Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 6, 2023; 11(16): 3780-3790
Published online Jun 6, 2023. doi: 10.12998/wjcc.v11.i16.3780
Psychological review of hemodialysis patients and kidney transplant recipients during the COVID-19 pandemic
Ayse Gokcen Gundogmus, Ebru Gok Oguz, Sanem Guler-Cimen, Yasemin Kocyigit, Ahmet Emin Dogan, Mehmet Deniz Ayli
Ayse Gokcen Gundogmus, Yasemin Kocyigit, Department of Psychiatry, Etlik City Hospital, Ankara 65100, Cankaya, Turkey
Ebru Gok Oguz, Mehmet Deniz Ayli, Department of Nephrology, Etlik City Hospital, Ankara 65100, Cankaya, Turkey
Sanem Guler-Cimen, Department of General Surgery, Etlik City Hospital, Ankara 65100, Cankaya, Turkey
Ahmet Emin Dogan, Department of Urology, Etlik City Hospital, Ankara 65100, Cankaya, Turkey
Author contributions: Gundogmus AG and Guler-Cimen S are the guarantors and designed the study; All authors participated in the acquisition, analysis, and interpretation of data and drafted the initial manuscript; Gundogmus AG, Guler-Cimen S, and Ayli MD revised the article for important intellectual content.
Institutional review board statement: This study was conducted at Ankara Diskapi Yildirim Beyazit Research and Training Hospital, Transplantation and Nephrology Clinic, affiliated with the Saglik Bilimleri University of Turkey, Ankara, Turkey. The local ethics committee approved the study protocol, No. 10.08.2020-93/01. The study was carried out in accordance with the Declaration of Helsinki and the Declaration of Istanbul.
Informed consent statement: All study participants provided written informed consent.
Conflict-of-interest statement: Preliminary results of this clinical study were presented as an oral abstract at the European Society for Organ Transplantation meeting held in Milan in 2021.
Data sharing statement: The technical appendix, statistical code, and dataset are available from the corresponding author at sanem.cimen@sbu.edu.tr.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non-Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sanem Guler-Cimen, Doctor, FEBS, MSc, Academic Editor, Adjunct Associate Professor, Chief Physician, Research Scientist, Department of General Surgery, Etlik City Hospital, Atatürk Caddesi, Ankara 65100, Cankaya, Turkey. sanem.cimen@sbu.edu.tr
Received: December 17, 2022
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

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.


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.


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 χ2 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.


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).


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.

Keywords: Kidney transplantation, Dialysis, Anxiety, Depression, Psychological resilience

Core Tip: Hemodialysis patients and kidney transplantation recipients with viral infections have higher mortality and morbidity rates compared to the general population. These patients are at a high risk of infectious complications due to immunosuppression, and this risk triggers psychosocial stress. Considering the possible negative effects of this psychosocial stress, an in-depth psychological analysis was performed using validated scales. Specific concerns and stressors related to coronavirus disease 2019 (COVID-19) were identified in both patient groups. Overall, the main concern was transmitting COVID-19 to family and friends, followed by financial hardship, loneliness, and stigmatization. The present findings showed that it is crucial to tailor supportive psychological interventions to these vulnerable patient groups.