A Study on the Attitude Toward Kidney Transplantation and Factors Among Hemodialysis Patients in China

Willingness of Patients With End-Stage Renal Disease to Accept a Kidney Transplant and Related Factors

BACKGROUND

The prevalence of end-stage renal disease (ESRD) in Taiwan is among the highest in the world. Although kidney transplant is the most effective treatment for ESRD, the willingness of patients with ESRD to undergo kidney transplantation is low in Taiwan. The factors associated with willingness to accept kidney transplantation remain unclear, and studies on kidney transplant willingness and associated factors among Taiwanese patients with ESRD are scarce.

PURPOSE

The aim of this study was to assess willingness to undergo a kidney transplant and related factors among patients with ESRD in Taiwan.

METHODS

A cross-sectional design was employed. Two hundred fourteen participants from a single medical center in Taiwan were recruited, and 209 valid questionnaires were collected (valid response rate: 97.7%). The study instruments included a kidney transplant knowledge scale, a kidney transplant attitude scale, and a kidney transplant willingness scale. Data were analyzed using Pearson's product-moment correlations, t tests, one-way analyses of variance, and multiple regressions.

RESULTS

The mean kidney transplant willingness in the sample was 13.23 (out of 20). Being male, younger, married, or employed; having a college education or above; and having a shorter dialysis duration were all associated with higher kidney transplant willingness. Sociodemographics, dialysis duration, knowledge, and attitudes explained 45.4% of the variance in kidney transplant willingness, with two of these, kidney transplant attitudes (β = .61, p < .001) and dialysis duration (β = -.11, p = .041), identified as significant.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The findings support the important role of cultivating positive attitudes in patients with ESRD to increasing willingness to undergo kidney transplantation interventions.

The Level of Knowledge of Organ Transplantation and Attitudes Toward Organ Donation of Carers of Patients Receiving Hemodialysis

Purpose: Renal transplantation is the most effective treatment method for chronic renal failure and helps improve the quality of life of patients and caregivers.In the present study, the purpose was to determine the knowledge level of the primary caregivers of patients receiving hemodialysis treatment about organ transplantation and their attitudes toward organ donation.Method: The study was conducted in a descriptive fashion with the relatives of 71 patients who were receiving treatment in the hemodialysis unit for the end-stage renal failure of a state hospital between 01.08.2022 and 15.10.2022. The data of the study were collected face to face with a questionnaire form, Organ Donation Attitude Scale, and Organ Tissue Donation and Transplantation Information Scale. The SPSS 24 package program was used in the analysis of the data. Descriptive statistics, numbers, percentages, and mean values were used in the analysis of the data. The One-Sample Kolmogorov-Smirnov Test was used to evaluate the homogeneity of the data. The Studentt test, the One-Way Analysis of Variance, the Kruskal-Wallis Test, and the Tukey Post-Hoc Test were used for the analysis between the groups. Statistical significance was taken as p < .05.Results: The benevolence and moral values/beliefs sub-dimension score average of the participants was found to be 98.44 ± 14.61, the fear of medical neglect was 32.10 ± 10.09, and the mean bodily injury sub-dimension score was 30.45 ± 11.28. It was also found that the mean score of the Organ-Tissue Donation and Transplant Information Scale was 11.41 ± 2.59. A statistically significant and negative relationship was detected between the participants' medical neglect and bodily injury attitudes and the Organ-Tissue Donation and Transplant Information Scale score averages (p < .05).Conclusion and Suggestions: As a result, it was found that the positive attitudes of the caregivers of individuals receiving hemodialysis treatment about organ donation were at a good level, and as the level of organ transplantation knowledge increased, negative attitudes towards organ donation decreased. In this context, it can be suggested that healthcare professionals provide training on organ transplantation and donation to the relatives of patients receiving hemodialysis treatment.

