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Steinack C, Krapf M, Ernst J, Gaisl T, Schuurmans M, von Känel R, Jordan KD. Psychosocial Wellbeing in Lung Transplants Before and After the COVID-19 Vaccine. EXP CLIN TRANSPLANT 2025; 23:220-226. [PMID: 40223386 DOI: 10.6002/ect.2024.0243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2025]
Abstract
OBJECTIVES Lung transplant recipients are vulnerable to respiratory infections because of their compromised immune response. Limited research has been published on mental health as a result of the COVID-19 pandemic on lung transplant recipients, and uncertainty remains whether the COVID-19 vaccine affected mental health in lung transplant recipients. MATERIALS AND METHODS In this longitudinal, retrospective study, we assessed the psychosocial wellbeing of lung transplant recipients during the COVID-19 pandemic at 2 different time points (before and after COVID-19 vaccination). We measured wellbeing with the Hospital Anxiety and Depression Scale (cutoff of 11 points indicated anxiety and depression) and the Symptom Checklist consisting of 9 questions. RESULTS Our study included 83 patients (mean age 52.4 ± 14.5 years, 55.4% male). Among the patients, 3.8% and 4.8% of patients with cystic fibrosis had abnormal values for anxiety before and after the vaccine, respectively; abnormal values for depression were shown in 0% and 2.4% of patients with cystic fibrosis before and after the vaccine, respectively. Sex, age, level of education, time since transplant, and chronic allograft dysfunction were not significantly associated with psychosocial wellbeing. Vaccination against COVID-19 was not associated with a change in psychosocial wellbeing. CONCLUSIONS We found no evidence that the COVID-19 vaccine affected the psychosocial wellbeing of lung transplant recipients. However, it may be important to monitor wellbeing closely during a pandemic, especially in patients with cystic fibrosis.
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wube TB, Asgedom SG, Mengesha AG, Bekele YA, Gebrekirstos LG. Behind the Healing: Exploring the Psychological Battles of Kidney Transplant Patients: A Qualitative Insight. Health Sci Rep 2025; 8:e70511. [PMID: 40008222 PMCID: PMC11850432 DOI: 10.1002/hsr2.70511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2024] [Revised: 01/04/2025] [Accepted: 02/05/2025] [Indexed: 02/27/2025] Open
Abstract
Background and Aims Kidney transplantation is widely regarded as the optimal treatment for end-stage renal disease, offering benefits like prolonged life expectancy, enhanced quality of life, and greater cost-effectiveness compared to dialysis. While dialysis imposes considerable restrictions on patients, including diminished independence, many of these challenges can be alleviated through successful transplantation. However, despite the physical advantages of kidney transplants, the psychological struggles faced by transplant recipients are often overlooked, particularly in Ethiopia. This study aimed to delve into the psychological experiences of kidney transplant patients, shedding light on the emotional and mental battles they encounter post-transplant. Methods This qualitative study involved kidney transplant patients at SPMMC (St. Paul's Millennium Medical College). during the study period, regardless of donor type. A total of ten participants were selected using purposive sampling. Data were collected through semi-structured, interviewer-administered questionnaires containing both closed and open-ended questions. The data were transcribed verbatim and analyzed using interpretative phenomenological analysis (IPA). The analysis focused on understanding participants' experiences and their interpretations of these experiences. Themes were identified by examining commonalities and differences in the participants' accounts, with special attention to areas of convergence and divergence. Results The analysis revealed both positive and negative psychological experiences among kidney transplant patients. Positive experiences included feelings of "re-birth," thankfulness, strengthened social bonds, freedom from dialysis, enhanced self-efficacy, and increased social support. Negative experiences included dependency, fear of the future, challenges with adherence to treatment, and occasional regret. Conclusion Life after a kidney transplant is significantly more positive and empowering compared to life on dialysis. However, psychological challenges remain, highlighting the need for ongoing psychological support to address both positive and negative aspects of the transplant experience. Future research should focus on providing continuous support, including counseling and support groups, and integrating these systems into kidney transplant care to enhance overall recovery.
