Abstract

Pre-emptive kidney transplantation (PEKT) is considered one of the most effective types of kidney replacement therapies to improve the quality of life (QOL) and physical prognosis of patients with end-stage renal disease (ESRD). In Japan, living-donor kidney transplantation is a common therapeutic option for patients undergoing dialyses (PDKT). Moreover, during shared decision-making in kidney replacement therapy, the medical staff of the multidisciplinary kidney team often provide educational consultation programmes according to the QOL and sociopsychological status of the ESRD patient. In Japan, the majority of kidney donations are provided by living family members. However, neither the psychosocial status of donors associated with the decision-making of kidney donations nor the interactions of the psychosocial status between donors and recipients have been clarified in the literature. In response to this gap, the present study determined the QOL, mood and anxiety status of donors and recipients at kidney transplantation decision-making between PEKT and PDKT. Deterioration of the recipient’s QOL associated with “role physical” shifted the decision-making to PEKT, whereas deterioration of QOL associated with “role emotional” and “social functioning” of the recipients shifted the decision-making to PDKT. Furthermore, increased tension/anxiety and depressive mood contributed to choosing PDKT, but increased confusion was dominantly observed in PEKT recipients. These direct impact factors for decision-making were secondarily regulated by the trait anxiety of the recipients. Unlike the recipients, the donors’ QOL associated with vitality contributed to choosing PDKT, whereas the physical and mental health of the donors shifted the decision-making to PEKT. Interestingly, we also detected the typical features of PEKT donors, who showed higher tolerability against the trait anxiety of reactive tension/anxiety than PDKT donors. These results suggest that choosing between either PEKT or PDKT is likely achieved through the proactive support of family members as candidate donors, rather than the recipients. Furthermore, PDKT is possibly facilitated by an enrichment of the life–work–family balance of the donors. Therefore, multidisciplinary kidney teams should be aware of the familial psychodynamics between patients with ESRD and their family members during the shared decision-making process by continuing the educational consultation programmes for the kidney-replacement-therapy decision-making process.

Highlights

  • Chronic kidney disease is a common disease affecting 5∼10% of the population worldwide [1,2,3]

  • A number of clinical studies have reported that pre-emptive kidney transplantation (PEKT) contributes to a better prognosis among recipients and better survival of the transplant compared to receiving a transplant after dialysis (PDKT) or receiving cadaveric kidney transplantation [14,15,16,17]

  • There were no differences of duration in chronic kidney disease between the PEKT and PDKT recipients (15.7 ± 15.3 and 11.4 ± 9.93 years, respectively)

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Summary

Introduction

Chronic kidney disease is a common disease affecting 5∼10% of the population worldwide [1,2,3]. The majority of patients with chronic kidney disease remain at risk of progressing to kidney failure (previously end-stage renal disease: ESRD). There are two types of major therapeutic modalities for ESRD: Dialyses (haemodialysis and peritoneal dialysis) and kidney transplantation [5]. It was established that kidney transplantation in eligible patients with ESRD is a better therapeutic option than long-term dialyses [6,7], due to its association with long-term survival and quality of life (QOL) [8,9,10,11,12]. In Japan, haemodialysis is the most common choice for ESRD treatment, followed by peritoneal dialysis and kidney transplantation [18]. PEKT still accounts for 10% of kidney transplantations in Japan compared to 27% for the United States [18]

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