Personality dimensions of haemodialysis patients related to initial renal disease

OBJECTIVE

The aim of the study was to investigate personality dimensions in uraemic patients undergoing haemodialysis (HD. The relationship between the disease that led to renal failure (and the subsequent need for haemodialysis) and the personality of the haemodialysis patients in question were investigated.

METHODS

In the present study, which was conducted in three Greek hospitals, 103 patients were analysed and compared to 138 control patients matching the groups according to their age, sex and place of residence. The investigation was conducted using the Eysenck Personality Questionnaire (EPQ), a reliable method for clinical studies that measures three dimensions of personality: neuroticism, psychoticism and introverted/extroverted.

RESULTS

The results from the EPQ were compared to the three disease categories that cause renal failure: glomerulonephritis, polycystic disease, and vascular disease. It was concluded that haemodialysis systematically affected all three scales of personality disorders in the patients. Male patients scored higher in neuroticism, while female patients appeared to score higher in psychoticism. Renal disease, the responsible factor for renal failure and the need for haemodialysis, significantly affected personality disorders.

CONCLUSION

The findings show that dialysis modality influences the personalities of patients, and that initial renal disease must be strongly considered in the psychosocial evaluation and care of these patients.

Perceptions of genetic risk in individuals with a one in two chance of developing autosomal dominant polycystic kidney disease

OBJECTIVE

To determine the level of understanding of personal genetic risk in people born with a one in two risk of having autosomal dominant polycystic kidney disease (ADPKD).

DESIGN

Consenting individuals, contacted through affected family members, were asked standard questions about their knowledge of their own genetic risk. These questions were incorporated into a study investigating the use of DNA diagnostic techniques in ADPKD which was an opportunity to interview a substantial number of Australians at risk of inheriting this condition.

SETTING

Interviews were conducted in the individuals' homes, or at the Royal Melbourne Hospital Renal Clinic or the Royal Children's Hospital Genetics Clinic.

PATIENTS

Three hundred and eighty-seven individuals aged 15 years or more, born with a one in two risk but who had remained undiagnosed up until the time of study were identified within 46 families. Sixty-six were excluded from the study either because they resided too far away or they declined involvement. The remaining 321 were assessed clinically, 304 of whom were also interviewed about their understanding of their risk of having inherited this condition.

RESULTS

Thirty per cent knew their risk at birth was one in two. Nine per cent were unaware that ADPKD was an inherited condition. Forty-one per cent were aware that ADPKD was inherited but had no opinion about their personal risk. Three per cent thought that they had no chance of having the condition, 3% thought that they were definitely affected, 8% considered their risk lay from 1%-49% and 6% thought their risk lay from 51%-99%.

CONCLUSION

Within this group of people with a high risk of having an inherited condition with preventable and treatable components, the majority has a poor understanding of their genetic risk.

Education and attitudes in families with adult polycystic kidney disease

The availability of methods for early accurate identification of individuals at risk of developing adult polycystic kidney disease (ADPKD) has raised a number of important clinical problems. As part of a project on clinical and genetic aspects of ADPKD, we have assessed the knowledge and attitudes of patients and their families. Most had a poor knowledge of the condition and its implications. Despite this, many were in favour of early, including antenatal, diagnosis. A videotape was therefore introduced as part of an educational programme to improve patients' knowledge. This resulted in a marked improvement in understanding of the condition. Although a significant number still wished to consider early diagnosis in their offspring, very few would consider terminating an affected pregnancy.

Organic manic syndrome associated with advanced uraemia due to polycystic kidney disease

Mania secondary to advanced uraemia caused by polycystic disease of the kidneys in a 62-year-old woman involved a complex interplay of physical, psychological and social factors. Psychotherapy and thioridazine led to full recovery.