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Affiliation(s)
- Tsiyon Birhanu wube
- Department of Surgical Nursing, School of NursingCollege of Health Sciences and Comprehensive Specialized Hospital, Aksum UniversityAxumEthiopia
| | - Solomon Gebremichael Asgedom
- Department of Surgical Nursing, School of NursingCollege of Health Sciences and Comprehensive Specialized Hospital, Aksum UniversityAxumEthiopia
| | - Abrehet Girmay Mengesha
- School of PsychologyCollege of Education and Behavioral Studies, Addis Ababa UniversityAddis AbabaEthiopia
| | - Yohannes Ayalew Bekele
- School of Nursing and MidwiferyCollege of Health Science, Addis Ababa UniversityAddis AbabaEthiopia
| | - Lielt Gebreselassie Gebrekirstos
- Department of Maternity and Reproductive Health NursingCollege of Health Science and Medicine, Wolaita Sodo UniversityWolaita SodoEthiopia
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Spinner CD, Bell S, Einsele H, Tremblay C, Goldman M, Chagla Z, Finckh A, Edwards CJ, Aurer I, Launay O, Casañas I Comabella C, James S, Dube S, Borkowska K, Jah F, Kandeil W, Yokota RTC, Artaud C, Gottenberg JE, Gesualdo L, Bertrand D, Arnetorp S, Magiorkinis G. Is COVID-19 Still a Threat? An Expert Opinion Review on the Continued Healthcare Burden in Immunocompromised Individuals. Adv Ther 2025; 42:666-719. [PMID: 39680311 PMCID: PMC11787180 DOI: 10.1007/s12325-024-03043-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Accepted: 10/17/2024] [Indexed: 12/17/2024]
Abstract
Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has had a profound global impact. The emergence of several variants during the pandemic has presented numerous challenges in preventing and managing this disease. The development of vaccines has played a pivotal role in controlling the pandemic, with a significant portion of the global population being vaccinated. This, along with the emergence of less virulent SARS-CoV-2 variants, has led to a reduction in the severity of COVID-19 outcomes for the overall population. Nevertheless, individuals with immunocompromising conditions continue to face challenges given their suboptimal response to vaccination and vulnerability to severe COVID-19. This expert review synthesizes recent published evidence regarding the economic and human impact of COVID-19 on such individuals. The literature suggests that rates of hospitalization, intensive care unit admission, and mechanical ventilation use were high during the pre-Omicron era, and remained high during Omicron and later, despite vaccination for this population. Moreover, studies indicated that these individuals experienced a negative impact on their mental health and health-related quality of life (HRQoL) compared to those without immunocompromising conditions, with elevated levels of anxiety, depression, and distress reported. Further, these individuals with immunocompromising conditions experienced substantial costs associated with COVID-19 and loss of income during the pandemic, though the evidence on the economic burden of COVID-19 in such individuals is limited. Generally, COVID-19 has increased healthcare resource use and costs, impaired mental health, and reduced HRQoL in those with varied immunocompromising conditions compared to both those without COVID-19 and the general population-underscoring the importance of continued real-world studies. Ongoing research is crucial to assess the ongoing burden of COVID-19 in vaccinated individuals with immunocompromising conditions who are still at risk of severe COVID-19 outcomes to ensure their needs are not disproportionately worse than the general population.
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Affiliation(s)
- Christoph D Spinner
- TUM School of Medicine and Health, Department of Clinical Medicine, Clinical Department for Internal Medicine II, University Medical Center, Technical University of Munich, 81675, Munich, Germany.
| | - Samira Bell
- Division of Population Health and Genomics, University of Dundee, Ninewells Hospital, Dundee, Scotland
| | - Hermann Einsele
- Department of Internal Medicine II, University Hospital Würzburg, 97080, Würzburg, Germany
| | - Cécile Tremblay
- Research Centre of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, H2X 0C1, Canada
- Department of Microbiology, Infectiology and Immunology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | | | | | | | - Christopher J Edwards
- NIHR Southampton Clinical Research Facility, University Hospital Southampton, NHS Foundation Trust, Southampton Hampshire, UK
| | - Igor Aurer
- University Hospital Center Zagreb Kišpatićeva ul. 12, and Medical School, University of Zagreb, Šalata 3, 10000, Zagreb, Croatia
| | - Odile Launay
- Université Paris Cité; Inserm CIC1417, F-CRIN I REIVAC; Assistance, Publique Hôpitaux de Paris, Cochin Hospital, Paris, France
| | | | - Samantha James
- Evidera, Evidence, Value and Access by PPD, Paris, France
| | - Sabada Dube
- Epidemiology, Vaccines and Immune Therapies Unit, AstraZeneca, Cambridge, UK
| | - Katarzyna Borkowska
- Evidera, Evidence, Value and Access by PPD, Granta Park Great Abington, Cambridge, UK
| | - Fungwe Jah
- Medical Affairs, BioPharmaceuticals Medical, AstraZeneca, Hamburg, Germany
| | - Walid Kandeil
- Vaccines and Immune Therapies, BioPharmaceuticals Medical, AstraZeneca, Baar, Switzerland
| | | | - Cécile Artaud
- Medical Affairs, Vaccines and Immune Therapies, BioPharmaceuticals Medical, AstraZeneca, Courbevoie, France
| | | | - Loreto Gesualdo
- Renal, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Dominique Bertrand
- Department of Nephrology and Transplantation, University of Rouen, Rouen, France
| | - Sofie Arnetorp
- Health Economics & Payer Evidence, Vaccines & Immune Therapies, BioPharmaceuticals Medical, AstraZeneca, Gothenburg, Sweden
| | - Gkikas Magiorkinis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 72, Athens, Greece
