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
Research background

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.

Research motivation

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.

Research objectives

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.

Research methods

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.

Research results

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.

Research conclusions

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.

Research perspectives

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.