title: Effects of acceptance of disability on death or dialysis in chronic kidney disease patients: a 3-year prospective cohort study.
abstract: BACKGROUND
  Acceptance of disability (AOD) is a useful construct that assesses the ability of a patient to psychologically cope with chronic diseases, but its effect on long-term outcomes of patients with chronic kidney disease (CKD) remains unclear. This study aimed to evaluate the relation between AOD level and clinical outcomes in a cohort of CKD patients in Taiwan.
  
  
  METHODS
  262 CKD patients without dialysis at a hospital in Taiwan were consecutively recruited, from 2010 to 2011, and followed up for 3 years. At enrollment, demographic and clinical data were obtained, including baseline level measurement of AOD, using the Acceptance of Disability Scale-Revised (AODS-R). During follow-up, the authors assessed the effect of AOD on progression to dialysis and all-cause mortality by using Cox proportional hazard regression analysis.
  
  
  RESULTS
  Of the patients included in the analyses, 145 (55.3 %) whose total scores of AOD were below the median (86.00) were regarded as having low AOD at enrollment. At the end of 3-year follow-up, 25 have died and 57 initiated dialysis. Participants with low AOD were more likely to have the composite end-point of progression to dialysis or death (adjusted hazard ratios [AHR] = 1.89, 95 % confidence interval [CI]: 1.18-3.20). In addition, CKD stage at IV or above and hemoglobin level were found to be associated with the occurrence of the composite end-point.
  
  
  CONCLUSIONS
  AOD was associated with an increased risk for poor clinical outcomes, thus suggesting that prompt awareness and management of the psychological reactions may improve clinical outcomes of patients with CKD.
authors.affiliation: Department of Nursing, Dalin Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, Chiayi, Taiwan.|College of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan.
authors.forename: Hsin-Hung
authors.initials: HH
authors.lastname: Chiang
authors.affiliation: Rehabilitation Counseling Program, Portland State University, Oregon, USA.
authors.forename: Hanoch
authors.initials: H
authors.lastname: Livneh
authors.affiliation: Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.|Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
authors.forename: How-Ran
authors.initials: HR
authors.lastname: Guo
authors.affiliation: Department of Nursing, Dalin Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, Chiayi, Taiwan.
authors.forename: Mei-Ling
authors.initials: ML
authors.lastname: Yen
authors.affiliation: Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan. dm732024@tzuchi.com.tw.|Department of Medical Research, Dalin Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, No. 2, Minsheng Rd., Dalin Township, Chiayi, County 62247, ROC, Taiwan. dm732024@tzuchi.com.tw.|Department of Nursing, Tzu Chi University of Science and Technology, Hualien, Taiwan. dm732024@tzuchi.com.tw.
authors.forename: Tzung-Yi
authors.initials: TY
authors.lastname: Tsai
mesh_terms: D000223:Adaptation, Psychological; D001293:Attitude to Death; D015331:Cohort Studies; D006233:Persons with Disabilities / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D011446:Prospective Studies; D006435:Renal Dialysis / Q000401:mortality / Q000523:psychology* / Q000706:statistics & numerical data; D051436:Renal Insufficiency, Chronic / Q000401:mortality / Q000523:psychology* / Q000628:therapy*; D018570:Risk Assessment / Q000379:methods; D013624:Taiwan / Q000453:epidemiology