Published online Jun 6, 2023. doi: 10.12998/wjcc.v11.i16.3780
Peer-review started: December 17, 2022
First decision: January 12, 2023
Revised: February 11, 2023
Accepted: May 6, 2023
Article in press: May 6, 2023
Published online: June 6, 2023
The recent coronavirus disease 2019 (COVID-19) pandemic has had significant psychological and social effects on the world’s population. Research has highlighted the effect on the psychological well-being of the most at risk groups, including hemodialysis (HD) patients and kidney transplantation (KT) recipients, who are highly likely to develop post-traumatic stress disorder (PTSD), anxiety, depression, and other symptoms of distress. COVID-19-related social distancing negatively affected interpersonal relationships and empathy toward others. The aim of the present clinical study was to identify the effect of the COVID-19 pandemic on these two patient groups and consider possible interventions based on the findings.
The psychological construct of coping, anxiety, depression, and psychological resilience has been studied in various patient populations and has more recently been applied in the field of transplant and end-stage renal disease (ESRD) psychology. The COVID-19 pandemic provided a good opportunity to study and explore the nature of stressors and their origins in KT recipients and ESRD patients undergoing HD.
Prolonged stress during the COVID-19 pandemic can trigger anxiety, depression, and the inability to manage traumatic and negative emotions. Furthermore, the constant fear of contracting the disease negatively affects daily life and leads to social isolation, modifying human relations. These features can be more profoundly observed in patients with chronic illnesses, such as ESRD. The present study aimed to analyze the levels of anxiety and depression in ESRD patients undergoing HD and KT recipients. Additionally, the primary stressors and psychological resilience were surveyed and compared between the KT recipients and HD patients, which is crucial in order to tailor specific treatment for each group.
The participants of this cross-sectional study completed a sociodemographic data form, the impact of events scale-revised, Connor-Davidson resilience scale, and hospital anxiety and depression scale. HD initiation and KT surgery dates were recorded. Additionally, routine laboratory parameters, including blood urea, creatinine, albumin, phosphorus, parathyroid hormone, calcium, hemoglobin, and C-reactive protein, were measured. Participants were administered a visual analog scale to evaluate the level of perceived COVID-19-related stress. Non-compliance with medication and follow-up care was evaluated with a yes/no question. The study included two groups: The HD group and the KT group.
The HD group was significantly older than the KT group. Additionally, the level of education was higher in the KT group than in the HD group. Patients in the two study groups had different concerns regarding the COVID-19 pandemic. The main concern with the highest intensity was the transmission of COVID-19 to family and friends in the HD group and the loss of caregiver and social support in the KT group. Concerns regarding financial hardship, loneliness, stigmatization, limited access to health care services, failure to find medical supplies, and transmission of COVID-19 to family and friends were more intense in the HD group. The levels of anxiety and depression were higher in the HD group than in the KT group, whereas the post-traumatic stress level was higher in the KT group. The rate of PTSD was significantly higher in the KT group as compared to HD group. The psychological resilience level was also higher in the KT group. In addition, in the KT group the reported non-compliance with treatment rate was significantly higher than in the HD group during the COVID-19 pandemic.
ESRD is a chronic condition characterized by kidney failure that requires either dialysis or KT for survival. Among these two treatment options, KT provides the best outcome, although at a cost. KT recipients must adhere to complex immunosuppressive regimens and medical follow-up. HD, on the other hand, is a more demanding treatment that requires visiting a dialysis center three times per week, blood work-ups, and the risk of exposure to COVID-19 in confined and crowded dialysis centers. The present study aimed to determine the levels of stress, anxiety, and depression, as well as psychological resilience and the frequency of PTSD in HD patients and KT recipients. The present findings highlight the differences in the COVID 19-related concerns and major stressors in the participants in the HD and KT groups. The levels of anxiety and depression were significantly higher in the HD than in the KT group. On the other hand, PTSD and non-compliance with treatment were more common in the KT group. These findings should help clinicians tailor specific support and treatment for HD patients and KT recipients.
Stress factors associated with the COVID-19 pandemic include fear of death, concerns about personal health and the health of loved ones, loneliness caused by social distancing mandates, concerns about the inability to access medical treatment, job loss, and financial hardship. The magnitude of these stressors and unknowns about COVID-19 and its treatment are likely to lead to PTSD in some individuals, and anxiety and depression set the stage for its development. ESRD patients constitute a vulnerable population, as the present findings show they have high levels of anxiety and depression and are prone to developing PTSD.