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Kidney transplantion improves the muldimensional quality of life
Kidney Transplantion Improves the Muldimensional Quality of Life C.T. Lazzaretti, J.G.R. Carvalho, R.A. Mulinari, and J.M. Rasia ABSTRACT Introduction. Quality of life is affected during any illness, especially chronic diseases, such as renal failure. Objective. To evaluate the quality of life after kidney transplantation. Methods. One hundred patients were interviewed (60 men, 40 women, mean age 36 ⫾ 10.4 years, median 35 years) from July to October 2000 using the multidimensional questionnaire WHOQL-Bref. Results. Eighty-eight percent of patients were satisfied/very satisfied with their general health condition. Seventy-seven percent manifested a good capacity to carry out daily activities, and 75% considered themselves satisfied with their work capacity. Quality of life was considered “very good” or “good” among 80%, and “neither good nor bad” in 20%. None considered quality of life in general as “bad” or “very bad.” Most (87%) were satisfied with their current condition and with themselves after the kidney transplant. Conclusion. Patients perceive kidney transplant as capable of improving their quality of life. The most important finding in this study is that the results of the physical and psychological domains did not show any significant difference. It was possible to conclude that the quality of life for most subjects is related to reduction or disappearance of the symptoms caused by the previous disease.
T
HE BURDEN OF A DISEASE cannot be entirely evaluated by the clinical state of the disease, nor by its functional recovery. Psychosocial factors, such as pain, apprehension, restricted mobility, and other functional impediments, restricted personal and family responsibilities, financial burden, and diminished cognition, must also be considered. Patients usually place their hope on organ transplantation to remain alive. Transplantation is designed to make life tolerable, and even harmonious as well as well balanced for the patient. What kind of life do transplant recipients have? What constraints are they subjected to? It is accepted that while there is no cure for a chronic disease, as kidney failure, the essential aim of treatment should be to maximize the quality of life. The objective of this study was to evaluate quality of life after kidney transplantation.
domains, excluding the 12 patients who failed to completely fill in the questionnaire. All patients gave informed consent to participate in the study. The standard model of the World Health Organization Quality of Life, WHOQOL-bref questionnaire, proposed by World Health Organization,1 was applied to the study group. The 24-item questionnaire gathered information on the following four domains: physical, psychological, social relationship, and environment. Multivariate analyses was used for comparison between the mean score of the domains (physical, psychological, social relationship, and environment) and general quality of life. A P value ⬍.05 was accepted as statistically significant.
RESULTS
Patients of mean age of 36 ⫾ 10.31 years and median of 35 years were predominantly male (60 men, 40 women). The mean posttransplant follow-up was 87 ⫾ 61.6 months
PATIENTS AND METHODS The study included a cohort of 100 patients regularly followed after a previous kidney transplant. The patients had good courses with creatinine levels ⱕ2.5 mg/dL, without acute rejection of the kidney. They had not been diagnosed with mental disease or altered mental state from medications. The analysis included the total scores for 0041-1345/04/$–see front matter doi:10.1016/j.transproceed.2004.03.094 872
From the Division of Nephrology, University Hospital, Department of Sociology, Federal University of Parana´, Curitiba, Brazil. Address reprint requests to C.T. Lazzaretti, Rua Saldanha Marinho, 989 CEP 80410-151 Curitiba, Parana´, Brasil E-mail: [email protected] © 2004 by Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010-1710 Transplantation Proceedings, 36, 872– 873 (2004)
KIDNEY TRANSPLANTION AND QUALITY OF LIFE
873
Table 1. Averages of the Scores of the Domains in Relation to the Answer on General Quality of Life
Very bad Bad Neither bad nor good Good Very good
n ⫽ 88
Physical condition
Psychological condition
Social relationship
Environment
— — 18 50 20 88
— — 59.72 61.00 72.86 63.43
— — 55.79 66.17 75.21 66.10
— — 66.20 76.83 88.33 77.27
— — 52.26 62.63 74.22 63.14
(median of 73 months). Married patients represented 62% with 51% completing basic schooling. Transplant patients were satisfied/very satisfied with their general health condition in 90%, 76% felt reported a good capacity to perform daily activities, and 74% were satisfied with their capacity for work. Most patients (86%) were satisfied with their condition after the kidney transplant. Only 11% of the respondents answered that they “very frequently or always” felt moody, or noted anxiety and depression. While 69% answered that they were “satisfied/ very satisfied” with their sexual life, 6% didn’t answer this question. The perception of the general quality of life after the kidney transplant, was considered “very good” by 23%, “good” by 57%, and “neither good, nor bad” by 20%. None considered his quality of life in general to be “bad” or “very bad.” Table 1 presents the averages of the scores of the domains in relation to answer numbers in the general evaluation of their quality of life. Comparing the domains, no significant differences were observed between physical, psychological and environmental domains. Only social relationship showed statistical difference when compared with others.
