Psychosocial and quality of life issues in women with end-stage renal disease

Perioperative Considerations Regarding Sex in Solid Organ Transplantation

Sex plays a pivotal role in all stages of the organ transplant process. In the preoperative phase, sex can affect being listed or considered for a transplant, and sex/size matching of organs is necessary for some organ transplants, thereby affecting organ availability. In the postoperative period, sex has a profound impact on complications as well as graft survival. Sex-related differences in organ transplantation are likely multifactorial related to biological and social characteristics. This article provides an overview of the impact of sex on various types of solid organ transplant, including kidney, pancreas, liver, lung, and heart transplants.

The management of women with kidney disease

Chronic Kidney disease (CKD) is more prevalent among women than men in the United States. This review highlights the important yet unique considerations that should be made in the care of women with kidney disease including psychosocial issues, preventive care and family planning. We emphasize the critical work that needs to be performed to prevent kidney disease progression in this population and manage comorbid conditions. Significance statement: The health of women with kidney disease has been understudied. This review offers insights on key areas in the management of women with kidney disease.

Perioperative Considerations Regarding Sex in Solid Organ Transplantation

Sex plays a role in all stages of the organ transplant process, including listing, sex/size matching of organs, complications, graft survival, and mortality. Sex-related differences in organ transplantation are likely multifactorial related to biological and social characteristics. More information is needed to determine how sex-related differences can lead to improved outcomes for future donors and recipients of solid organs. This article provides an overview on the impact of sex on various types of solid organ transplant, including kidney, pancreas, liver, lung, and heart transplants.

The quality of life and associated factors in patients on maintenance hemodialysis - a multicenter study in Shanxi province

Objectives: To assess the quality of life (QOL) and factors affecting QOL in hemodialysis patients so as to improve QOL of dialysis patients and provide the basis for better clinical care.

Methods: A retrospective study was performed to assess the QOL and factors affecting QOL in hemodialysis patients. We recruited 125 patients who had been receiving hemodialysis for at least 2 years in the dialysis units of nine hospitals in Shanxi Province, China, and conducted a multi-center questionnaire survey between 1 May 2015 and 1 July 2016. We investigated the patients’ general condition and clinical data and used the Short Form-36 (SF-36) scale to measure QOL in these patients.

Results: The overall SF-36 score was 107.55 ± 14.50 in patients who had received hemodialysis for more than 2 years. Age (p < .05, F = 4.972) and gender (p < .01, t = 3.993) significantly affected the overall QOL score in these patients. Education level was also an influencing factor (p < .05, Z= −0.838), especially on the mental health of these patients. In addition, residual urine volume (p < .05, Z= −2.465) and diabetic nephropathy (p < .05, Z= −2.062) were important factors that affected the physical strength and QOL score in these patients. However, sources of medical expenses, marital status and different methods of dialysis, had no effect on the QOL score.

Conclusion: The overall score of QOL in patients who have received maintenance hemodialysis for more than 2 years is higher in Shanxi Province than that in other provinces of China. Only a few factors influenced the QOL of these patients.

Sex and gender differences in chronic kidney disease: progression to end-stage renal disease and haemodialysis

Sex and gender differences are of fundamental importance in most diseases, including chronic kidney disease (CKD). Men and women with CKD differ with regard to the underlying pathophysiology of the disease and its complications, present different symptoms and signs, respond differently to therapy and tolerate/cope with the disease differently. Yet an approach using gender in the prevention and treatment of CKD, implementation of clinical practice guidelines and in research has been largely neglected. The present review highlights some sex- and gender-specific evidence in the field of CKD, starting with a critical appraisal of the lack of inclusion of women in randomized clinical trials in nephrology, and thereafter revisits sex/gender differences in kidney pathophysiology, kidney disease progression, outcomes and management of haemodialysis care. In each case we critically consider whether apparent discrepancies are likely to be explained by biological or psycho-socioeconomic factors. In some cases (a few), these findings have resulted in the discovery of disease pathways and/or therapeutic opportunities for improvement. In most cases, they have been reported as merely anecdotal findings. The aim of the present review is to expose some of the stimulating hypotheses arising from these observations as a preamble for stricter approaches using gender for the prevention and treatment of CKD and its complications.

