Adherence, depression and quality of life in patients on a renal transplantation waiting list

Abstract

Summary To study nonadherence, and its relationship with depression and quality of life (QOL) in patients on a cadaveric renal transplantation waiting list (RTWL). In 86 RTWL patients (56 men/30 women), there were 49 nonadherent patients (age, 46.8 ± 21.8 years) and 37 adherent patients (age, 42.8 ± 12.1 years). Clinical nonadherence was defined as skipping or shortening dialysis sessions, interdialytic weight gain (IDWG) of >5.7% body weight, a predialysis potassium level of >6 mEq/l and a predialysis phosphate level of >7.5 mg/dl. For each study subject, marital status, level of education duration of dialysis, prior renal transplantation, IDWG, predialysis blood urea nitrogen (BUN) value and creatinine, potassium, phosphate levels were recorded as were scores from the short form‐36 and Beck depression inventory (BDI). A high IDWG (33.7% of the subjects) was the most common nonadherence pattern noted. Age, sex, marital status, duration of dialysis, prior transplantation, comorbid conditions the predialysis BUN values, the levels of creatinine, potassium, and phosphate were not significantly different between the two groups (P > 0.05). The level of education was higher in adherent group (P = 0.018). QOL and BDI scores were negatively correlated (P = 0.001, r = −0.561). Nonadherent patients had lower QOL (P = 0.04) and higher depression scores (P = 0.01) than did adherent patients. Of the depressed patients, 77.8% had a comorbid condition. Nonadherence was only associated with BDI scores (OR, 2.146; CI, 2.052–2.350; P = 0.002). In dialysis patients, close monitoring of adherence, early diagnosis of depression, and the treatment of disease may further enhance QOL during the waiting period for a cadaveric renal transplant.

Waiting for a kidney from a deceased donor: an interpretative phenomenological analysis

“…In addition to this, quantitative research has shown that those on the waiting list for a kidney from a deceased donor are more prone to depression and anxiety than those due to receive from a living donor (Akman et al, 2007). As such, these findings 4 strengthen the argument that this group is worthy of further exploration.…”

Depressive Symptoms in Dialysis: Prevalence and Relationship with Uremia-Related Biochemical Parameters

“…A recent quantitative review reported that depressed patients with a chronic illness are about threefold noncompliant to medical treatment than non-depressed patients [27]. Similarly, depressive disorder in dialysis was associated with double risk of no compliance to calcium-phosphorus dietary prescriptions [26]. According to this, the patient's perception of adherence to dietary restriction can be undermined by decreased cognitive functions, reduced concentration abilities, no care about prescribed therapies and negative thoughts about self [28][29].…”

“…This finding may be possibly related to patient's poor compliance to therapy induced by depressive feelings. In fact, depression could be responsible for non-adherence with treatment through behavioural pathways [26]. A recent quantitative review reported that depressed patients with a chronic illness are about threefold noncompliant to medical treatment than non-depressed patients [27].…”

Comparison of quality of life between hemodialysis patients waiting and not waiting for kidney transplant from a poor region of Brazil

“…Studies of HD patients generally focus on those awaiting for it. [8][9][10][11][12][13][14][15] . The medical reasons for not being eligible to transplant mainly involve critical organ function (advanced heart failure, liver cirrhosis, obstructive pulmonary disease, visceral malignancies, and coronariopathy).…”