mobility. In other words, except for medication and the routine consultations, patients have the opportunity to redirect their interests and activities. Patients had better chances to apply for jobs, because they do not need to undergo dialysis.6,7 The most important finding in this study is that the results of the physical and psychological domains did not show significant differences. It is known that the psychological dimension has important consequences for the results of kidney transplants because of either the emotional stress caused by the chronic character of the disease or the constant concern about graft loss, as well as the difficulties of social and professional reinsertion. In this sense, it is important to consider that the quality of life for most individuals is seen as a reduction or disappearance of symptoms caused by the previous disease. Such an attitude is probably associated with the concept that patients have about what is quality of life. It is plausible that because of the disadvantaged socioeconomic condition of most patients in the study, the perception of quality of life was restricted to the individual’s own concept of healthfulness.
DISCUSSION
1. World Health Organization: Psychological Medicine 28:551, 1998 2. Andrews PA: Bri Medica Jour 321:530, 2002 3. Dew MA, Switzer GE, Goyollea JM, et al: Transplantation 64:1261, 1997 4. Jofre R, Lopez-Gomez JM, Moreno F, et al: Am J Kidney Dis 32:93, 1998 5. Scott Babe R: Organ Transplantation 4:173, 1999 6. Arredondo A, Rangel R, Icaza E: Revista de Sau ´de Public 32:556, 1998 7. De Oreo PB: Am J Kidney Dis 30:204, 1997
Although in kidney transplantation, there are not many quality-of-life studies using the multidimensional definition, most studies have shown that patients notice improvements in their global quality of life, especially physical function.2–5 The data suggest that after transplantation patients recover a portion of the capacities that they had before the chronic kidney failure, because transplant allows a less restrictive diet, in most cases, a better use of time, and improved
REFERENCES
T
HE BURDEN OF A DISEASE cannot be entirely evaluated by the clinical state of the disease, nor by its functional recovery. Psychosocial factors, such as pain, apprehension, restricted mobility, and other functional impediments, restricted personal and family responsibilities, financial burden, and diminished cognition, must also be considered. Patients usually place their hope on organ transplantation to remain alive. Transplantation is designed to make life tolerable, and even harmonious as well as well balanced for the patient. What kind of life do transplant recipients have? What constraints are they subjected to? It is accepted that while there is no cure for a chronic disease, as kidney failure, the essential aim of treatment should be to maximize the quality of life. The objective of this study was to evaluate quality of life after kidney transplantation.
domains, excluding the 12 patients who failed to completely fill in the questionnaire. All patients gave informed consent to participate in the study. The standard model of the World Health Organization Quality of Life, WHOQOL-bref questionnaire, proposed by World Health Organization,1 was applied to the study group. The 24-item questionnaire gathered information on the following four domains: physical, psychological, social relationship, and environment. Multivariate analyses was used for comparison between the mean score of the domains (physical, psychological, social relationship, and environment) and general quality of life. A P value ⬍.05 was accepted as statistically significant.