Female sexual function and depression after kidney transplantation: comparison between deceased- and living-donor recipients

Disturbances in sexual function and depression are a common feature in women with chronic renal failure. Living-donor kidney transplantation seems to warrant better results than its cadaveric counterpart in many aspects but its impact on post-transplantation sexual function remains unknown. This study aimed to compare post-transplantation sexual function and depression in women receiving kidney grafts from living and deceased donors. From a single-center prospective database of 2016 renal transplantations between June 2011 and June 2013, we enrolled 50 sexually active women after kidney transplantation. Female sexual function was evaluated with the Female Sexual Function Index Questionnaire (FSFI) and depression was assessed using the Beck Depression Inventory-II (BDI-II) scale. Thirty-four patients referred the questionnaires. The sexual domains of satisfaction and desire were significantly better in living-donor receptors; in all other domains evaluated by FSFI no statistically significant difference was encountered between groups, although living-donor receptors tended to report better function. Total BDI-II was well correlated with total FSFI score in our study cohort (Spearman's rho = -0.80, P < .001). Only 34.6% of women referred to have discussed sexual issues with their physicians before transplantation, whereas 73.1% stated it would have been important. In conclusion, living-donor transplantation exerted a positive effect on women's sexual function.

Gender differences in appraisal of stress and coping 5 years after heart transplantation

OBJECTIVES

We examined whether gender differences exist regarding stress, symptom distress, coping, adherence, and social support 5 years after heart transplantation.

BACKGROUND

Differences exist in health-related quality of life outcomes by gender after heart transplantation; women report poorer outcomes.

METHODS

Patients (n = 210, female = 42), were from a prospective, multi-site, study of health-related quality of life long-term after heart transplantation. Patients completed self-report instruments 5 years after heart transplantation (mean = 4.98 ± 0.17 years after transplant). Statistical analyses included two-sample t-tests, Chi-square or Fisher's exact test, and multivariable modeling.

RESULTS

Women did not report more overall stress or symptom distress, but reported more difficulty adhering to the transplant regimen, yet more actual adherence than men. Women reported using more negative coping styles, but reported more satisfaction with social support.

CONCLUSIONS

Gender differences exist regarding appraisal of stress, coping styles, and coping resources long-term after heart transplantation. These differences may guide tailoring therapy regarding stress, poor coping, and lack of resources.

Family income is associated with quality of life in patients with chronic kidney disease in the pre-dialysis phase: a cross sectional study

BACKGROUND

Chronic kidney disease (CKD) is a condition of high prevalence in the general population mainly due to hypertension and diabetes mellitus. It is often associated with a high prevalence of complications and worse quality of life. The main objective of this study is to evaluate quality of life (QOL) using the generic instrument SF-36 in patients with CKD in pre-dialysis and identify the possible influence of the degree of renal function, hemoglobin level, age, gender, family income and level of education on QOL.

METHODS

A cross-sectional study was conducted and included 170 individuals (83 men) with a mean age of 57 ± 15 years who met the inclusion criteria and answered the SF-36. Laboratory tests and clinical and demographic data were obtained, and the glomerular filtration rate was estimated using the CKD-EPI formula.

RESULTS

The degree of renal function did not influence QOL. Women had lower scores in functional capacity, physical aspects, pain, and mental health. Patients younger than 47 years old showed better QOL in the functional capacity; however, their QOL was worse in terms of social aspects. Subjects with an income higher than 5.1 times the minimum wage had better QOL in the functional capacity, pain, social, physical and emotional roles, and mental health. Hemoglobin levels and education did not globally influence QOL.

CONCLUSION

Gender and age influenced QOL, but family income was the most important factor affecting QOL (6 out of 8 domains investigated by SF-36) in this sample of 170 individuals with CKD in pre-dialysis. These findings suggest that many efforts should be made to reduce the effect of these factors on quality of life in patients with CKD and reinforce the need for longitudinal studies and intervention.

The perception of trauma patients from social support in adjustment to lower-limb amputation: a qualitative study

INTRODUCTION

The effect of amputation on an individual's psychological condition as well as family and social relationships is undeniable because physical disability not just affects the psycho-social adjustment, but also the mental health. When compared to normal people, such people are mostly experiencing social isolation. On the other hand, social support is known as the most powerful force to cope with stressful situations and it allows patients to withstand problems. The present study aims to explain understanding the trauma of patients and the experience of support sources during the process of adaptation to a lower limb amputation.