Reasons for kidney transplant refusal among patients receiving peritoneal dialysis: A qualitative study

BACKGROUND

Even though kidney transplantation has better outcomes compared to dialysis therapies, some patients undergoing peritoneal dialysis (PD) refuse to consider kidney transplantation. Identification of the underlying reason for patient refusal may improve patients' acceptance of kidney transplantation.

AIM

The aim of this study was to describe the reasons given by Iranian PD patients for refusing kidney transplantation.

METHOD

Eighteen patients undergoing PD participated. Data were collected using semi-structured interviews and were analysed using conventional qualitative content analysis.

RESULTS

The analysis leads to the emergence of two categories and six subcategories: negative outcomes of kidney transplantation (financial burden, psychosocial problems and physical complications) and doubtful factors for kidney transplantation (negative attitudes towards kidney transplantation, long waiting time for kidney transplantation and compatibility of PD with daily life). The financial burden and long waiting time for kidney transplantation were the most important factors in the reluctance of kidney transplantation by PD patients.

IMPLICATION FOR PRACTICE

Patients undergoing PD declined kidney transplantation for several reasons, such as financial burden, fear of post-transplantation side effects, long waiting time for kidney transplantation. Reducing the time of kidney transplantation and insurance coverage of transplant costs can change the attitude of PD patients towards transplant.

Knowledge and Attitudes Toward Renal Transplantation in Individuals Undergoing Transplant Evaluation

INTRODUCTION

The underutilization of kidney transplant as the preferred treatment for end-stage kidney disease is influenced by a lack of knowledge, poor attitudes, and various socio-demographic characteristics. Negative attitudes toward renal transplant disengage patients from the evaluation process and often hinder their likelihood of receiving a transplant.

PURPOSE

Determine whether a standardized educational session successfully improves knowledge and attitudes toward kidney transplant. Explore which socio-demographic variables are associated with more negative baseline attitude scores.

DESIGN

The program evaluation utilized a pre-test/post-test design to assess attitudes and knowledge toward renal transplant before and after an educational session. The pre- and post-surveys were distributed to a convenience sample of 341 and 115 patients, respectively, between the months of September and December 2019.

RESULTS

Exposure to a kidney transplant education program resulted in greater levels of knowledge (P = 0.019, d = 0.334). Individuals with no college education were found to have more negative baseline attitudes toward renal transplantation (P = 0.048, d = 0.382).

CONCLUSION

More research is needed to explore how knowledge, attitudes, and certain socio-demographic characteristics impact a patient's intention to pursue kidney transplant. Uncovering reasons as to why certain populations of individuals have more negative baseline attitudes toward kidney transplant may also provide clinicians and transplant programs with valuable information on how pre-transplant education can be tailored to meet the needs of specific populations.

The probability of receiving a kidney transplantation in end-stage kidney disease patients who are treated with haemodiafiltration or haemodialysis: a pooled individual participant data from four randomised controlled trials

Background

Due to a critical shortage of available kidney grafts, most patients with Stage 5 Chronic Kidney Disease (CKD5) require bridging dialysis support. It remains unclear whether treatment by different dialysis modalities changes the selection and/or preparation of a potential transplant candidate. Therefore, we assessed whether the likelihood of receiving kidney transplant (both living or deceased kidney donors) differs between haemodialysis (HD) and online haemodiafiltration (HDF) in patients with CKD5D.

Methods

Individual participant data from four randomised controlled trials comparing online HDF with HD were used. Information on kidney transplant was obtained during follow-up. The likelihood of receiving a kidney transplant was compared between HD and HDF, and evaluated across different subgroups: age, sex, diabetes, history of cardiovascular disease, albumin, dialysis vintage, fistula, and level of convection volume standardized to body surface area. Hazard ratios (HRs), with corresponding 95% confidence intervals (95% CI), comparing the effect of online HDF versus HD on the likelihood of receiving a kidney transplant, were estimated using Cox proportional hazards models with a random effect for study.