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Ford EC, Sohansoha GK, Patel NA, Billany RE, Wilkinson TJ, Lightfoot CJ, Smith AC. The association of micro and macro worries with psychological distress in people living with chronic kidney disease during the COVID-19 pandemic. PLoS One 2024; 19:e0309519. [PMID: 39436948 PMCID: PMC11495632 DOI: 10.1371/journal.pone.0309519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 08/07/2024] [Indexed: 10/25/2024] Open
Abstract
BACKGROUND Psychological distress can be exacerbated by micro (personal) and macro (societal) worries, especially during challenging times. Exploration of this relationship in people with chronic kidney disease is limited. OBJECTIVES (1) To identify the types and levels of worries concerning people with chronic kidney disease in the context of the COVID-19 pandemic; (2) to explore the association of worries with psychological distress including depression, stress, anxiety, and health anxiety. DESIGN AND PARTICIPANTS A cross-sectional online survey collected data at two time points (Autumn 2020, n = 528; Spring 2021, n = 241). Participants included kidney transplant recipients and people with non-dialysis dependent chronic kidney disease. MEASUREMENTS The survey included questions about worry taken from the World Health Organisation COVID-19 Survey, the Depression, Anxiety and Stress Scale, and the Short Health Anxiety Index. Data were analysed using descriptive statistics and multiple regression. RESULTS Worries about loved ones' health, the healthcare system becoming overloaded, losing a loved one, economic recession, and physical health were the highest rated concerns. Worrying about mental health was associated with higher depression, stress, anxiety, and health anxiety. Worrying about physical health was associated with anxiety and health anxiety. Worrying about losing a loved one was associated with health anxiety, and worrying about not being able to pay bills was associated with stress. CONCLUSIONS People with kidney disease reported micro and macro worries associated with psychological distress during the COVID-19 pandemic. This study highlights factors that should be considered to improve the mental health and well-being of people with kidney disease.
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Affiliation(s)
- Ella C. Ford
- Leicester Kidney Lifestyle Team, Department of Population Health Sciences, University of Leicester, Leicester, United Kingdom
- Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
| | - Gurneet K. Sohansoha
- Leicester Kidney Lifestyle Team, Department of Population Health Sciences, University of Leicester, Leicester, United Kingdom
- Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
| | - Naeema A. Patel
- Leicester Kidney Lifestyle Team, Department of Population Health Sciences, University of Leicester, Leicester, United Kingdom
- Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
| | - Roseanne E. Billany
- Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Thomas J. Wilkinson
- Leicester Kidney Lifestyle Team, Department of Population Health Sciences, University of Leicester, Leicester, United Kingdom
- Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
| | - Courtney J. Lightfoot
- Leicester Kidney Lifestyle Team, Department of Population Health Sciences, University of Leicester, Leicester, United Kingdom
- Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
| | - Alice C. Smith
- Leicester Kidney Lifestyle Team, Department of Population Health Sciences, University of Leicester, Leicester, United Kingdom
- Leicester NIHR Biomedical Research Centre, Leicester, United Kingdom
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Greig AE, Rennie KL, Ali J, Summers D. Exploring the attitudes of solid organ transplant recipients towards COVID-19 shielding communications and the language of 'clinically extremely vulnerable': a qualitative study investigating lessons for the future. BMJ PUBLIC HEALTH 2024; 2:e000695. [PMID: 40018215 PMCID: PMC11812840 DOI: 10.1136/bmjph-2023-000695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 03/01/2024] [Indexed: 03/01/2025]
Abstract
Introduction Solid organ transplant (SOT) recipients were among the first individuals in the UK identified as 'clinically extremely vulnerable' (CEV) to COVID-19 and asked to 'shield' at the beginning of the pandemic in March 2020. This qualitative study explores the attitudes of SOT recipients towards COVID-19 shielding communications and the language used. Methods Semistructured interviews were conducted with 43 adult heart, liver and kidney transplant recipients in England between January 2022 and May 2023. Open-ended questions enabled participants to fully explore their experiences of the pandemic and how they felt towards the shielding advice they received. Interviews were transcribed, anonymised and thematically analysed and coded using NVivo V.12. Results Communications about shielding evoked significant fear and anxiety among participants. These communications were perceived as implying that death was probable, or even inevitable, should they leave their home or fail to follow the official advice. Participants expressed widespread dislike for the term 'CEV', with the word 'vulnerable' being particularly difficult for participants to accept owing to its connotations of weakness and the reminder that participants were not as 'normal' as they typically felt. While shielding restrictions have come to an end, longer term impacts were highlighted by participants who expressed ongoing anxiety, with many still choosing to shield and wear a mask if in public. Conclusions This study suggests that governments and health authorities should carefully consider how they communicate with individuals with underlying health conditions in future public health emergencies. We have developed recommendations for how to improve shielding communications in the future, including replacing the phrase 'CEV' with that of 'higher risk', avoiding using those at higher risk as a national benchmark for risk of illness and death and providing more balanced and engaged communication and advice that takes into consideration the importance of mental well-being.
