Health-related quality of life of predialysis patients with chronic renal failure.

BACKGROUND: Health-related quality of life (HQOL) of predialysis patients with chronic renal failure (CRF) has received less attention than that of dialysis patients. We investigated changes in SF-36 over 1 year and examined associations between clinical parameters and SF-36 in predialysis CRF patients. METHODS: Subjects were 471 predialysis CRF patients. SF-36 and clinical parameters were measured every 8 weeks for 48 weeks. Of the 471 subjects, 294 underwent one or more follow-ups. We analyzed the pooled dataset of the 294 CRF patients and 2002 subjects from Japanese general population using analysis of covariance. RESULTS: After adjustment for age and sex, the 1-year declines in SF-36 domains were significantly greater in the predialysis patients than in the general population. For a 10% decline in hematocrit from the baseline survey value, the decline in vitality of SF-36 was 4.5 points (p = 0.003), while for a 10% increase in serum creatinine from the baseline survey value, respective declines in physical functioning, role-physical and mental health were 1.2 (p = 0.004), 1.9 (p = 0.035), and 1.0 points (p = 0.008). CONCLUSION: Among these predialysis CRF patients, the decline in HQOL was faster than that in the general population, and was associated with an increase in serum creatinine and decline in hematocrit.

[Psychiatric problems in organ transplants: examples on the renal transplants from living relatives in Japan].

There has been an increase of the renal transplants from living relatives, making over 80% of all renal transplants thus leaving under 17% of them from cadaveric. As for living donors, anxiety and fear of physical vulnerability, possible complications/disabilities, and death/dying, triggered by the hospitalization; a sense of guilt and/or self-blame, or seeking for rewards/compensation, triggered by the transplant; and introjection, probiosis, regression, often presented post transplant. Depression is one of the significant problems among donors after failed transplant, but also even after successful renal transplant. It is called "paradoxical depression". As for recipients, anxiety, guilt feeling, anger are very common psychological issues before the operation. There are number of young adults who present marked anger and short temper, aggression and acting-out behavior as their defense mechanisms.