Purpose: Long-term dialysis has been shown to adversely affect physical health-related quality of life (HRQOL) but its effect on mental HRQOL and symptoms of depression and anxiety in kidney transplant (KTX) recipients has not been studied. We examined whether duration of dialysis preceding KTX is associated with the values and temporal trajectories of mental health-related patient-reported outcomes (PROs).

Methods: PROs were measured using the Short Form 36 Health Survey Mental Component Summary (MCS), Center for Epidemiologic Studies Depression Scale, and Beck Anxiety Inventory. Duration of pre-KTX dialysis was stratified based on frequency distribution quartiles, with no dialysis as the reference group. Multivariable mixed effects models evaluated gender- and age-adjusted effects of follow-up time, duration of dialysis (none, ≤12, 13-24, 25-60, >60 months) and the time by dialysis group interaction effect on PROs.

Results: The sample included 217 adults with pre- and post-transplant PRO data (44% male; age 50+32 years; follow up time 39+32 months; KTX years 2002-2016; 789 longitudinal data points). After adjusting for age and gender, levels of depression and anxiety did not change significantly over time (p>0.292) but the temporal trajectories of anxiety scores by dialysis duration group was statistically marginal (interaction p=0.070). Patients dialyzed greater than 5 years had significantly higher depression and anxiety scores compared to those who were never dialyzed (p≤0.011). While overall MCS scores improved over time (p=0.020), their trajectories differed between dialysis duration groups (interaction p=0.003), with scores of patients on dialysis between 1 and 5 years declining within general population limits compared to those who were never dialyzed (interaction p<0.003).

Conclusions: Recent modifications to the kidney allocation system have resulted in increased KTXs for those who have been on chronic maintenance dialysis for 5 or more years. This research suggests that pre-KTX duration of dialysis greater than 5 years is associated with increased symptoms of depression and anxiety in KTX recipients and supports the relevance of enhanced mental health monitoring in patients who were dialyzed for extended periods.

CITATION INFORMATION: Radomski S, Feurer I, Forbes R, Concepcion B, Schaefer H. A Possible Unintended Consequence of the Kidney Allocation System: The Effect of Duration of Dialysis on Mental Health Outcomes. Am J Transplant. 2017;17 (suppl 3).

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