Adult polycystic kidney disease: knowledge, experience, and attitudes to prenatal diagnosis

One hundred and ninety subjects from 100 adult polycystic kidney disease (APKD) families on the North Western Regional Genetic Register were interviewed to determine the likely demand for prenatal diagnosis. A detailed questionnaire was used to assess understanding and experience of clinical, therapeutic, and genetic aspects of APKD. Major features of the disease (presence of renal cysts which can lead to renal failure) and forms of therapy (dialysis and transplantation) were known; knowledge of less common features was related to experience. The cohort had had genetic counselling and the majority knew the risk to their own offspring, although the mechanics of the mode of inheritance was often misunderstood. Uptake of presymptomatic ultrasound testing was high, and some implications of early diagnosis are noted. A minority changed their reproductive behaviour as a result of APKD, and although the majority felt a prenatal test should be available, only 23% at high risk of passing on the disease and contemplating children felt they would be interested, and so far only one request for prenatal diagnosis has been received. Thus, demand appears to be low and to be related to perception of the seriousness of APKD.

Attitudes of at-risk and affected individuals regarding presymptomatic testing for autosomal dominant polycystic kidney disease

One hundred forty-one individuals with autosomal dominant polycystic kidney disease (ADPKD) and 137 at-risk individuals from 107 kindreds answered a questionnaire to determine knowledge and attitudes about ADPKD and the use of gene linkage analysis for prenatal and postnatal presymptomatic diagnosis. Both groups of individuals displayed a high level of knowledge about the disease. Although 87% of affected individuals considered the recurrence risk of ADPKD high, only 11% of ADPKD did not have children for this reason after diagnosis. Ninety-seven percent of at-risk individuals would utilize gene testing for themselves. Eight-eight percent of ADPKD and 89% of at-risk individuals would test offspring (not significant, NS) and 65% of ADPKD and 50% of at-risk individuals between the ages of 18 and 40 would use prenatal testing (NS). Only 4% of ADPKD and 8% of at-risk individuals between the ages of 18 and 40 would terminate a pregnancy for ADPKD. A greater percentage would terminate a pregnancy for a serious medical problem. The factors influencing presymptomatic testing were analyzed. The data suggest that presymptomatic testing will not substantially modify incidence of ADPKD since it may only occasionally alter reproductive plans.

Genetic counseling in adult polycystic kidney disease in Israel

45 patients with autosomal dominant polycystic kidney disease (APKD) were interviewed with regard to their knowledge about the familial nature of their disease. 22 patients (mean age up to 57 years) were treated with chronic dialysis, and 23 (mean age up to 49 years) had either normal serum creatinine or chronic renal failure without dialysis (serum creatinine range 1-7 mg/dl). Most of the patients knew the name and prognosis of their disease, but only 9% of them knew that half of their children might be at risk. Only 38% of the patients wanted to know that they had APKD before they had children and only 18% would not have had children if they had known beforehand that they were ill. 45% of the patients on dialysis and 78% of the patients not on dialysis would have had children in spite of their disease. The difference between the two groups is significant (p = 0.006). There was a correlation between the duration of follow-up of the patients and their children's knowledge (r = 0.38; p = 0.017). Genetic counseling in Israel is similar to that in other countries, but there is a large difference between the patients in Israel and others regarding their attitude towards childbearing. The finding of a linkage between a polymorphic region on chromosome 16 (3' HVR) to the locus of APKD makes a prenatal diagnosis of the disease possible. This could be a valuable tool for efficient counseling in the future.

Individual and family coping with polycystic kidney disease: the harvest of denial

A multigeneration family with polycystic kidney disease (PCKD) was studied by personal interviews of all affected and most suspected-affected adults. A clear pattern of denial was identified, which strongly influenced individuals' awareness of PCKD and individuals' taking actions appropriate to that awareness, as well as family cohesion and communication. Time lags--in fact, availability, awareness and action-taking had serious consequences in terms of continued genetic transmission, future "burden" to the family and society, and the psychological stability of individual family members. The potentially important roles of the family physician in this type of familial disease are discussed as: a source of information, a facilitator of awareness and appropriate action, and a counselor in assisting adaptation to this major life stress.