MATERIALS AND METHODS

The present study was conducted using qualitative content analysis. Participants included 20 patients with lower limb amputation due to trauma. Sampling was purposive initially and continued until data saturation. Unstructured interviews were used as the main method of data collection. Collected data were analyzed using qualitative content analysis and constant comparison methods.

RESULTS

The main theme extracted from the data was support sources. The classes include "supportive family", "gaining friends' support", "gaining morale from peers", and "assurance and satisfaction with the workplace."

CONCLUSION

Given the high number of physical, mental and social problems in trauma patients, identifying and strengthening support sources can be effective in their adaptation with the disease and improvement of the quality of their life.

Interplay of anxiety and depression with quality of life in endstage renal disease

BACKGROUND

Endstage renal disease (ESRD) is increasingly being recognized as a major public health issue globally. Planning of intervention measures is preferably hinged on what is known about outcome parameters.

OBJECTIVES

This study investigated the influence of anxiety with depression and psychosocial- and treatment-related correlates on quality of life (QOL) in ESRD.

METHODOLOGY

Overall, 100 eligible individuals with ESRD were recruited by systematic random sampling technique. They were initially interviewed using the sociodemographic/clinical profile questionnaire, followed by assessment with the Hospital Anxiety and Depression Scale. Subsequently, subjective QOL of participants was assessed using the World Health Organization QOL-BREF.

RESULTS

The mean age of participants was 41.9 ± 10.9 years, and males (55.0%) were preponderant. A total of 29 (29.0%) participants had diagnosable anxiety with depression psychopathology based on Hospital Anxiety and Depression Scale scores ≥ 8. Different degrees of impairment across domains of QOL were observed. Factors like being employed, married status, younger age, and spending less on treatment correlated positively with good QOL across specific domains, whereas comorbid anxiety with depression, history of dialysis, monthly income less than ₦50,000 ($300), and having up to 50 dialysis sessions correlated negatively with good outcome in specific domains of QOL (p < 0.05). However, only age, anxiety/depression, employment, and history of dialysis were independently related to QOL following logistic regression analyses.

CONCLUSION

The care of ESRD should be matched with need-based mental health services, and psychosocial support across important illness trajectories is indicated for best outcome. Further research among people with ESRD is also warranted.

Quality of life in dialysis: A Malaysian perspective

There is a growing interest to use quality of life as one of the dialysis outcome measurement. Based on the Malaysian National Renal Registry data on 15 participating sites, 1569 adult subjects who were alive at December 31, 2012, aged 18 years old and above were screened. Demographic and medical data of 1332 eligible subjects were collected during the administration of the short form of World Health Organization Quality of Life questionnaire (WHOQOL-BREF) in Malay, English, and Chinese language, respectively. The primary objective is to evaluate the quality of life among dialysis patients using WHOQOL-BREF. The secondary objective is to examine significant factors that affect quality of life score. Mean (SD) transformed quality of life scores were 56.2 (15.8), 59.8 (16.8), 58.2 (18.5), 59.5 (14.6), 61.0 (18.5) for (1) physical, (2) psychological, (3) social relations, (4) environment domains, and (5) combined overall quality of life and general health, respectively. Peritoneal dialysis group scored significantly higher than hemodialysis group in the mean combined overall quality of life and general health score (63.0 vs. 60.0, P < 0.001). Independent factors that were associated significantly with quality of life score in different domains include gender, body mass index, religion, education, marital status, occupation, income, mode of dialysis, hemoglobin, diabetes mellitus, coronary heart disease, cerebral vascular accident and leg amputation. Subjects on peritoneal dialysis modality achieved higher combined overall quality of life and general health score than those on hemodialysis. Religion and cerebral vascular accident were significantly associated with all domains and combined overall quality of life and general health.

