The Impact of Social Determinants on the Well-Being of Patients with Chronic Kidney Disease: A journey within Biology, Society and Existence towards a meaning-making experience

Evangelos C. Fradelos^1*Victoria Alikari²

• ¹Department of Nursing, School of Health Science, University of Thessaly, Larissa, Greece
• ²Department of Nursing, University of West Attica, Athens, Greece

reduce adherence to treatment (Lian & Wang, 2025). Conversely, supportive social networks, cultural acceptance, and spirituality can serve as protective factors, enhancing resilience and meaning in life. CKD, therefore, is not merely a medical condition but also a reflection of social and existential inequalities (Fradelos et al., 2021;Fradelos et al., 2022).Our Research Topic, entitled "The Impact of Social Determinants on the Well-being of Patients with Chronic Kidney Disease," launched in Frontiers, explores the influence of social determinants on the well-being, health, and quality of life of individuals living with CKD. Within this Research Topic, ten articles have been published, which collectively have received more than 24,000 views, 17,000 reads, and 5,645 downloads to date. These articles address a wide range of themes, from the impact of social determinants of health on disease progression (Lalo et al., 2025), to the relationship between environmental exposure, diagnosis, and disease trajectory (Liang & Li, 2025), and mental well-being (Beyrami & Amiri, 2025). This body of research investigates both the direct and indirect effects of social determinants on the well-being of individuals diagnosed with CKD, while also proposing causal mechanisms that link social inequalities and resource availability to disease outcomes. The findings can inform health policy development by supporting the design of evidence-based, patient-and workforce-centered interventions, emphasizing the need to strengthen access to healthcare services, provide psychosocial support, train professionals in existential care and communication, and acknowledge social inequalities as determinants of care (Jindal et al., 2023). In today's technocratic society, where care tends to become cold, distant, and impersonal, the existential dimension of nursing reminds us of the urgent need to redefine the meaning of health and illness within a human-centered and holistic framework. Hemodialysis may prolong life, yet it is meaning that renders life worth living. The care of individuals with Chronic Kidney Disease (CKD) should therefore focus not only on biological survival but also on the process of meaning-making, encompassing both the biological and existential dimensions of health and illness at individual and societal levels (Li et al., 2025).Within this context, technology emerges as an inseparable but ambivalent component of care. Nurses are required to combine technical proficiency with interpersonal and empathic competence, recognizing technology as an integral element of holistic, humanistic care -one that must never overshadow the patient. The hemodialysis setting exemplifies this complexity, as technology and nursing coexist and interact continuously. The patient and the machine become physically connected, yet they must remain distinct entities. As Sandelowski (1999) argues, when a nurse identifies the sound of an alarm with the patient themself, critical questions arise: Is the machine an extension of the patient or of the nurse? Such perceptions may diminish the patient's image as a unique and autonomous person. Thus, nurses must cultivate self-awareness and reflexivity, ensuring that their behaviors and interactions with technology do not depersonalize care but rather enhance it.Evidence suggests that in dialysis units, technical expertise and precision are highly valued, as they are directly linked to measurable outcomes -such as urea clearance, hemoglobin, and phosphorus levels -and confer professional status and authority within the clinical hierarchy. However, excessive emphasis on technical performance risks overshadowing the relational essence of care. The notion of existential care entails an authentic presence and accompaniment -a mode of "being with" the patient, in which their experience is acknowledged without attempts to correct, interpret, or rationalize it (Bright, 2015).Consequently, the role of the nurse is fundamentally expanded: from a technical provider of care to a companion in the patient's search for meaning -a professional who bridges biomedical knowledge with existential understanding. Care thus becomes an act of participation, relationship, and meaning-making, in which technology supports, rather than supplants, human connection. True well-being is not defined by the absence of symptoms or the achievement of clinical targets, but by the presence of meaning, dignity, and social justice. Only then can care in the context of chronic kidney disease be considered genuinely holistic -embracing human existence in all its depth, transcending the boundaries of disease, and guiding the individual toward a path of authenticity, meaning, and solidarity (Davis, 2015).