Sleep disorders, depressive symptoms and health-related quality of life-a cross-sectional comparison between kidney transplant recipients and waitlisted patients on maintenance dialysis
ABSTRACT Kidney transplantation is believed to improve health-related quality of life (HRQoL) of patients requiring renal replacement therapy (RRT). Recent studies suggested that the observed difference in HRQoL between kidney transplant recipients (Tx) vs patients treated with dialysis may reflect differences in patient characteristics. We tested if Tx patients have better HRQoL compared to waitlisted (WL) patients treated with dialysis after extensive adjustment for covariables.
Eight hundred and eighty-eight prevalent Tx patients followed at a single outpatient transplant clinic and 187 WL patients treated with maintenance dialysis in nine dialysis centres were enrolled in this observational cross-sectional study. Data about socio-demographic and clinical parameters, self-reported depressive symptoms and the most frequent sleep disorders assessed by self-reported questionnaires were collected at enrollment. HRQoL was assessed by the Kidney Disease Quality of Life Questionnaire.
Patient characteristics were similar in the Tx vs WL groups: the proportion of males (58 vs 60%), mean ± SD age (49 ± 13 vs 49 ± 12) and proportion of diabetics (17 vs 18%), respectively, were all similar. Tx patients had significantly better HRQoL scores compared to the WL group both in generic (Physical function, General health perceptions, Energy/fatigue, Emotional well-being) and in kidney disease-specific domains (Symptoms/problems, Effect- and Burden of kidney disease and Sleep). In multivariate regression models adjusting for clinical and socio-demographic characteristics, sleep disorders and depressive symptoms, the modality of RRT (WL vs Tx) remained independently associated with three (General health perceptions, Effect- and Burden of kidney disease) out of the eight HRQoL dimensions analysed.
Kidney Tx recipients have significantly better HRQoL compared to WL dialysis patients in some, but not all, dimensions of quality of life after accounting for differences in patient characteristics. Utilizing multidimensional disease-specific questionnaires will allow better understanding of treatment, disease and patient-related factors potentially affecting quality of life in patients with chronic medical conditions.
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ABSTRACT: Context-For adults with end-stage kidney disease, live donor kidney transplant (LDKT) has better outcomes than long-term dialysis and deceased donor kidney transplant. However, black patients receive LDKT at a much lower rate than adults of any other race or ethnicity.Objective-To examine the LDKT readiness stage of black patients on the transplant waiting list and its association with LDKT knowledge, concerns, and willingness.Design-Cross-sectional analysis of baseline data from a randomized controlled trial to improve knowledge and reduce concerns about LDKT.Patients and Setting-One hundred fifty-two black patients on the kidney transplant waiting list at a single transplant center in the northeastern United States.Main Outcome Measures-LDKT readiness stage, knowledge, concerns, and willingness to talk to others about living donation.Results-Sixty percent of patients were not considering or not yet ready to pursue LDKT, and only 11% had taken action to talk to family members or friends about the possibility of living kidney donation. Patients in later stages of LDKT readiness (ie, who had talked to others about donation or were preparing to do so) had significantly more knowledge (P<.001), fewer concerns (P=.002), and more willingness (P=.001) to talk to others about living donation than those in earlier readiness stages.Conclusions-The large percentage of black patients who are in the earlier stages of LDKT readiness may account for the low rate of LDKT in this patient population at our transplant center. Innovative and tailored LDKT educational strategies for black patients are needed to help reduce racial disparities in LDKT.Progress in transplantation (Aliso Viejo, Calif.) 12/2014; 24(4):355-61. DOI:10.7182/pit2014337 · 0.69 Impact Factor
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ABSTRACT: Universidade Federal do Rio Grande do Norte, Natal, RN, Brasil. Resumo Objetivo: Identificar as mudanças na qualidade de vida após a efetivação do transplante renal e verificar a influência dos fatores sociodemográficos na percepção da qualidade de vida. Métodos: Trata-se de estudo descritivo com desenho longitudinal. Os dados foram coletados em local privado utilizando a versão abreviada do instrumento World Health Organization Quality of Life (WHOQOL-bref), adaptado e validado para língua Portuguesa por meio do Grupo WHOQOL. Resultados: Observou-se neste estudo o predomínio de pacientes adultos jovens com idade até 35 anos (50,8%) e idade média de 38,9 anos (DP=12,9). Os fatores sociodemográficos não influenciaram a percepção de qualidade de vida dos pacientes. A qualidade de vida melhorou significativamente em todos os domínios. As maiores mudanças foram observadas na qualidade de vida geral, domínio físico e domínio relações sociais. O domínio que demonstrou a menor variação após o transplante foi o domínio meio ambiente. Conclusão: Este estudo avaliou o impacto da efetivação do transplante renal na qualidade de vida de pacientes com doença renal crônica. Os resultados indicaram que o transplante teve impacto positivo na percepção de qualidade de vida desses pacientes. Abstract Objective: To identify changes on quality of life after the effectiveness of kidney transplantation and verify the influence of sociodemographic factors on quality of life. Methods: This is a descriptive study with study with longitudinal design. Data were collected in a private place, using the World Health Organization Quality of Life (WHOQOL-bref) validated and culturally adapted to Brazilian Portuguese by WHOQOL-Group. Results: Aged up to 35 years (50.8%), mean age 38.9 years (SD=12.9), married (60.3%), with children (51.8%). The sociodemographic factors did not influence these patients' perception of quality of life. The QoL improved significantly in all domains. The greatest change was observed in the general QoL, Physical Domain and Social Relationship Domain. The domain that showed less variation after transplantation was the Environment Domain. Conclusion: This study examined the impact of the effectiveness of kidney transplantation on quality of life quality of life of chronic disease patients. The results indicated that transplantation had a positive impact and changed the perception of these patients.Acta Paulista de Enfermagem 01/2014; 27(3):287. · 0.27 Impact Factor
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ABSTRACT: Patients undergoing renal transplantation consume immunosuppressive drugs to prevent graft rejection. Cardiovascular complications and reduced quality of sleep are among the side effects of these drugs. Studies have indicated that the use of non-therapeutic methods such as exercise is important to reduce these complications. To evaluate the effect of a period of exercise training, as a non-therapeutic method, on quality and quantity of sleep and lipid profile in renal transplant patients. 44 renal transplant recipients were selected to participate in the study and randomized into exercise (n=29) and control (n=15) groups. The exercise group participated in a cumulative exercise program 3 days a week for 10 weeks in 60-90-minute exercise sessions. Control group subjects did not participate in any regular exercise activity during this period. Sleep quality of the subjects was evaluated using Pittsburgh Sleep Quality Index (PSQI) questionnaire; the sleep quantity was assessed by recording the duration of convenient nocturnal sleep of the subjects. Physiological sleep-related variables (serum triglyceride [TG], and total, high-density lipoprotein [HDL], and low-density lipoprotein [LDL] cholesterol) were measured before and after 10 weeks of exercise training RESULTS: In exercise training group, sleep quality of the subjects was improved by 27%; the sleep quantity was increased by 30 minutes (p<0.05). TG, cholesterol and LDL values were significantly (p<0.05) decreased after 10 weeks of exercise training in the exercise group compared to the control group, however, no change was observed in serum HDL level in exercise group compared to the control. There was also a significant (p=0.05) difference in sleep quality and quantity between control and exercise groups. However, there was no correlation between changing quality and quantity of sleep with sleep-related physiological factors. 10 weeks of exercise activity improved the quality and quantity of sleep as well as a number of sleep-related physiological parameters in renal transplant recipients, and would be an effective approach to treat sleep-related disorders in renal transplant recipients.