Sleep disorders, depressive symptoms and health-related quality of life-a cross-sectional comparison between kidney transplant recipients and waitlisted patients on maintenance dialysis

Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary.
Nephrology Dialysis Transplantation (Impact Factor: 3.58). 03/2011; 26(3):1058-65. DOI: 10.1093/ndt/gfq476
Source: PubMed


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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    • "Supporting these findings, Sabbatini et al. (2005) showed that sleep significantly improved from pre- (PSQI mean: 8.52 ± 3.81, P < 0.001) to post-RTx (PSQI mean: 6.46 ± 3.71, P < 0.001), although it remained higher than in control subjects (3.54 ± 1.61, P < 0.0001) [3]. Finally, poor SQ has been linked to pre-RTx impaired health status [14,15], with post-RTx health status improving alongside SQ [13,16]. "
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    ABSTRACT: Poor sleep quality (SQ) and daytime sleepiness (DS) are common in renal transplant (RTx) recipients; however, related data are rare. This study describes the prevalence and frequency of self-reported sleep disturbances in RTx recipients. This cross-sectional study included 249 RTx recipients transplanted at three Swiss transplant centers. All had reported poor SQ and / or DS in a previous study. With the Survey of Sleep (SOS) self-report questionnaire, we screened for sleep and health habits, sleep history, main sleep problems and sleep-related disturbances. To determine a basis for preliminary sleep diagnoses according to the International Classification of Sleep Disorders (ICSD), 164 subjects were interviewed (48 in person, 116 via telephone and 85 refused). Descriptive statistics were used to analyze the data and to determine the frequencies and prevalences of specific sleep disorders. The sample had a mean age of 59.1 +/- 11.6 years (60.2% male); mean time since Tx was 11.1 +/- 7.0 years. The most frequent sleep problem was difficulty staying asleep (49.4%), followed by problems falling asleep (32.1%). The most prevalent sleep disturbance was the need to urinate (62.9%), and 27% reported reduced daytime functionality. Interview data showed that most suffered from the first ICSD category: insomnias. Though often disregarded in RTx recipients, sleep is an essential factor of wellbeing. Our findings show high prevalences and incidences of insomnias, with negative impacts on daytime functionality. This indicates a need for further research on the clinical consequences of sleep disturbances and the benefits of insomnia treatment in RTx recipients.
    Full-text · Article · Oct 2013 · BMC Nephrology
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    • "The resilience of sleep–wake rhythms to disturbance by CRF indicates that the circadian pacemaker is not impaired by uremic toxins. Our results suggest therefore that the deleterious effect of conventional HD on sleep quality in patients is a sideeffect of the treatment and not a consequence of the disease itself (Mucsi et al. 2004; Parker et al. 2005; Koch et al. 2009; Kovacs et al. 2011). This view is consistent with recent studies showing that nocturnal methods such as automated peritoneal dialysis and nocturnal HD lead to the restoration of the nocturnal melatonin peak, correlating with improved sleep quality (Koch et al. 2009). "
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    ABSTRACT: Circadian rhythms regulate blood pressure, hormonal release, and sleeping patterns. Chronic renal failure (CRF) is associated with a loss of nocturnal blood pressure decrease, and dialyzed patients experience sleep disturbances. We induced CRF in mice (thermocauterization-nephrectomy) and compared their rest-activity rhythm with sham-operated animals over a 12‐week period. Mice were housed individually in constant darkness. An infrared motion sensor continuously recorded their behavioral activity. Actograms were generated and subsequent periodogram analysis quantified the free-running period (FRP) and the strength of the circadian rhythm. Chronic renal failure mice compared to sham had high levels of serum urea, anemia, and a slight increase in the rhythm strength. However, the FRP was comparable in both groups. Twelve weeks of CRF do not decrease the strength or alter the period of the endogenous circadian rest-activity rhythm in mice. Our results suggest that uremic toxins do not impair the central circadian pacemaker.
    Full-text · Article · Oct 2013 · Biological Rhythm Research
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    • "While its causes are undefined, it is managed as a syndrome (given some accepted " operational " diagnostic criteria; Wessely, 2001) and sufferers are offered multidisciplinary care. Patients on maintenance HD therapy share many similarities to those suffering by CFS since they experience generalized weakness (Johansen et al., 2003), exercise in tolerance (Koufaki et al., 2002), and disturbed sleep (Sakkas et al., 2008a) all leading to a sense of generalized fatigue and " lack of energy " (McCann and Boore, 2000; Kovacs et al., 2011). This chronic state of " HD Fatigue " among HD patients satisfies one major requirement for the diagnosis of CFS which is persistent fatigue present at least during 50% of the time over a period of at least 6 months (Jason et al., 2003). "

    Full-text · Article · Jul 2012 · Frontiers in Physiology
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