Anxiety and depression in patients with end stage renal disease while awaiting renal transplantation

Abstract

Kidney transplantation offers a lifesaving treatment with the greatest potential for return to near normal renal function and enhanced quality of life. However, research showed that the waiting period for renal transplantation is a time in which patients suffer great uncertainties and stress (Baker and William 2002; Dew et al 2002; Lok 1996). The main aim of this study was to investigate the nature of anxiety and depression experienced by patients with End Stage Renal Disease (ESRD) on haemodialysis while awaiting renal transplantation. A descriptive, exploratory small-scale research study was undertaken using quantitative and qualitative questions containing the Hospital Anxiety and Depression (HAD) Scale (Zigmond and Snaith 1983) and open-ended questions. The sample recruited was a random sample of 22 Maltese patients undergoing haemodialysis and awaiting transplantation at the Renal Unit at the Local General Hospital with a response rate of 90.9% (n=20). This sample included 13 male and 7 female aged between 18 and 70 years. The HAD Scale was utilized to assess the presence of anxiety and depression in patients with ESRD during the waiting period and it was revealed that anxiety was more prevalent than depression for these patients. Accounts from the questionnaire indicated that uncertainty was the most distressing stressor experienced by patients with ESRD followed by dependence on the haemodialysis machine and limitations and restrictions imposed by the illness and treatment modality. Uncertainty experienced by these patients was oriented towards doubt on when, if ever, an organ donor would be available, the outcome of the surgery itself, uncertainty on whether they will survive the waiting period or if any other complication would emerge. A set of recommendations was included, with reference to the clinical practice, education and further research, to increase the awareness of health care professionals on the stressful waiting period of patients prior to transplantation.