الفهرس 
Historical Background of renalOnly 14 pages are availabe for public view
 |  | from | 259 |  |  |
| | | from | 259 | | |
Abstract
Psychiatric disorders such as depression and anxiety may be seen after a successful renal transplantation. The frequency of psychiatric disorders is quite high in renal transplantation patients (Araplasan et al, 2004).
This work aims to review previous studies on the psychiatric morbidity and QoL in renal transplant patients, to study prevalence of psychiatric disorders among renal transplant recipients, and toidentify the quality of life among renal transplant recipients.
In the present cross sectional stratified random study, a stratified random sample (230 PRTR) were collected from Naser Institute Nephrology Clinics. during the time interval from 1st of January until 1st of June 2007. All cases were subjected to:
A semi-structured questionnaire for renal transplant recipients,
the Arabic version General Health Questionnaire-28 (GHQ-28),
the Egyptian version of Beck Depression Inventory (BDI-II),
the Egyptian version of the Suicide Probability Scale (SPS), and
the Arabic version of the World Health Organization Quality of Life Questionnaire (WHOQOL-100). ICD-10 checklist was applied to PRTR who have bad mental health (score of GHQ-28>/5).
The results were analyzed using the statistical package for the social sciences (SPSS) version 12. Qualitative data was described using frequency and percentage. Quantitative data was described using mean and standard deviation. The following inferential statistical procedures were used Chi- square (Chi 2) to compare categoric variables and Correlation method to compare continuous variables.
The sample composed of early and late PRTR ( time since RTS ranges from 3 months to 18 years). RTS is done sponsored by government or Health insurance and we find the following:
Only 6% (13/230) of PRTR are above 50 years old at time of RTS. Most of PRTR are males (165/230, 72%), married (169/230, 75%) moslems (172/230, 75%), rural (162/230, 75%) and educated (189/230, 82%) and have low occupational levels (111/230, 48% in levels 1 and 2). All PRTR are of low social class except 4% are of low middle social class. All PRTR have financial problems as regards the costs of RTS, post operative immunosuppressants and follow up investigations; but no one faced religious problems.
All PRTR did hemodialysis therapy before RTS (230/230, 100%) three times /week, three hours/ session, but the duration of hemodialysis varied from 1 months to 7 years, with a mean of 1.4 +_0.6 years More than 1/3 of the PRTR (87/230) have medical diseases other than renal impairment before RTS and more than 1/2 of the PRTR (140/230) have side effects from the immunosuppressive drugs received after RTS and the most common side effect is edema (30/230).
All PRTR (230/230, 100%) receive the transplant kidneys from living donors; there are no cadaveric donors. About 3/4 of PRTR receive the transplant kidneys from non relative donors. Only one PRTR (1/230, 0.4%) has previous history of RTS and 6.5% (15/230) have history of symptoms of rejection which is controlled by drug therapy. 1/3 of PRTR who receive the transplant kidneys from relative donors, receive it from their mothers.
No one of PRTR (230/230) has guilt feelings towards the donors. 72%of the PRTR (165/230) have poor mental health. 39% of PRTR (90/230) have a psychiatric disorder (ICD-10) and the commonest diagnosis is depression (major depressive episode, adjustment disorder depressive type, dysthymia), follwed by anxiety (generalized anxiety disorder and PTSD). 8% (19/230) of PRTR have severe depression (BDI-II) and 11% (26/230) of PRTR have moderate depression (BDI-II). 5.56% (13/230) of PRTR have moderate risk of suicide (SPS) and no one has high risk of suicide. 7.8% (17/230) of PRTR have suicidal ideation. Hopelessness is present among 20% (46/230) of PRTR.
Although all the PRTR are satisfied about RTS itself because they stopped going to the hemodialysis unit, all of them have unsatisfactory Social QoL and more than 3/4 of PRTR have unsatisfactory QoL in all the other domains of QoL except the spiritual QoL where only 15.6% (35/230) have unsatisfactory spiritual QoL.
Old PRTR (>50-60 years), female PRTR, those with less than one year hemodialysis therapy before RTS and those with recent RTS (less than one year) have the highest percent of poor mental health.
All divorced PRTR have psychiatric disorders whereas married PRTR have high percent of psychiatric disorders than single PRTR. The major depressive disorder is highly presented among PRTR with low occupational level where dysthymia and risk of suicide is highly present among PRTR with high occupational level.
As regards the severity of depression is highly present among old PRTR (>50-60 years) and among those having side effects from the drugs received after RTS. Also, depression among highly educated PRTR is more severe than the less educated. Also, depression is more severe among PRTR with low and low middle social classes.
The risk of suicide is more presented among PRTR with secondary school education and those coming form low social class, also hostility and suicidal ideation are more presented among those coming from low social class. Also we found +ve correlation between hostility and social class. Negative self evaluation is more present among those with high educational level with positive correlation between the occupational level and –ve self evaluation. As regards hopelessness, there is –ve correlation with age and +ve correlation with educational level.
Other factors as religion, residence, and medical diseases other than renal impairment and type of donors haven’t got effect on the psychiatric condition of PRTR.
All domains of QoL except social and overall domains are affected by the age and occupational level of PRTR,where they are more affected at the extremities of age especially young age groups.
The psychological and independence domains of QoL are affected by the educational level of PRTR where they are less affected among PRTR with 2 years institute or with secondary educational levels.
As regards the independence domain of QoL, there is a +ve correlation with age, educational and occupational level. As regards the psychological domain of QoL, there is a +ve correlation with age and -ve correlation with educational level. Also, there is +ve correlation between the physical domain of QoL and age and between the overall domain of QoL. Lastly, there is +ve correlation between the environmental domain of QoL and occupational level.