Psychosocial Dimensions in Hemodialysis Patients on Kidney Transplant Waiting List: Preliminary Data

Abstract

Although the donation rate for deceased and living kidneys has been increasing, the donor organ availability meets only the 30% of kidney needs in Italy. Consequently, hemodialysis patients stay for a long time, an average of 3.2 years, on a waiting list for a kidney transplant with consequent relevant psychological distress or even full-fledged psychiatric disorders, as diagnosed with traditional psychiatric nosological systems. Recent studies report, however, a higher prevalence of other psychosocial syndromes, as diagnosed by using the Diagnostic Criteria for Psychosomatic Research (DCPR) in medically ill and kidney transplant patients. Nevertheless, no data regarding DCPR prevalence are available in patients waitlisted for a renal transplant (WKTs). Thus, the primary aim of this study was to identify sub-threshold or undetected syndromes by using the DCPR and, secondly, to analyze its relationship with physical and psychological symptoms and daily-life problems in WKTs. A total of 30 consecutive WKTs were assessed using the DCPR Interview and the MINI International Neuropsychiatric Interview 6.0. The Edmonton Symptom Assessment System (ESAS) and the Canadian Problem Checklist were used to assess physical and psychological distress symptoms and daily-life problems. A total of 60% of patients met the criteria for at least one DCPR diagnosis; of them, 20% received one DCPR diagnosis (DCPR = 1), and 40% more than one (DCPR > 1), especially the irritability cluster (46.7%), Abnormal Illness Behavior (AIB) cluster (23.3%) and somatization cluster (23.3%). Fifteen patients met the criteria for an ICD diagnosis. Among patients without an ICD-10 diagnosis, 77.8% had at least one DCPR syndrome (p < 0.05). Higher scores on ESAS symptoms (i.e., tiredness, nausea, depression, anxiety, feeling of a lack of well-being and distress), ESAS-Physical, ESAS-Psychological, and ESAS-Total were found among DCPR cases than DCPR non-cases. In conclusion, a high prevalence of DCPR diagnoses was found in WKTs, including those who resulted to be ICD-10 non-cases. The joint use of DCPR and other screening tools (e.g., ESAS) should be evaluated in future research as part of a correct psychosocial assessment of WKTs.

Impacts of Interaction of Mental Condition and Quality of Life between Donors and Recipients at Decision-Making of Preemptive and Post-Dialysis Living-Donor Kidney Transplantation

“…These findings are consistent with those of other studies, which frequently reported on the association between psychological disturbances and various other physical diseases among patients [10,34,51]. Therefore, the tendencies shown in this study are understandable, as patients with ESRD are often worried about the unknown factors of their condition, based on a fear that they may lose their renal functions and experience other unexpected outcomes [10,34,50,51].…”

“…It is well-known that anxiety plays important roles in the psychological and biological risk factors for the impairment of emotional perception/cognition [50]. The trait anxiety of the recipients enhanced negative mental responses (POMS-TA/POMS-D and POMS-C) in the selection between PDKT, and PEKT, respectively.…”

“…Confusion and anxiety/tension/depression are emotional/cognitive impairments that are unfavourable for independent rational decision-making. A recent clinical study reported a high prevalence of irritability (46.7%); abnormal illness behaviour, including anxiety (23.3%); and somatization (23.3%) among patients waitlisted for cadaveric kidney transplantation using the Diagnostic Criteria for Psychosomatic Research (DCPR) [50]. Notably, among patients with a negative score based on the International Classification of Diseases version 10, 77.8% patients exhibited DCPR syndrome [50].…”

“…A recent clinical study reported a high prevalence of irritability (46.7%); abnormal illness behaviour, including anxiety (23.3%); and somatization (23.3%) among patients waitlisted for cadaveric kidney transplantation using the Diagnostic Criteria for Psychosomatic Research (DCPR) [50]. Notably, among patients with a negative score based on the International Classification of Diseases version 10, 77.8% patients exhibited DCPR syndrome [50]. These findings are consistent with those of other studies, which frequently reported on the association between psychological disturbances and various other physical diseases among patients [10,34,51].…”

Underdiagnosis of Major Depressive Episodes in Hemodialysis Patients: The Need for Screening and Patient Education

“…Awareness of the presence of subclinical depressive disorders among both dialysis patients and their physicians is of great importance. A recently published study [ 46 ] showed a high percentage of hemodialysis patients affected by undetected syndromes such as irritability identified by the Diagnostic Criteria for Psychosomatic Research (DCPR) [ 47 ]. This report is congruent with data from a pilot study, which found that the prevalence of depression among hemodialysis patients was 30%.…”