title: Denial Defense Mechanism in Dialyzed Patients.
abstract: BACKGROUND
  It is a struggle to identify the most adaptive coping strategies with disease-mediated stress. Here, we hypothesize that intensity of coping strategies, including denial, in patients with end-stage renal disease (ESRD), varies with type of renal replacement therapy (RRT).
  
  
  METHODS
  We enrolled 60 in-center hemodialyzed patients (HD) and 55 patients treated with continuous ambulatory peritoneal dialysis (CAPD). We administered the Coping Inventory with Stressful Situation, Profile of Mood States, and Stroop Anxiety Inventory to measure patient coping strategies in the context of their ESRD. Denial defense mechanism was measured via the IBS-R/ED. The Nottingham Health Profile was used to evaluate self-perceived quality of life. Serum potassium, urea, creatinine, phosphorus, calcium, albumin, and hematocrit were utilized as the measurements of adequacy of dialysis.
  
  
  RESULTS
  HD patients had higher self-reported intensity of denial mechanism and avoidance-oriented strategies versus CAPD patients. Because a single strategy is almost never employed, we conducted cluster analysis. We identify 3 patterns of coping strategies using cluster analysis. "Repressors" employed denial and avoidance strategies and were predominant in HD. The second cluster consists of subjects employing predominantly task-oriented strategies with equal distribution among dialyzed patients. The third cluster encompassed a small group of patients who shared higher intensity of both denial and task-oriented strategies. Health-related outcome, anxiety, and mood profile were similar across all patients.
  
  
  CONCLUSIONS
  HD patients predominantly used "repressive" strategies. Patients on RRT utilized denial and avoidance-based strategies to achieve satisfactory outcome in terms of perceived quality of life. We conclude that these coping mechanisms that were previously thought to be inferior are beneficial to patient compliance with RRT.
authors.affiliation: Department of Nephrology and Dialysotherapy, Military Institute of Medicine, Warsaw, Poland.
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Nowak
authors.affiliation: Department of Nephrology and Dialysotherapy, Military Institute of Medicine, Warsaw, Poland.
authors.forename: Zofia
authors.initials: Z
authors.lastname: Wańkowicz
authors.affiliation: Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Laudanski
mesh_terms: D000223:Adaptation, Psychological / Q000502:physiology*; D000328:Adult; D000339:Affect / Q000502:physiology; D000368:Aged; D000418:Albumins / Q000378:metabolism; D001007:Anxiety / Q000209:etiology; D002118:Calcium / Q000097:blood; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D003430:Cross-Sectional Studies; D003717:Denial, Psychological; D005260:Female; D006400:Hematocrit; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000523:psychology*; D010758:Phosphorus / Q000097:blood; D011188:Potassium / Q000097:blood; D011788:Quality of Life / Q000523:psychology*; D006435:Renal Dialysis / Q000523:psychology* / Q000592:standards; D018709:Statistics, Nonparametric; D014508:Urea / Q000097:blood
chemical_list: D000418:Albumins; D010758:Phosphorus; D014508:Urea; D003404:Creatinine; D011188:Potassium; D002118:Calcium