Illness and treatment beliefs, cognitive functioning and quality of life in end stage renal disease (ESRD)
This thesis examines the neuropsychological functioning and health-related quality of life (HQoL) in patients with ESRD undergoing on different treatments (hemodialysis; peritoneal dialysis and transplantation). The aim was to investigate the effects of illness and treatment beliefs on HQoL in patients with End Stage Renal Disease. Comparisons were undertaken between dialysis and transplant patients, between patients on haemodialysis (HD) and on peritoneal dialysis (PD) and patients with a cadaver (CAD) or a living related renal transplant (LRD). A sample of 117 transplant (mean age = 50.3 years) and 145 dialysis patients (mean age = 50.1 years) completed questionnaires assessing illness and treatment beliefs, mood and HQoL. A neuropsychological test battery was also administered and the patients' biochemistry was assessed. Haemodialysis and Peritoneal Dialysis patients were administered the neuropsychological battery test battery on 2 consecutive days (pre-and 24-hours post-dialysis) whereas transplant patients were only assessed once. Neuropsychogical results indicated almost equivalent cognitive functioning among treatment groups. Transplant patients outperformed dialysis patients only in memory tasks. Significant improvements in neuropsychological functioning (attention, concentration, memory, and psychomotor speed) were found in hemodialysis patients 24 hours postdialysis. No such fluctuations were found in peritoneal dialysis patients. Although biochemical changes were found in the hemodialysis patients at the same time points, these were not consistently related to the neurospychological changes. Results also showed that illness and treatment beliefs did not differ between the dialysis groups. Transplant recipients however, were more likely to hold an acute timeline, perceive more control, less consequences, less symptoms and less illness and treatment related burden compared to dialysis. HQoL was impaired in dialysis patients, particularly in physical SF-36 dimensions compared to transplant patients and general population norms. Post-hoc analyses revealed that peritoneal dialysis patients had more compromised HQoL than both haemodialysis and transplant patients. Multiple regressions indicated that illness and treatment intrusiveness, consequences and medication concerns predicted QoL in both dialysis and transplant patients over and above the effect of sociodemographic, medical. and mood variables. Explained variance ranged from 28.4% to 65.8%, with different variables emerging as significant predictors in emotional and physical SF-36 dimensions (mental and physical component scores) in dialysis and transplantation. The findings suggest that although NP outcomes are roughly equivalent in ESRD treatments, dialysis and transplantation may induce distinct illness and treatment beliefs which appear to have a direct influence on HQoL.