The quality of life of hemodialysis and transplant patients

Johnson, John P.; McCauley, Clark; Copley, John B.

doi:10.1038/ki.1982.167

“…The majority of patients (77%) rated 1 or 2 on the 7-point scale for overall life satisfaction. Similar observations were made before in renal (2> [15][16][17] and liver transplant patients (20,21). The favorable scores in these patient groups have been attributed to the feeling of being reborn after transplantation, to the desire to fulfill certain expectations, and to psychological defense mecha nisms against fear for rejection and complications (21).…”

Section: Discussionsupporting

confidence: 61%

The Effect of Immunosuppressive Drugs on Quality of Life After Renal Transplantation

Hilbrands

¹

,

Hoitsma²,

Koene³

1995

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This prospective, randomized study investigates the effect of two immunosuppressive treatment regimens on quality of life after renal transplantation. At 3 months after transplantation, patients treated with cyclosporine (CsA) and prednisone (Pred) were allo cated to either withdrawal of Pred (n=60) or to con version of CsA to azathioprine (Aza) (Aza-Pred, n=60). Quality of life was evaluated just before randomiza tion, and at 6 and 12 months after transplantation using the Sickness Impact Profile (SIP), the Affect Bal ance Scale (ABS), the Center for Epidemiological Stud ies Depression Scale (CES-D), measures of satisfaction with several domains o f life experience, and a popula tion-specific physical symptoms questionnaire. In both groups, the overall SIP score as well as the scores on its physical and psychosocial dimensions improved continuously after transplantation, reaching levels that are comparable to those found in the general population. The occurrence of acute or chronic rejec tion had a significantly negative effect on SIP and CES-D scores. Intention-to-treat analysis showed no differences between groups for scores on SIP, ABS, CES-D, and satisfaction measures. Exclusion of 41 pa tients who did n ot strictly adhere to their originally designated therapy showed a tendency for better psy chosocial SIP scores in CsA patients (P=0.05), which mainly resulted from a difference on the category of social interaction (P-0,01). This difference occurred despite a similar rejection rate and worse renal func tion in CsA-treated patients. Shortly after steroid withdrawal, a high proportion of CsA patients com plained of stiff or painful muscles (CsA: 74%, Aza-Pred: 36%; P = 0.002). Our data indicate that if successfully completed, CsA monotherapy from 3 months after transplantation may lead to a higher degree of psycho social well-being as compared with conversion from CsA-Pred to Aza-Pred. It seems likely that this advan tage is related to the withdrawal of Pred.One of the primary goals of renal transplantation is to improve the quality of life of the patient with end-stage renal disease. Traditional research efforts, however, have mainly been directed at prolonging patient and graft survival. These survival rates have improved considerably during the last decades and any further progress will be hard to achieve. Therefore, it is not surprising that the quality of life of the patients with prolonged survival is receiving a growing amount of attention (i, 2).The type of immunosuppressive drug therapy is one of the factors that determine the quality of life after renal trans plantation. First, an effective immunosuppressive regimen, leading to prolonged patient and graft survival, is a prereq uisite to reach an optimal level of quality of life. Besides, treatment schedules may act more directly on quality of life by means of their adverse effects, which will differ according to the drugs that are used. Patients' psychosocial function ing, which they will partly attribute to prescribed medica tion, will in turn hav...

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“…Previous, cross-sectional studies established a higher quality of life in transplanted patients when compared with patients on hemodialysis or continuous ambulatory peritoneal dialysis (15)(16)(17), while a few prospective studies have reported a rise in health status after successful transplantation (18,19). Our results indicate that the figures obtained in renal graft recipients depend on the time elapsed after transplantation.…”

Section: Discussionsupporting

confidence: 39%

The Effect of Immunosuppressive Drugs on Quality of Life After Renal Transplantation

