Abstract

Background and objectives: Chronic Kidney Disease is a significant health problem and little is known beyond traditional outcome measures. This study explores outcomes of renal transplantation in patients with End Stage Renal Disease (ESRD) on dialyses in terms of self-reported ‘Quality of Life (QOL)’ and further explores determinants of psychosocial aspects of health in terms of depression and anxiety. Methods: Consecutive patients from Jan 2011 till Mar 2012 with ESRD on dialyses were asked to self-assess QOL and case-ness for anxiety and
depression with World Health Organisation Quality of Life - BREF (WHOQOL-BREF) and Hospital Anxiety and Depression Scale (HADS) questionnaire respectively; 2 days before and 6 months after transplant. Data was also collected about duration of dialyses prior to transplant, clinical success of transplant, education level, marital status, employment status, insurance status, residence and relationship of donor with the recipient. Results: 50 patients with successful transplant were included. 6 (12%) and 13 (26%) patients had HADS anxiety and depression subscale scores respectively above the threshold defining case-ness preoperatively and this decreased to 2 (4%) and 3 (6%) patients respectively 6 months later. Scores increased significantly across all four domains of WHOQOL-BREF postoperatively. Depression predicted poor outcomes on ‘physical health’ and ‘environment’ domain while anxiety predicted a poor outcome in ‘social relationship’ domain of QOL. Employment and insurance status predicted outcomes in ‘environment’ domain of QOL even while adjusting for presence of depression and anxiety. Interpretation and conclusions: Anxiety and depression are significant contributors to QOL reported by patients with ESRD. While successful transplant ameliorates most such mood depression disorders yet employment and insurance status play a significant role in the ultimate improvement of QOL experienced.