Psychological Factors in End-stage Renal Disease
Studies of the influence of psychological factors upon the course of end-stage renal disease (ESRD) have nearly all focused on de-pression or noncompliance. There has been essentially no inves-tigation of psychological factors in chronic renal failure before end stage. Depression is associated with smoking, alcoholism and other forms of substance abuse that are highly prevalent in ESRD patients. It is clear that depression predicts higher mortality.
Compliance is a complex, multidimensional array of be-haviors, and its relationship with health outcomes in dialysis patients is difficult to study. Thus, whereas effects of noncom-pliance on dialysis patients’ outcomes are well recognized by physicians, they have not been adequately characterized empiri-cally. Nevertheless, the widespread belief among physicians and nurses that noncompliance results in worse outcomes including higher mortality in ESRD is supported by a large multicenter study (Leggat et al., 1998). The chronic overuse of nonsteroidal anti-inflammatory agents and analgesics is a maladaptive health behavior recognized as a fairly common contributing cause of chronic renal insufficiency.