HILBKANDS

¹

,

Hoitsma

²

,

Koene

³

1995

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This prospective, randomized study investigates the effect of two immunosuppressive treatment regimens on quality of life after renal transplantation. At 3 months after transplantation, patients treated with cyclosporine (CsA) and prednisone (Pred) were allo cated to either withdrawal of Pred (n=60) or to con version of CsA to azathioprine (Aza) (Aza-Pred, n=60). Quality of life was evaluated just before randomiza tion, and at 6 and 12 months after transplantation using the Sickness Impact Profile (SIP), the Affect Bal ance Scale (ABS), the Center for Epidemiological Stud ies Depression Scale (CES-D), measures of satisfaction with several domains o f life experience, and a popula tion-specific physical symptoms questionnaire. In both groups, the overall SIP score as well as the scores on its physical and psychosocial dimensions improved continuously after transplantation, reaching levels that are comparable to those found in the general population. The occurrence of acute or chronic rejec tion had a significantly negative effect on SIP and CES-D scores. Intention-to-treat analysis showed no differences between groups for scores on SIP, ABS, CES-D, and satisfaction measures. Exclusion of 41 pa tients who did n ot strictly adhere to their originally designated therapy showed a tendency for better psy chosocial SIP scores in CsA patients (P=0.05), which mainly resulted from a difference on the category of social interaction (P-0,01). This difference occurred despite a similar rejection rate and worse renal func tion in CsA-treated patients. Shortly after steroid withdrawal, a high proportion of CsA patients com plained of stiff or painful muscles (CsA: 74%, Aza-Pred: 36%; P = 0.002). Our data indicate that if successfully completed, CsA monotherapy from 3 months after transplantation may lead to a higher degree of psycho social well-being as compared with conversion from CsA-Pred to Aza-Pred. It seems likely that this advan tage is related to the withdrawal of Pred.One of the primary goals of renal transplantation is to improve the quality of life of the patient with end-stage renal disease. Traditional research efforts, however, have mainly been directed at prolonging patient and graft survival. These survival rates have improved considerably during the last decades and any further progress will be hard to achieve. Therefore, it is not surprising that the quality of life of the patients with prolonged survival is receiving a growing amount of attention (i, 2).The type of immunosuppressive drug therapy is one of the factors that determine the quality of life after renal trans plantation. First, an effective immunosuppressive regimen, leading to prolonged patient and graft survival, is a prereq uisite to reach an optimal level of quality of life. Besides, treatment schedules may act more directly on quality of life by means of their adverse effects, which will differ according to the drugs that are used. Patients' psychosocial function ing, which they will partly attribute to prescribed medica tion, will in turn hav...

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“…It was evaluated using an 1 l-item checklist developed for the present study (eg, use ofvalid and reliable measurement instruments, use of sampling controls, and examination of and,/or control for case-mix differences). We also included the Science RT vCHD (25) RT vCAPD (10) RT vHHD (7) CAPD vCHD (17) CAPD vHHD (7) CHD vHHD (11) -0.3e+ (1e) -0.88+ (6) -o.il+ (6) -0.05 (12) 0.28+ (6) 0.1e (8) -0.4e+ (14) -0.46+ (7) -0.41+ (6) -0.21+ (10) 0.12 (5) 0.22+ (7) 0.28+ (13) 0.54+ (4) 0.14 (3) 0.16 (8) -0.58 (2) -0.26 (3) 0.27f (e) 0.11 (4) 0.66+ (4) 0.23+ (7) 0.07 (4) -0. RT vCHD (16) RT vCAPD (11) RT vHHD (7) CAPD vCHD (18) CAPD vHHD (7) CHD vHHD (7) -0.73+ (11) -0.8e+ (6) -0.06 (6) -0.03 (13) -0.07 (6) -0.25+ (6) *Treatment comparison (number of studies examining emotional distress or psychological well-being).…”

Section: Independent Variablesmentioning

confidence: 99%

Differences in quality of life across renal replacement therapies: A meta-analytic comparison

Cameron

¹

,

Whiteside

²

,

Katz

³

et al. 2000

American Journal of Kidney Diseases

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o A meta-analysis compared emotional distress and psychological well-being across renal replacement therapies (RRTs) and examined whether differences could be explained by: (1) treatment modalities, (2) case mix, or (3) methodologic rigor, Standard meta-analytic procedures were used to evaluate published comparative studies, Successful renal transplantation was associated with: (1) lower distress (effect size, d = -0.43 SD) and greater welf-being (d = 0.62 SD) than incenter hemodialysis (CHD) and (2)

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The quality of life of hemodialysis and transplant patients

Cited by 192 publications

References 28 publications

The Effect of Immunosuppressive Drugs on Quality of Life After Renal Transplantation

The Effect of Immunosuppressive Drugs on Quality of Life After Renal Transplantation

The Effect of Immunosuppressive Drugs on Quality of Life After Renal Transplantation

Differences in quality of life across renal replacement therapies: A meta-analytic comparison

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