NDT Advance Access originally published online on November 30, 2008
Nephrology Dialysis Transplantation 2009 24(2):653-660; doi:10.1093/ndt/gfn660
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Sociodemographic factors and patient perceptions are associated with attitudes to kidney transplantation among haemodialysis patients
1 Institute of Behavioral Sciences 2 1st Department of Internal Medicine 3 Fresenius Medical Care Dialysis Center 4 Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary 5 Department of Psychiatry, University Health Network 6 Division of Nephrology, Faculty of Medicine, University of Toronto, Toronto, Canada
Correspondence and offprint requests to: Istvan Mucsi, Institute of Behavioral Sciences, Semmelweis University, Nagyvarad ter 4, Budapest, Hungary. Tel: +36-1-266-0926 Ext. 6111; Fax: +36-1-210-1220; E-mail: istvan{at}nefros.net
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Abstract |
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Background. Treatment decisions made by patients with chronic kidney disease are crucial in the renal transplantation process. These decisions are influenced, amongst other factors, by attitudes towards different treatment options, which are modulated by knowledge and perceptions about the disease and its treatment and many other subjective factors. Here we study the attitude of dialysis patients to renal transplantation and the association of sociodemographic characteristics, patient perceptions and experiences with this attitude.
Methods. In a cross-sectional study, all patients from eight dialysis units in Budapest, Hungary, who were on haemodialysis for at least 3 months were approached to complete a self-administered questionnaire. Data collected from 459 patients younger than 70 years were analysed in this manuscript.
Results. Mean age of the study population was 53 ± 12 years, 54% were male and the prevalence of diabetes was 22%. Patients with positive attitude to renal transplantation were younger (51 ± 11 versus 58 ± 11 years), better educated, more likely to be employed (11% versus 4%) and had prior transplantation (15% versus 7%)(P < 0.05 for all). In a multivariate model, negative patient perceptions about transplantation, negative expectations about health outcomes after transplantation and the presence of fears about the transplant surgery were associated, in addition to incre- asing age, with unwillingness to consider transplantation.
Conclusions. Negative attitudes to renal transplantation are associated with potentially modifiable factors. Based on this we suggest that it would be necessary to develop standardized, comprehensible patient information systems and personalized decision support to facilitate modality selection and to enable patients to make fully informed treatment decisions.
Keywords: attitude to renal transplantation; dialysis; end-stage renal disease; patient perceptions; renal transplantation
Received for publication: 23. 5.08
Accepted in revised form: 3.11.08