Women and ESRD: modalities, survival, unique considerations

Women currently constitute 44.3% of prevalent patients on hemodialysis and 47% of those on peritoneal dialysis. Women on dialysis do not experience the survival benefit seen in those not on dialysis. This loss of a survival advantage is partially related to a lower cardiovascular survival benefit along with a higher noncardiovascular mortality rate compared with their male counterparts. Of particular concern is the markedly higher mortality rates seen in women less than 45 years of age on dialysis. There are several female hormonal abnormalities in the female dialysis patient that can result in menstrual irregularities, anovulation, infertility, sexual dysfunction, early menopause, accelerated bone loss, and potentially increased risk of cardiovascular complications. Although fertility is impaired in dialysis, conception occurs in 1% to 7% of women of childbearing years on dialysis. Hence, all women with a potential for pregnancy should be counseled regarding the risks of pregnancy and contraceptive options. There are specific gynecologic considerations unique to peritoneal dialysis, including hemoperitoneum, decreased fertility, and uterine prolapse. Sexual dysfunction is commonly seen in the female dialysis population and is associated with depression and a lower quality of life; however, despite the high prevalence, it is generally not assessed nor is it treated. Depression is also common in the female dialysis population. Like sexual dysfunction, depression is underdiagnosed and undertreated in this population.

Psychiatric consultation after kidney transplantation: a 10-year single-center study including outpatients in Japan

BACKGROUND

The aim of this study was to elucidate the clinical characteristics and frequency of psychiatric consultation in a routine clinical setting after kidney transplantation.

METHODS

Subjects were 1,139 consecutive recipients who received kidney transplantation at our hospital between January 1997 and September 2006. The hospital patient database was searched to determine whether these recipients received psychiatric consultation after their transplantation during this period.

RESULTS

Among 1,139 recipients, 118 (10%) received psychiatric consultation after their transplantation. There were significantly more women among these recipients (p = 0.036). Many of the recipients had received psychiatric consultation before transplantation (p < 0.0001) and had received dialysis for a long time (p = 0.018). There were three main psychiatric diagnoses according to ICD-10 diagnostic criteria in these 118 recipients: 42 (36%) had neurotic, stress-related, and somatoform disorders (F4); 35 (30%) had organic, including symptomatic, mental disorders (F0); and 27 (23%) had mood (affective) disorders (F3). The median length of time between kidney transplantation and initial psychiatric consultation was 57 days (interquartile range: 10-650 days). The lengths were 7 days (6-17 days) for F0, 75 days (18-650 days) for F4, 243 days (35-1,004 days) for F3, and 253 days (10-1,393 days) for other diagnostic groups. Significant differences were observed among these four groups (Jonckheere-Terpstra test, p < 0.001).

CONCLUSION

Our results show that appropriate psychiatric intervention is necessary not only in early stages after kidney transplantation but also over the long term.

Relationship between depression and health-related quality of life in older Korean patients with chronic obstructive pulmonary disease

AIMS AND OBJECTIVES

The aims are to determine the prevalence of depression and examine its impact on the health-related quality of life (HRQoL) among older Korean patients with chronic obstructive pulmonary disease (COPD).

BACKGROUND

Realising the effects of depression on HRQoL, many studies have reported the prevalence of depression and its negative impacts on HRQoL in COPD patients. However, the majority of the studies were performed in developed countries, with very few studies occurring in developing or non-developed countries.

DESIGN

Survey with the comparison of HRQoL between the COPD patients with and without depression.

METHODS

A total of 91 COPD patients completed the St. George respiratory questionnaire (SGRQ), Medical outcomes short form-36 (SF-36) and Beck depression inventory (BDI).

RESULTS

The prevalence of depression was 15.4%. The SGRQ total and impact subscores were significantly worse in the patients with depression (p < 0.05). The physical functioning, bodily pain, vitality and general health dimensions from the SF-36 were statistically poor in the patients with depression (p < 0.05). The patients with severe and very severe lung function defects showed significantly worse total, activity and impact scores of the SGRQ and significantly poor physical functioning, role physical, bodily pain, social functioning, mental health, role emotional and general health scores on the SF-36 (p < 0.05).

CONCLUSION

In South Korea, the prevalence of depression is considerable, and depression has a negative impact on the HRQoL among older COPD patients.

RELEVANCE TO CLINICAL PRACTICE

The study results suggest that depression is prevalent in older COPD patients in South Korea. The presence of depression negatively impacts on the HRQoL of the COPD patients. Considering the importance of the relationship between psychological problems and HRQoL in caring for and promoting the welfare of COPD patients, this study provides fundamental information and a basis for further evaluation of this issue in developing and non-developed countries.