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Affiliation(s)
- Abbie E Greig
- Department of Geography, University of Cambridge, Cambridge, UK
| | | | - Jason Ali
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Dominic Summers
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Surgery, University of Cambridge, Cambridge, UK
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De Pasquale C, Pistorio ML, Veroux M, Barbagallo N, Cottone PM, Ekser B, Lorenzano G, Giaquinta A, Veroux P. Mental health, COVID-19 burden and quality of life of kidney transplant recipients two years after the COVID-19 pandemic. Front Psychiatry 2024; 15:1338934. [PMID: 38751418 PMCID: PMC11094710 DOI: 10.3389/fpsyt.2024.1338934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 04/15/2024] [Indexed: 05/18/2024] Open
Abstract
Introduction Few studies have evaluated the psychological distress of COVID-19 in kidney transplantation and the psychological impact that the COVID-19 pandemic has had on kidney transplant recipients is not yet well understood. The present study aimed to investigate the change in symptom burden and health-related quality of life in the two years after initial assessment, by outlining the change over time of symptoms at 12 and 24 months of follow-up. Methods This is a follow-up study. We performed a study published in 2021 (phase 1 of COVID-19); of the 89 kidney transplant recipients evaluated in this study, 60 completed the 12 months follow-up (March 2021 June 2021, phase 2 of COVID-19) and 57 completed the 24 months follow-up (March 2022 June 2022, post COVID-19). The same tools as in previous study were administered: the ad hoc questionnaire on emotional state and psychophysical well-being during COVID-19, the Middlesex Hospital Questionnaire (MHQ) to provide a simple and rapid quantification of the psychological and somatic symptoms and the Short Form Health Survey 36 (SF-36) was used to assess health-related quality of life. Results Compared to the first and second phase of COVID-19, the mean score of quality of life variables were higher in the post COVID-19 phase; thus the recipients physical health, mental health and their perception of their general health improved. Regarding the psychopathology variables the levels of Anxiety, Depression and Phobia in the Post COVID-19 phase decreased, while the Somatization score was higher. Lastly, burden of COVID-19 scores in the third phase, significantly decreased. Discussion Our study highlights a significant association between mental health and the burden of COVID-19 pandemic in kidney transplant recipients. This study showed, a significant worsening, over time, of some specific symptoms, such as somatization and phobias. However, the results showed that depressive symptoms improved during the study period. Long-term monitoring of kidney transplant recipients therefore remains fundamental. These results confirmed the need to provide integrated multidisciplinary services to adequately address the long-term effects of the COVID-19 pandemic on the mental health of the most vulnerable subjects.
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Affiliation(s)
- Concetta De Pasquale
- Vascular Surgery and Organ Transplant Unit, Department of Educational Sciences, University of Catania, Catania, Italy
| | - Maria Luisa Pistorio
- Vascular Surgery and Organ Transplant Unit, Department of General Surgery and Medical-Surgical Specialties, University Hospital of Catania, Catania, Italy
| | - Massimiliano Veroux
- Organ Transplant Unit, Department of Surgical and Medical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy
| | - Noemi Barbagallo
- Vascular Surgery and Organ Transplant Unit, Department of General Surgery and Medical-Surgical Specialties, University Hospital of Catania, Catania, Italy
| | - Provvidenza Marisa Cottone
- Regional Transplant Center, Department of Advanced Diagnostics and Services, Civico and Di Cristina Hospital, Palermo, Italy
| | - Burcin Ekser
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Giuseppina Lorenzano
- Vascular Surgery and Organ Transplant Unit, Department of General Surgery and Medical-Surgical Specialties, University Hospital of Catania, Catania, Italy
| | - Alessia Giaquinta
- Vascular Surgery and Organ Transplant Unit, Department of General Surgery and Medical-Surgical Specialties, University Hospital of Catania, Catania, Italy
| | - Pierfrancesco Veroux
- Vascular Surgery and Organ Transplant Unit, Department of General Surgery and Medical-Surgical Specialties, University Hospital of Catania, Catania, Italy