RESULTS
Patients of mean age of 36 ⫾ 10.31 years and median of 35 years were predominantly male (60 men, 40 women). The mean posttransplant follow-up was 87 ⫾ 61.6 months
PATIENTS AND METHODS The study included a cohort of 100 patients regularly followed after a previous kidney transplant. The patients had good courses with creatinine levels ⱕ2.5 mg/dL, without acute rejection of the kidney. They had not been diagnosed with mental disease or altered mental state from medications. The analysis included the total scores for 0041-1345/04/$–see front matter doi:10.1016/j.transproceed.2004.03.094 872
From the Division of Nephrology, University Hospital, Department of Sociology, Federal University of Parana´, Curitiba, Brazil. Address reprint requests to C.T. Lazzaretti, Rua Saldanha Marinho, 989 CEP 80410-151 Curitiba, Parana´, Brasil E-mail: [email protected] © 2004 by Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010-1710 Transplantation Proceedings, 36, 872– 873 (2004)
KIDNEY TRANSPLANTION AND QUALITY OF LIFE
873
Table 1. Averages of the Scores of the Domains in Relation to the Answer on General Quality of Life
Very bad Bad Neither bad nor good Good Very good
n ⫽ 88
Physical condition
Psychological condition
Social relationship
Environment
— — 18 50 20 88
— — 59.72 61.00 72.86 63.43
— — 55.79 66.17 75.21 66.10
— — 66.20 76.83 88.33 77.27
— — 52.26 62.63 74.22 63.14
(median of 73 months). Married patients represented 62% with 51% completing basic schooling. Transplant patients were satisfied/very satisfied with their general health condition in 90%, 76% felt reported a good capacity to perform daily activities, and 74% were satisfied with their capacity for work. Most patients (86%) were satisfied with their condition after the kidney transplant. Only 11% of the respondents answered that they “very frequently or always” felt moody, or noted anxiety and depression. While 69% answered that they were “satisfied/ very satisfied” with their sexual life, 6% didn’t answer this question. The perception of the general quality of life after the kidney transplant, was considered “very good” by 23%, “good” by 57%, and “neither good, nor bad” by 20%. None considered his quality of life in general to be “bad” or “very bad.” Table 1 presents the averages of the scores of the domains in relation to answer numbers in the general evaluation of their quality of life. Comparing the domains, no significant differences were observed between physical, psychological and environmental domains. Only social relationship showed statistical difference when compared with others.
mobility. In other words, except for medication and the routine consultations, patients have the opportunity to redirect their interests and activities. Patients had better chances to apply for jobs, because they do not need to undergo dialysis.6,7 The most important finding in this study is that the results of the physical and psychological domains did not show significant differences. It is known that the psychological dimension has important consequences for the results of kidney transplants because of either the emotional stress caused by the chronic character of the disease or the constant concern about graft loss, as well as the difficulties of social and professional reinsertion. In this sense, it is important to consider that the quality of life for most individuals is seen as a reduction or disappearance of symptoms caused by the previous disease. Such an attitude is probably associated with the concept that patients have about what is quality of life. It is plausible that because of the disadvantaged socioeconomic condition of most patients in the study, the perception of quality of life was restricted to the individual’s own concept of healthfulness.
DISCUSSION
1. World Health Organization: Psychological Medicine 28:551, 1998 2. Andrews PA: Bri Medica Jour 321:530, 2002 3. Dew MA, Switzer GE, Goyollea JM, et al: Transplantation 64:1261, 1997 4. Jofre R, Lopez-Gomez JM, Moreno F, et al: Am J Kidney Dis 32:93, 1998 5. Scott Babe R: Organ Transplantation 4:173, 1999 6. Arredondo A, Rangel R, Icaza E: Revista de Sau ´de Public 32:556, 1998 7. De Oreo PB: Am J Kidney Dis 30:204, 1997
Although in kidney transplantation, there are not many quality-of-life studies using the multidimensional definition, most studies have shown that patients notice improvements in their global quality of life, especially physical function.2–5 The data suggest that after transplantation patients recover a portion of the capacities that they had before the chronic kidney failure, because transplant allows a less restrictive diet, in most cases, a better use of time, and improved
REFERENCES