Dialysis and kidney transplantation: similarities and differences in the psychological aspects of noncompliance.
BACKGROUND
Dialysis and kidney transplantation represent two effective strategies in treating chronic uremia, albeit with different results. Our study compared the psychological aspects of two categories of patients: patients who faced kidney transplantation and have been on dialysis, and noncompliant patients treated with these therapies.


METHODS
On 170 patients (120 hemodialysis and 50 peritoneal dialysis) we used a personality analysis (MMPI2) and the COPE, which assessed the ability of patients to cope under certain conditions that can be perceived as stressful or, in any case, unusual. The screening succeeded in 11 cases among the first group and 9 in the second. Three of the 20 patients were considered to be partially noncompliant: 1 on peritoneal and the other 2 on hemodialysis. We also tested a control group of 300 people of different ages, sexes, social and cultural status, dates and kinds of transplantation (cadaveric or living donors). Of the 36 feedbacks received, only 30 were considered valuable.


RESULTS
The results of the research showed that patients with less than 2 years of dialysis treatment and patients with more than 2 years survival after transplantation time were inclined to deny their disease and the possible emotions about their clinical status, drawing an inadequate attention to the difficulties. This behavior was clearer among noncompliant patients. Family problems and couple malaise in everyday life can push more and more of these patients to be noncompliant with therapeutic prescriptions, as they do not feel adequate support. The result is an excessive foreboding, poor disposition, and nervousness.


CONCLUSIONS
Screening of patients' social and psychological status is useful as is psychological intervention for those who miss emotional support from the family. This psychological support is advisable for uremics who have to enter a waiting list and for those who are subject to postoperative treatment in order to promote compliant behavior.
Rapisarda
F
F
Cattedra di Chirurgia Generale e Trapianti d'Organo, Palermo, Italy. fabrapis@libero.it
Tarantino
A
A
De Vecchi
A
A
Baggio
G
G
Ghezzi
F
F
Nicodemo
D
D
Resega
R
R
Li Vecchi
M
M
D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000523:psychology*; D008950:MMPI; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000523:psychology*; D011581:Psychological Tests; D006435:Renal Dialysis / Q000523:psychology*; D013315:Stress, Psychological; D016312:Treatment Refusal / Q000523:psychology*