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De Pasquale C, Barbagallo N, Veroux M, Pistorio ML, Zerbo D, Giaquinta A, Ekser B, Veroux P. Nonadherence to Immunosuppressants Among Transplant Recipients: Emotional Intelligence as a Predictive Factor During COVID-19 Pandemic. Patient Prefer Adherence 2023; 17:3083-3092. [PMID: 38045111 PMCID: PMC10691268 DOI: 10.2147/ppa.s426358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/11/2023] [Indexed: 12/05/2023] Open
Abstract
Purpose To evaluate the association between emotional intelligence and fear of COVID-19 on self-reported adherence, based on a cross-sectional design. Patients and Methods Transplants recipient of both sexes aged 23-75 years old were evaluated at the Organ Transplant Unit, University Hospital of Catania, Italy. Data were analyzed using frequency, descriptives, Spearman and Pearson correlations, Chi-square goodness of fit test, and linear regression. Self-reported adherence was estimated with the Basel Assessment of Adherence with Immunosuppressive Medication Scale (BAASIS). Emotional intelligence and fear of COVID were, respectively, measured with the Emotional Intelligence Scale (EIS) and Multidimensional Assessment of COVID-19 Related Fears Scale (MAC-RF). This was a cross-sectional study of kidney transplant recipients. In reporting this study the authors followed the STROBE guidelines. Results A correlation was found between EIS and MAC and between EIS and adherence but there was no correlation between MAC and adherence. A linear regression model was also conducted using a stepwise method, which indicated that EIS was a significant predictor of adherence (p <0.05). Conclusion This study was found that EIS is a predictor of adherence to treatment in transplant patients. Fear of COVID, while positively correlated to EIS, is not correlated to the adherence's outcome, possibly due to the proper follow-up performed to the patients. Indeed, according to these results, we suggest to provide good follow-ups with recipients, with interviews also based on self-regulation and awareness.
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Affiliation(s)
| | - Noemi Barbagallo
- Department of General Surgery and Medical-Surgical Specialties, University Hospital of Catania, Catania, Italy
| | - Massimiliano Veroux
- Department of Surgical and Medical Sciences and Advanced Technologies, University Hospital of Catania, Catania, Italy
| | - Maria Luisa Pistorio
- Department of General Surgery and Medical-Surgical Specialties, University Hospital of Catania, Catania, Italy
| | - Domenico Zerbo
- Department of General Surgery and Medical-Surgical Specialties, University Hospital of Catania, Catania, Italy
| | - Alessia Giaquinta
- Department of General Surgery and Medical-Surgical Specialties, University Hospital of Catania, Catania, Italy
| | - Burcin Ekser
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Pierfrancesco Veroux
- Department of General Surgery and Medical-Surgical Specialties, University Hospital of Catania, Catania, Italy
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Du C, Wang Z, Zhu Y. Analysis of Anxiety and Influencing Factors in Kidney Transplant Recipients and General Public During the COVID-19 Pandemic. Ann Transplant 2023; 28:e941489. [PMID: 37846047 PMCID: PMC10591740 DOI: 10.12659/aot.941489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/23/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has had a profound impact on mental health worldwide. Kidney transplant recipients represent a vulnerable population that may experience increased anxiety due to their health concerns and the risk of infection. This study aims to delve into the psychological anxiety levels and influential factors of kidney transplant patients during the Omicron variant of COVID-19 pandemic in China. MATERIAL AND METHODS A retrospective analysis was conducted using an online survey questionnaire to investigate the anxiety levels of 203 kidney transplant recipients and 53 individuals from the general population. The Self-Rating Anxiety Scale (SAS) was employed to evaluate anxiety levels, and the influencing factors affecting anxiety levels were analyzed for both cohorts. RESULTS Among the cohort of the 203 kidney transplant recipients, 28 individuals (13.8%) had symptoms indicative of anxiety, with an average SAS score of 40.5±9.0. Out of the 53 individuals from the general population, 9 (17.0%) had symptoms of anxiety, with an average SAS score of 39.6±10.7. Notably, females and those with chronic respiratory diseases within the general population showed higher anxiety levels, and having a chronic respiratory condition was found to be an independent risk factor for anxiety levels in the general population. CONCLUSIONS This investigation demonstrates that anxiety levels in kidney transplant recipients and the general population were comparable during the Omicron variant of COVID-19 pandemic. However, kidney transplant patients showed more stable anxiety levels.
