Psychological review of hemodialysis patients and kidney transplant recipients during the COVID-19 pandemic

Abstract

BACKGROUND

Kidney transplantation (KT) and end-stage renal disease (ESRD) requiring hemodialysis (HD) increase the incidence of morbidity and mortality associated with coronavirus disease 2019 (COVID-19) infection. The COVID-19 pandemic has had a negative effect on the psychological well-being of COVID-19 patients, especially those with a high-risk of infectious complications. The prevalence of anxiety and depression is known to be higher in ESRD patients undergoing HD than in the general population. On the other hand, KT recipients have different treatment requirements compared to HD patients, including adherence to complex immunosuppressive regimens and compliance with follow-up appointments. We hypothesized that psychosocial difficulties and stressors would differ between ESRD patients undergoing HD and KT recipients during the COVID-19 pandemic. If so, each group may require different interventions to maintain their psychosocial well-being.

AIM

To measure and compare the levels of stress, anxiety, depression, concerns related to the pandemic, and coping skills in ESRD patients undergoing HD and KT recipients during the COVID-19 pandemic.

METHODS

This cross-sectional study was performed at a training and research hospital. The study included ESRD patients undergoing HD (HD group) and KT recipients (with stable graft function for ≥ 6 mo prior to the study) (KT group). Patients completed a demographics form, the impact of events scale, the hospital anxiety and depression scale, and the Connor-Davidson resilience scale. Laboratory findings at the last clinical follow-up were recorded. The χ ² test was used to assess the relationship between the HD and KT groups and the categorical variables. The relationships between the scale scores were analyzed using Pearson’s correlation test, and differences between the groups were analyzed using the independent groups t-test.

RESULTS

The study included 125 patients, of which 89 (71.2%) were in the HD group and 36 (28.8%) were in the KT group. The levels of anxiety and depression were higher in the HD group than in the KT group [9.36 ± 4.38 vs 6.89 ± 4.06 ( P = 0.004) and 8.78 ± 4.05 vs 6.42 ± 4.26 ( P = 0.004), respectively], whereas the post-traumatic stress score was higher in the KT group [46.75 ± 13.98 vs 37.66 ± 18.50 ( P = 0.009)]. The concern with the highest intensity in the HD group was transmission of COVID-19 to family and friends (93.3%) and in the KT group was loss of caregiver and social support (77.8%). Concerns regarding financial hardship, stigmatization, loneliness, limited access to health care services, failure to find medical supplies, and transmission of COVID-19 to family and friends were more prevalent in the HD group. Connor-Davidson resilience scale tenacity and personal competence, tolerance, and negative affect scores were higher in the KT group than in the HD group [43.47 ± 11.39 vs 33.72 ± 12.58, 15.58 ± 4.95 vs 11.45 ± 5.05, and 68.75 ± 17.39 vs 55.39 ± 18.65 ( P < 0.001), respectively]. Biochemical parameters, such as creatine, urea, phosphorus, parathyroid hormone, and calcium, were lower, and the albumin and hemoglobin values were higher in the KT group than in the HD group ( P < 0.001).

CONCLUSION

Psychosocial difficulties and the level of stress differ in ESRD patients undergoing HD and KT recipients; therefore, psychosocial interventions should be tailored for each patient group.