Results

After a median follow-up of 2.5 years (Q1 to Q3: 1.9–3.0), 331 of the 1620 (20.4%) patients with CKD5D received a kidney transplant. This concerned 22% (n = 179) of patients who were treated with online HDF compared with 19% (n = 152) of patients who were treated with HD. No differences in the likelihood of undergoing a kidney transplant were found between the two dialysis modalities in both the crude analyse (HR: 1.07, 95% CI: 0.86–1.33) and adjusted analysis for age, sex, diabetes, cardiovascular history, albumin, and creatinine (HR: 1.15, 95%-CI: 0.92–1.44). There was no evidence for a differential effect across subgroups based on patient- and disease-characteristics nor in different categories of convection volumes.

Conclusions

Treatment with HD and HDF does not affect the selection and/or preparation of CKD5D patients for kidney transplant given that the likelihood of receiving a kidney transplant does not differ between the dialysis modalities. These finding persisted across a variety of subgroups differing in patient and disease characteristics and is not affected by the level of convection volume delivered during HDF treatment sessions.

How to increase kidney transplant activity throughout Europe-an advocacy review by the European Kidney Health Alliance

Kidney transplantation offers better outcomes and quality of life at lower societal costs compared with other options of renal replacement therapy. In this review of the European Kidney Health Alliance, the current status of kidney transplantation throughout Europe and suggestions for improvement of transplantation rates are reported. Although the European Union (EU) has made considerable efforts in the previous decade to stimulate transplantation activity, the discrepancies among European countries suggest that there is still room for improvement. The EU efforts have partially been neutralized by external factors such as economic crises or legal issues, especially the illicit manipulation of waiting lists. Hence, growth in the application of transplantation throughout Europe virtually remained unchanged over the last few years. Continued efforts are warranted to further stimulate transplantation rates, along with the current registration and data analysis efforts supported by the EU in the Effect of Differing Kidney Disease Treatment Modalities and Organ Donation and Transplantation Practices on Health Expenditure and Patient Outcomes project. Future actions should concentrate on organization, harmonization and improvement of the legal consent framework, population education and financial stimuli.

Comparison of peritoneal dialysis with hemodialysis on survival of diabetic patients with end-stage kidney disease: a meta-analysis of cohort studies

Aim: Renal replacement therapy was primary treatment for end stage kidney (ESRD) patients. Numbers of studies comparing peritoneal dialysis (PD) and hemodialysis (HD) yielded inconsistent results. The aim of this study was to assess the mortality risk between diabetic PD patients and those in HD.

Methods: We included cohort studies comparing the risk of death among diabetic ESRD patients who receiving peritoneal dialysis or hemodialysis by searching Medline and Embase. Overall estimates were calculated using the random-effects model.

Results: Seventeen studies were included in the meta-analyses. Mortality comparison between PD and HD in the diabetic ESRD patients showed PD significantly increased mortality rate (hazard ratio (HR) 1.20; 95% confidence interval (CI) 1.10–1.30; I² = 89.1%). The overall HR using an intention-to-treat analysis was 1.23 with 95% CI (1.13 to 1.34). Meta-regression demonstrated PD patients from Asian country were associated with increase in mortality risk (coefficient = 0.270, SE = 0.112, p = .033).

Limitation: The high heterogeneity in our meta-analyses undermined the robustness of the findings.

Conclusion: ESRD patients with diabetes may benefit more from HD than PD.

Knowledge of Chronic Hemodialysis Patients on Kidney Transplantation in Morocco

BACKGROUND

Kidney transplantation (KT) is the optimal treatment for chronic end-stage renal failure. However, it is experiencing a huge delay in Morocco, and the lack of information on this alternative treatment could contribute to this delay. The purpose of our work is to evaluate the knowledge of hemodialysis (HD) on renal transplantation and to propose sensitization and information strategies.

METHODS

This is a multicenter study conducted in 4 hemodialysis centers in Marrakesh from November to December 2017. An individual questionnaire was submitted to 310 patients concerning sociocultural status, willingness to be transplanted, the main benefits and risks of renal transplantation, knowledge of religious attitudes toward organ donation and transplantation, cost, and survival of the KT.