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Frölke SC, Bouwmans P, Messchendorp AL, Vervoort JP, Abrahams AC, de Vries AP, Nieuwkerk PT, Hemmelder MH, Gansevoort RT, Hilbrands LB, Reinders ME, Sanders JSF, Bemelman FJ, Geerlings SE, RECOVAC Collaborators ImhofC.IdzingaC.SiegertC.BaanC.C.KoningsC.J.A.M.van KesselC.van BaarleD.DiavatopoulosD.A.StandaarD.ten HoopeE.TilE.RemmerswaalE.B.M.van der KlisF.FritsenH.R.StijnmanI.BrinkmanJ.N.ChengJ.den BiggelaarL.ten DamM.SteenhuisM.ZwerinkM.BraksM.H.J.WillemsM.KhoM.L.RotsN.VartP.van der MolenR.G.van den DorpelR.M.A.MalahaR.S.R.K.ter MeulenR.C.G.RispensT.SteenvoordenT.de RondeT.PetersV.J.P.KonijnW.S.JanssenW.M.T.BosW.J.AdemaY.M.R.VegtingY.. Adherence to preventive measures after SARS-CoV-2 vaccination and after awareness of antibody response in kidney transplant recipients in the Netherlands: a nationwide questionnaire study. EClinicalMedicine 2023; 62:102103. [PMID: 37533418 PMCID: PMC10393559 DOI: 10.1016/j.eclinm.2023.102103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 06/21/2023] [Accepted: 06/29/2023] [Indexed: 08/04/2023] Open
Abstract
Background Kidney transplant recipients (KTRs) were advised to tightly adhere to government recommendations to curb the spread of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) because of a high risk of morbidity and mortality and decreased immunogenicity after vaccination. The aim of this study was to analyse the change in adherence to preventive measures after vaccination and awareness of antibody response, and to evaluate its effectiveness. Methods In this large-scale, national questionnaire study, questionnaires were sent to 3531 KTRs enrolled in the Dutch RECOVAC studies, retrospectively asking for adherence to nine preventive measures on a 5-point Likert scale before and after SARS-CoV-2 vaccination and after awareness of antibody response. Blood samples were collected 28 days after the second vaccination. Antibody response was categorised as non-responder (≤50 BAU/mL), low-responder (>50 ≤ 300 BAU/mL) or high-responder (>300 BAU/mL), and shared with participants as a correlate of protection. Participants of whom demographics on sex and age, blood samples and completed questionnaires were available, were included. Our study took place between February 2021 and January 2022. The primary outcome of adherence before and after vaccination was assessed between August and October 2021 and compared via the Wilcoxon signed rank sum test. Logistic regression analysis was performed to estimate the association between antibody response and non-adherence, and adherence on acquiring SARS-CoV-2 infection. This study is registered at ClinicalTrials.gov (NCT04841785). Findings In 2939 KTRs (83%) who completed the first questionnaire on adherence to preventive measures, adherence was higher before than after vaccination (4.56, IQR 4.11-4.78 and 4.22, IQR 3.67-4.67, p < 0.001). Adherence after awareness of antibody response was analysed in 2399 KTRs (82%) of whom also blood samples were available, containing 949 non-responders, 500 low-responders and 950 high-responders. Compared to non-responders, low- and high-responders reported higher non-adherence. Higher adherence was associated with lower infection rates before and after vaccination (OR 0.67 [0.51-0.91], p = 0.008 and OR 0.48 [0.28-0.86], p = 0.010). Interpretation Adherence decreased after SARS-CoV-2 vaccination and in KTRs who were aware of a subsequent antibody response compared with those without. Preventive measures in this vulnerable group seem to be effective, regardless of vaccination status. This study starts a debate on sharing antibody results with the patient and future studies should elucidate whether decreased adherence in antibody responders is justified, also in view of future pandemics. Funding The Netherlands Organization for Health Research and Development and the Dutch Kidney Foundation.
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Affiliation(s)
- Sophie C. Frölke
- Amsterdam UMC Location University of Amsterdam, Renal Transplant Unit, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, the Netherlands
| | - Pim Bouwmans
- Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - A. Lianne Messchendorp
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Johanna P.M. Vervoort
- Dutch Kidney Patient Association (NVN), Bussum, the Netherlands
- Global Health Unit, Department of Health Sciences, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Alferso C. Abrahams
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Aiko P.J. de Vries
- Department of Medicine, Division of Nephrology, Leiden University Medical Centre, Leiden, the Netherlands
- Leiden Transplant Centre, Leiden, the Netherlands
| | - Pythia T. Nieuwkerk
- Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, the Netherlands
- Amsterdam UMC Location University of Amsterdam, Medical Psychology, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
| | - Marc H. Hemmelder
- Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - Ron T. Gansevoort
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Luuk B. Hilbrands
- Department of Nephrology, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Marlies E.J. Reinders
- Department of Internal Medicine, Nephrology and Transplantation, Erasmus MC Transplant Institute, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Jan-Stephan F. Sanders
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Frederike J. Bemelman
- Amsterdam UMC Location University of Amsterdam, Renal Transplant Unit, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, the Netherlands
| | - Suzanne E. Geerlings
- Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, the Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
- Amsterdam UMC Location University of Amsterdam, Infectious Diseases, Meibergdreef 9, Amsterdam, the Netherlands
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10
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Kuntz K, Engel K. Adherence in transplantation. Curr Opin Organ Transplant 2022; 27:530-534. [PMID: 36166274 DOI: 10.1097/mot.0000000000001025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW Adequately managing a complex medical regimen is paramount to the success of organ transplants. When patients stray from their prescribed medical regimen posttransplant, graft rejection, and death can occur. Predictors of adherence have been studied for many years, and various factors have been identified as contributing to adequate or poor adherence. Both demographic and personal characteristics have been associated with adherence behavior. However, recent developments, such as the COVID-19 pandemic, increased use of mobile health interventions, and use of medical biomarkers have affected the way adherence is measured and applied. RECENT FINDINGS The COVID-19 pandemic affected patients' comfort with accessing outpatient care and created a wider use of telehealth services. Measurement of adherence through serum lab levels continues to be reviewed as a potential objective assessment of adherence. Psychosocial factors continue to be identified as major contributors to nonadherence. SUMMARY Adherence to antirejection medication, lab work, appointments, and exercise and dietary instructions remains critical to the health of the transplant patient. It is critical that providers involved in the selection process and posttransplant treatment of these patients remain well informed of potential new factors affecting adherence.
