# Comparative psychological well-being evaluation among CKD patients on conservative therapy, dialysis, or kidney transplantation: a cross-sectional study

## TL;DR

This study compares the mental health of CKD patients on dialysis, kidney transplantation, or conservative therapy, finding that dialysis patients have worse psychological outcomes.

## Contribution

The study introduces the role of serum irisin levels in influencing psychological well-being among dialysis patients.

## Key findings

- Dialysis patients scored worse on psychological tests than preemptive and transplant patients.
- Higher serum irisin levels in dialysis patients correlated with better psychological conditions.
- Transplanted patients over 50 years old showed better psychological outcomes than younger ones.

## Abstract

Background Chronic kidney disease (CKD) has a significant impact on psychological well-being. Here, the psychological evaluation of patients with CKD undergoing replacement treatment (dialysis or kidney transplantation) and conservative therapy (preemptive patients, who are waiting list for kidney transplantation) was analyzed. In addition, serum irisin levels, a protein displaying anxiolytic and antidepressant effects in mice, were measured in dialysis patients. Methods Dialysis (N = 57), non-dialysis (preemptive, N = 31) and kidney transplant patients (N = 33) were enrolled. All participants underwent psychometric tests including State–Trait Anxiety Inventory (STAI-Y 1 and 2 form), Psychological General Well-Being Index (PGWBI), Symptom Checklist-90-R (SCL-90-R), etc. Serum irisin levels in dialyzed patients were measured by ELISA assay. Results Dialysis patient group scored worse on all tests performed than both preemptive and kidney transplant patients. Indeed, dialysis patients displayed the lowest PGWBI score, and higher scores of BDI, and STAY-1 and STAY-2, compared with preemptive and kidney transplant patients. We also found that about 40% of dialysis patients showed significant psychological distress with higher clinical attention values in the somatization, obsessive-compulsive, depression, and anxiety domains assessed by SCL-90. Furthermore, the stratification of all patients into groups younger and older than 50 years showed that the older group of transplanted patients displayed better outcomes than the younger ones. Finally, stratification of dialysis patients according to irisin levels revealed that only those with higher serum irisin levels had better psychological conditions in tests. Conclusions Kidney transplantation as well as conservative therapy were related to a lower prevalence of depressive symptoms and other psychological disorders than dialysis. Furthermore, all transplanted patients over 50 years of age showed better outcomes than the younger ones. However, dialyzed patients with high levels of circulating irisin displayed better psychological conditions. Overall, our findings supported the importance to provide timely access to transplantation and to improve psychological support for dialysis patients.