RESULTS

Of the 310 patients, 56% were men, with a mean age of 49.43 ± 10.3 years. The mean duration of hemodialysis was 6.7 ± 5.3 years. Only 18% were in school, and 57% had moderate economic status. Of the 310 respondents, 71% said they wanted to be transplanted, and 15.5% believed that Islam was unfavorable by encouraging them to accept the fate that God chose for them. The rest were afraid of multiple complications and returning to dialysis. However, 41.7% thought transplantation was more expensive than hemodialysis. Only 65.8% believed that renal transplantation provided a better quality of life.

CONCLUSIONS

Raising the awareness of hemodialysis patients and their families is essential to promote KT in Morocco.

Native American patients' perception and attitude about kidney transplant: a qualitative assessment of patients presenting for kidney transplant evaluation

OBJECTIVE

Native Americans suffer from lower rates of kidney transplantation compared with whites. Our goal was to elicit patients' perceptions of and attitudes about kidney transplant and the impact of financial burden and cultural taboos.

DESIGN

This is an exploratory qualitative interview study of 12 Native American patients recruited after completion of the kidney transplant evaluation.

SETTING

Semistructured interviews were conducted. Interviews were coded using inductive methods, followed by interpretive coding by the investigators.

RESULTS

Thematic analysis revealed the following themes: (1) experience with kidney transplant education by the healthcare team; (2) cultural beliefs regarding kidney transplant; (3) personal motivation and attitude towards kidney transplant; (4) financial burden of kidney transplant and post-transplant care and (5) attitude about living donation.Most participants were educated about transplant as a treatment option after dialysis initiation. All patients in this study recognised that some taboos exist about the process of organ procurement and transplantation; however, the traditional views did not negatively impact their decision to pursue kidney transplant evaluation. Patients shared the common theme of preferring an organ from a living rather than a deceased person; however, the majority did not have a living donor and preferred not to receive an organ from a family member. Most patients did not perceive transplant-related cost as negatively impacting their attitude about receiving a transplant even for patients with below poverty level income.

CONCLUSIONS

Native American patients presenting for kidney transplant were less likely to be educated about transplant before dialysis initiation; did not perceive financial burden and cultural beliefs were not discussed as obstacles to transplant. While a living donor was the preferred option, enthusiasm for living donation from family members was limited.

Awareness and attitude to deceased kidney donation among health-care workers in Sokoto, Nigeria

Background:

Access to renal replacement therapy by the increasing population of patients with end-stage kidney disease across Sub-Saharan Africa, including Nigeria, has become a major public health challenge. Although deceased kidney donation constitutes a viable source, its uptake by patients is contingent on its acceptance by health-care workers.

Objectives:

The aim of this study is to assess the awareness and attitude to deceased kidney donation among health-care workers in Sokoto, Nigeria.

Materials and Methods:

A cross-sectional study was conducted among 470 staff of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria (attending a 1-week seminar), selected by universal sampling. Data were collected with a set of pretested, self-administered, and semi-structured questionnaire.

Results:

The mean age of the respondents was 34.1 ± 7.8 years, and most of them (77.7%) were aged <40 years. Majority of respondents were males (60.6%), married (76.5%), and Moslems (73.5%). While almost all the respondents (98.1%) were aware of deceased kidney donation, only about half (51.9%) were willing to accept deceased kidney donation. Furthermore, 43.4% were willing to give consent to donate deceased relative's kidney, and 26.1% were willing to carry an organ donation card. Predictors of willingness to accept deceased kidney donation were male sex, being a medical doctor or laboratory scientist and being a Moslem (Odds ratio >2, P < 0.05). The major disincentives reported were fear that it may not work (42%) and fear of disease transmission (37.0%).

