title: Sleep disorders, depressive symptoms and health-related quality of life--a cross-sectional comparison between kidney transplant recipients and waitlisted patients on maintenance dialysis.
abstract: BACKGROUND
  Kidney transplantation is believed to improve health-related quality of life (HRQoL) of patients requiring renal replacement therapy (RRT). Recent studies suggested that the observed difference in HRQoL between kidney transplant recipients (Tx) vs patients treated with dialysis may reflect differences in patient characteristics. We tested if Tx patients have better HRQoL compared to waitlisted (WL) patients treated with dialysis after extensive adjustment for covariables.
  
  
  METHODS
  Eight hundred and eighty-eight prevalent Tx patients followed at a single outpatient transplant clinic and 187 WL patients treated with maintenance dialysis in nine dialysis centres were enrolled in this observational cross-sectional study. Data about socio-demographic and clinical parameters, self-reported depressive symptoms and the most frequent sleep disorders assessed by self-reported questionnaires were collected at enrollment. HRQoL was assessed by the Kidney Disease Quality of Life Questionnaire.
  
  
  RESULTS
  Patient characteristics were similar in the Tx vs WL groups: the proportion of males (58 vs 60%), mean ± SD age (49 ± 13 vs 49 ± 12) and proportion of diabetics (17 vs 18%), respectively, were all similar. Tx patients had significantly better HRQoL scores compared to the WL group both in generic (Physical function, General health perceptions, Energy/fatigue, Emotional well-being) and in kidney disease-specific domains (Symptoms/problems, Effect- and Burden of kidney disease and Sleep). In multivariate regression models adjusting for clinical and socio-demographic characteristics, sleep disorders and depressive symptoms, the modality of RRT (WL vs Tx) remained independently associated with three (General health perceptions, Effect- and Burden of kidney disease) out of the eight HRQoL dimensions analysed.
  
  
  CONCLUSIONS
  Kidney Tx recipients have significantly better HRQoL compared to WL dialysis patients in some, but not all, dimensions of quality of life after accounting for differences in patient characteristics. Utilizing multidimensional disease-specific questionnaires will allow better understanding of treatment, disease and patient-related factors potentially affecting quality of life in patients with chronic medical conditions.
authors.affiliation: Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary.
authors.forename: Agnes Zsofia
authors.initials: AZ
authors.lastname: Kovacs
authors.forename: Miklos Zsolt
authors.initials: MZ
authors.lastname: Molnar
authors.forename: Lilla
authors.initials: L
authors.lastname: Szeifert
authors.forename: Csaba
authors.initials: C
authors.lastname: Ambrus
authors.forename: Marta
authors.initials: M
authors.lastname: Molnar-Varga
authors.forename: Andras
authors.initials: A
authors.lastname: Szentkiralyi
authors.forename: Istvan
authors.initials: I
authors.lastname: Mucsi
authors.forename: Marta
authors.initials: M
authors.lastname: Novak
mesh_terms: D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis*; D005260:Female; D005919:Glomerular Filtration Rate; D006304:Health Status; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011788:Quality of Life; D006435:Renal Dialysis; D017582:Renal Replacement Therapy; D012307:Risk Factors; D012893:Sleep Wake Disorders / Q000175:diagnosis*; D014850:Waiting Lists