 2006 ， 39 （ 2 ）： 141 - 143 .

Expert Consensus Panel on the Definition，Diagnosis，and Pharmacotherapy of Insomnia . Expert consensus on definition，diagnosis and drug treatment of insomnia（draft） [J ] . Chin J Neurol ， 2006 ， 39 （ 2 ）： 141 - 143 .

Tomida K ， Shimoda T ， Nakajima C ， et al . Validation of the optimal university of California los angeles loneliness scale cutoff score in screening for the prevention of disability occurrence among older Japanese adults [J ] . Int J Geriat Psychiatry ， 2024 ， 39 （ 9 ）： e6137 .

Chiu JL ， Wei LC . Loneliness as a predictor of disability in older adults：implications of the UCLA Loneliness scale cutoff score across cultural contexts [J ] . Int J Geriat Psychiatry ， 2024 ， 39 （ 11 ）： e70011 .

尹艳茹，梁发存，刘梦如，等 . 维持性血液透析患者社会隔离与孤独感、抑郁的关系研究 [J ] . 军事护理， 2023 ， 40 （ 3 ）： 79 - 82 .

Yin YR ， Liang FC ， Liu MR ， et al . Relationships among social isolation，loneliness and depression in maintenance hemodialysis patients [J ] . Mil Nurs ， 2023 ， 40 （ 3 ）： 79 - 82 .

Russell DW . UCLA Loneliness scale（version 3）：reliability，validity，and factor structure [J ] . J Pers Assess ， 1996 ， 66 （ 1 ）： 20 - 40 .

罗　静，张颖君，陈　林 . 中青年维持性血液透析患者心理弹性与领悟社会支持及生活质量的相关性研究 [J ] . 中国血液净化， 2020 ， 19 （ 5 ）： 350 - 352 .

Luo J ， Zhang YJ ， Chen L . Study on the correlation between resilience，perceived social support and quality of life in young and middle-aged maintenance hemodialysis patients [J ] . Chin J Blood Purif ， 2020 ， 19 （ 5 ）： 350 - 352 .

邱　瑛，李雪芹 . 心理弹性、社会支持对维持性血液透析诱导期病人恐惧疾病进展的影响 [J ] . 蚌埠医学院学报， 2023 ， 48 （ 12 ）： 1755 - 1758，1765 .

Qiu Y ， Li XQ . Effects of psychological elasticity and social support on the fear of progression in patients during induction period of maintenance hemodialysis [J ] . J Bengbu Med Coll ， 2023 ， 48 （ 12 ）： 1755 - 1758，1765 .

汪志芳，赵茜芸，汪春燕 . 维持性血液透析患者透析孤独感现状及相关因素研究 [J ] . 皖南医学院学报， 2025 ， 44 （ 1 ）： 59 - 62 .

Wang ZF ， Zhao QY ， Wang CY . Loneliness status and related factors of patients undergoing maintenance hemodialysis [J ] . J Wannan Med Coll ， 2025 ， 44 （ 1 ）： 59 - 62 .

王孟孟，温　鑫，石华歌，等 . 维持性血液透析病人就业状况的研究进展 [J ] . 护理研究， 2020 ， 34 （ 23 ）： 4182 - 4185 .

Wang MM ， Wen X ， Shi HG ， et al . Research progress on employment situation of maintenance hemodialysis patients [J ] . Chin Nurs Res ， 2020 ， 34 （ 23 ）： 4182 - 4185 .

Jakobsen IS ， Madsen LMR ， Mau M ， et al . The relationship between resilience and loneliness elucidated by a Danish version of the resilience scale for adults [J ] . BMC Psychol ， 2020 ， 8 （ 1 ）： 131 .

Balki E ， Hayes N ， Holland C . Loneliness and older adults：psychological resilience and technology use during the COVID-19 pandemic：a cross sectional study [J ] . Front Aging ， 2023 ， 4 ： 1184386 .

Adjei CA ， Stutterheim SE ， Naab F ， et al . Chronic Hepatitis B stigma in Ghana：a qualitative study with patients and providers [J ] . BMJ Open ， 2019 ， 9 （ 6 ）： e025503 .

Barqawi HJ ， Samara KA ， Al Ansari MM ， et al . Hepatitis B knowledge and stigma in the united Arab emirates [J ] . Sci Rep ， 2025 ， 15 ： 10412 .

Adekanle O ， Komolafe AO ， Ijarotimi O ， et al . Gender disparity and stigma experience of patients with chronic hepatitis B virus infection：A prospective cross-sectional study from a hospital in Nigeria [J ] . J Infect Prev ， 2022 ， 23 （ 6 ）： 263 - 268 .

Behera MK ， Nath P ， Behera SK ， et al . Unemployment and illiteracy are predictors of hepatitis B virus-related stigma and discrimination [J ] . J Clin Exp Hepatol ， 2022 ， 12 （ 3 ）： 767 - 773 .

Griffin SC ， Williams AB ， Ravyts SG ， et al . Loneliness and sleep：A systematic review and meta-analysis [J ] . Health Psychol Open ， 2020 ， 7 ： 2055102920913235 .

Song YJ ， Zhu C ， Shi BQ ， et al . Social isolation，loneliness，and incident type 2 diabetes mellitus：results from two large prospective cohorts in Europe and East Asia and Mendelian randomization [J ] . eClinicalMedicine ， 2023 ， 64 ： 102236 .

Rosenkilde S ， Hoffmann SH ， Thorsted AB ， et al . Loneliness and the risk of type 2 diabetes [J ] . BMJ Open Diab Res Care ， 2024 ， 12 （ 2 ）： e003934 .

Wang WW ， Lin FF ， Zhang C ， et al . Could loneliness accelerate the progression of diabetes among adults with prediabetes：national longitudinal cohort [J ] . BMC Public Health ， 2025 ， 25 （ 1 ）： 2441 .

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