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Affiliation(s)
- Kristin Kuntz
- The Ohio State University Wexner Medical Center, Department of Psychiatry & Behavioral Health, Columbus, Ohio, USA
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11
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Wongtanasarasin W, Phinyo P. Emergency department visits and hospital admissions in kidney transplant recipients during the COVID-19 pandemic: A hospital-based study. World J Transplant 2022; 12:250-258. [PMID: 36159077 PMCID: PMC9453295 DOI: 10.5500/wjt.v12.i8.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/27/2022] [Accepted: 07/25/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Several studies have demonstrated that the coronavirus disease 2019 (COVID-19) has affected daily living and the healthcare system. No previous study has described the consequences of COVID-19 on emergency department (ED) visits and hospital admission among kidney transplant (KT) recipients. AIM To investigate the impact of the COVID-19 pandemic on ED visits and hospital admissions within 1 year in patients who underwent KT in Thailand. METHODS We conducted a retrospective study at a university hospital in Thailand. We reviewed the hospital records of KT patients who visited the ED during the outbreak of COVID-19 (from January 2020 to December 2021). We used the previous 2 years as the control period in the analysis. We obtained baseline demographics and ED visit characteristics for each KT patient. The outcomes of interest were ED visits and ED visits leading to hospital admission within the 1st year following a KT. The rate of ED visits and ED visits leading to hospital admissions between the two periods were compared using the stratified Cox proportional hazards model. RESULTS A total of 263 patients were included in this study: 112 during the COVID-19 period and 151 during the control period. There were 34 and 41 ED visits after KT in the COVID-19 and control periods, respectively. The rate of first ED visit at 1 year was not significantly different in the COVID-19 period, compared with the control period [hazard ratio (HR) = 1.02, 95% confidence interval (CI): 0.54-1.92; P = 0.96]. The hospital admission rate was similar between periods (HR = 0.92, 95%CI: 0.50-1.69; P = 0.78). CONCLUSION ED visits and hospital admissions within the 1st year in KT recipients were not affected by the COVID-19 pandemic. Despite these findings, we believe that communication between post-KT patients and healthcare providers is essential to highlight the importance of prompt ED visits for acute health conditions, particularly in post-KT patients.
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Affiliation(s)
- Wachira Wongtanasarasin
- Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, CA 95817, United States
| | - Phichayut Phinyo
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
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12
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Nimmo A, Gardiner D, Ushiro-Lumb I, Ravanan R, Forsythe JLR. The Global Impact of COVID-19 on Solid Organ Transplantation: Two Years Into a Pandemic. Transplantation 2022; 106:1312-1329. [PMID: 35404911 PMCID: PMC9213067 DOI: 10.1097/tp.0000000000004151] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 02/06/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has had a major global impact on solid organ transplantation (SOT). An estimated 16% global reduction in transplant activity occurred over the course of 2020, most markedly impacting kidney transplant and living donor programs, resulting in substantial knock-on effects for waitlisted patients. The increased severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection risk and excess deaths in transplant candidates has resulted in substantial effort to prioritize the safe restart and continuation of transplant programs over the second year of the pandemic, with transplant rates returning towards prepandemic levels. Over the past 2 y, COVID-19 mortality in SOT recipients has fallen from 20%-25% to 8%-10%, attributed to the increased and early availability of SARS-CoV-2 testing, adherence to nonpharmaceutical interventions, development of novel treatments, and vaccination. Despite these positive steps, transplant programs and SOT recipients continue to face challenges. Vaccine efficacy in SOT recipients is substantially lower than the general population and SOT recipients remain at an increased risk of adverse outcomes if they develop COVID-19. SOT recipients and transplant teams need to remain vigilant and ongoing adherence to nonpharmaceutical interventions appears essential. In this review, we summarize the global impact of COVID-19 on transplant activity, donor evaluation, and patient outcomes over the past 2 y, discuss the current strategies aimed at preventing and treating SARS-CoV-2 infection in SOT recipients, and based on lessons learnt from this pandemic, propose steps the transplant community could consider as preparation for future pandemics.
