Psychological Indices and Health-Related Quality of Life in Renal Replacement Therapy: A Three Groups Cross-Sectional Study.

Background: Chronic kidney disease (CKD) is a significant global health concern. Patients in the last stage of CKD, also known as end stage kidney disease (ESKD), need to use one of the methods of renal replacement therapy including hemodialysis (HD), peritoneal dialysis (PD), and kidney transplantation (KT). ESKD adversely affects physical and mental health, as well as overall quality of life. However, limited research has explored the association between these health burdens and treatment modalities in Iran. Methods and Materials: This cross-sectional study included 215 patients with ESKD undergoing HD (n = 66), PD (n = 70), and KT (n = 79) at treatment centers in Mashhad, Iran. A checklist of demographic information, quality of life questionnaire specific for kidney disease patients (Kidney Disease Quality of Life Short Form [KDQOL-SF], version 1.3), Hamilton depression and anxiety inventories, and the Cassidy inventory for problem-solving and social support were distributed among patients. A regression model was employed to adjust for potential confounders, and statistical analysis was conducted using SPSS 11.5. Results: Kidney transplant recipients were younger than patients in the HD and PD groups and exhibited significantly higher mean scores in most domains of the KDQOL, both in general and specific domains. After adjusting for confounding variables such as age, transplant patients were found to have the highest quality of life scores in specific domains. Depression prevalence was high, ranging from 60% to 65% across all groups, with no significant intergroup differences. Anxiety prevalence ranged from 21% to 26%, also without significant differences. Social support was reported as high among ESKD patients (70%-82%) with no variation between treatment modalities. Conclusion: KT was associated with better quality-of-life outcomes compared to HD and PD, highlighting the potential benefits of organ donation programs. Given the substantial burden of mental health issues among ESKD patients, early detection and intervention for depression and anxiety should be prioritized in both dialysis and transplant populations.