Conclusion:

Periodic education of health-care workers on effectiveness and safety of deceased kidney donation is crucial to promoting its acceptance among them.

Sleep Quality and Related Psychosocial Variables Among Renal Transplant Patients

BACKGROUND

Several studies have examined sleep quality in the post renal transplant population of China, but few studies have actually confirmed the related psychosocial variables of sleep quality in renal transplant recipients with home care.

OBJECTIVES

This study investigates sleep quality and its related psychosocial variables among renal transplant patients.

METHODS

This is a cross-sectional study using a convenient sampling approach. Self-report questionnaires were applied to 485 renal transplant patients. All participants completed the General Data Questionnaire, the Pittsburgh Sleep Quality Index (PSQI), the Self-Rating Depression Scale, the Three-Dimensional Inventory of Character Strengths, and the Flourishing Scale.

RESULTS

A total of 438 valid questionnaires were included in the analysis. The global PSQI score was 5.86 (SD, 3.20), significantly lower than the norm; 128 (29.2%) recipients were classified as having poor sleep quality (global PSQI > 7). In the component score of PSQI, sleep onset latency was the highest; the others from high to low are sleep disturbance, daytime dysfunction, subjective sleep quality, sleep efficiency, sleep duration, and use of hypnotic medication. A total of 19.6% reported sleeping fewer than 6 hours a night, 64.8% reported that they had to get up to use the bathroom, and 50.0% woke up in the middle of the night or early morning at least 1 night per week in the past month. Significant differences in the PSQI scores were observed in renal transplant patients of different sex, age, residence, career, length of post-renal transplant period, comorbidity, kidney function, and depressive symptoms (P < .05). The PSQI scores were positively correlated with depression (Self-Rating Depression Scale) (P < .01) but negatively correlated with inquisitiveness (Three-Dimensional Inventory of Character Strengths-inquisitiveness) and psychological well-being (Flourishing Scale) (P < .01).

CONCLUSION

The sleep quality of renal transplant patients was lower than that of the general population. Character strengths and well-being can increase the level of sleep quality in renal transplant patients. Psychosocial intervention is necessary for improving the sleep quality of renal transplant recipients in China.

Hemodialysis Patients' Willingness to Undergo Kidney Transplantation: An Observational Study

BACKGROUND

The number of dialysis patients is increasing, with only 20% undergoing kidney transplantation. In Saudi Arabia, no studies had examined transplantation barriers from the patients' perspectives. We aimed in this study to estimate hemodialysis (HD) patients' willingness to undergo kidney transplantation and to explore its underlying determinants.

METHODS

In an observational cross-sectional study involving adult HD patients from King Abdulaziz Medical City and King Abdullah Dialysis Center-Jeddah, patients were interviewed through a pre-tested questionnaire. Calculated sample size was 243.

RESULTS

Among the 252 HD patients (mean age, 55 years [standard deviation = 15.21]; 59% men; median duration on HD, 24 months [interquartile range, 11.1, 60]), 61% described their knowledge about kidney transplantation as "poor" or "very poor." Only 69% chose "willingness to undergo kidney transplantation" (proportion, 0.69; 95% confidence interval [CI], 0.64-0.75). The main reported reasons against willingness were being too old for transplantation (61%) and fear of surgical complications (26%). Less willingness was shown with age ≥60 years (adjusted odds ratio [AOR], 0.2; 95% CI, 0.11-0.36; P < .001), duration on HD ≥5 years (AOR, 0.47; 95% CI, 0.25-0.89; P = .021), and being non-married (AOR, 0.47; 95% CI, 0.24-0.93; P = .03).

CONCLUSIONS

Approximately one third of the respondents did not choose "willingness to undergo kidney transplantation." Willingness was negatively associated with older age, lack of spouse, and longer duration on HD. The majority of HD patients reported poor knowledge about kidney transplantation. Therefore, structured education may optimize the knowledge, perceptions, and attitudes of HD patients toward kidney transplantation and hence improve their transplantation willingness.