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Affiliation(s)
- Ailish Nimmo
- Renal Department, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
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McKeaveney C, Noble H, Courtney AE, Griffin S, Gill P, Johnston W, Maxwell AP, Teasdale F, Reid J. Dialysis, Distress, and Difficult Conversations: Living with a Kidney Transplant. Healthcare (Basel) 2022; 10:healthcare10071177. [PMID: 35885704 PMCID: PMC9321787 DOI: 10.3390/healthcare10071177] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 11/19/2022] Open
Abstract
Background: Providing holistic care to kidney patients is important; however, without full consideration of the perspectives of people living with a kidney transplant, the provision of truly ‘holistic healthcare’ cannot be possible. It is imperative to understand patient experiences by including kidney patients in key strategies and future renal service planning. Ignoring these important patient views means that there is a significant risk of inappropriate renal service provision and lack of adequate support, impacting overall health. The aim of this study was to develop an in-depth understanding of the lived experiences of kidney transplant recipients. Methods: A total of 23 participants were recruited between two regional nephrology units within the United Kingdom via clinical gatekeepers. In-depth interviews were undertaken. Interviews were digitally recorded, transcribed verbatim, and subjected to interpretative phenomenological analysis. Results: Two themes emerged: “managing ongoing fears of dialysis, distress, and COVID-19” and “dealing with difficult conversations”. Conclusions: Renal healthcare professionals need to understand more than the biological impact of receiving a kidney transplant. Understanding the holistic and multidomain experiences that these participants experience will help healthcare professionals to recognize the needs of this group and ensure more responsive psychosocial care.
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Affiliation(s)
- Clare McKeaveney
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK; (C.M.); (H.N.)
| | - Helen Noble
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK; (C.M.); (H.N.)
| | | | - Sian Griffin
- Department of Nephrology and Transplantation, Cardiff & Vale University Health Board, Cardiff CF14 4XW, UK;
| | - Paul Gill
- School of Healthcare Sciences, Cardiff University, Cardiff CF24 0AB, UK;
| | - William Johnston
- Northern Ireland Kidney Patients Association, Belfast BT9 7AB, UK;
| | | | | | - Joanne Reid
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK; (C.M.); (H.N.)
- Correspondence:
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Stressors and Information-Seeking by Dialysis and Transplant Patients During COVID-19 Reported on a Telephone Hotline: A Mixed Methods Study. Kidney Med 2022; 4:100479. [PMID: 35571230 PMCID: PMC9087151 DOI: 10.1016/j.xkme.2022.100479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Rationale & Objective In early 2020, we activated a telephone hotline, the coronavirus disease 2019 (COVID-19) Kidney or Transplant Listening and Resource Center, to learn more about the impact of the COVID-19 pandemic on the stress and information-seeking behaviors of dialysis and transplant patients. Study Design A mixed-methods study including semi-structured, qualitative interviews probing about emotional, health, and financial challenges experienced and quantitative surveys assessing depression and anxiety levels and information-seeking behaviors. Setting & Participants 99 participants (28 dialysis patients; 71 transplant patients), varying by race and ethnicity (Hispanic, 25.3%; White, 23.2%; Asian, 24.2%; Black, 24.2%), shared their COVID-19 pandemic experiences and information-seeking behaviors by telephone. Interviews and surveys were conducted from June 17, 2020, to November 24, 2020. Analytical Approach Qualitative themes were identified using thematic analysis. Frequencies were calculated to assess levels of depression and anxiety using the Patient Health Questionnaire for Depression and Anxiety and types of information-seeking behaviors. Results 7 themes and 16 subthemes emerged. Themes of commonly reported stressors include postponing medical visits; decreased accessibility of getting medication; difficulty in receiving up-to-date, patient-focused health information and dialysis supplies; and delays in medical appointments. Other stressors include losses of health insurance and income, and increased vigilance in behaviors to avoid contracting COVID-19. 15 participants had moderate to severe anxiety and depression symptoms and reported more frequent and severe panic attacks after the COVID-19 pandemic. Participants sought emotional support from family, friends, and faith communities. They also commonly obtained information from news media and reported needing more transplant-specific updates about COVID-19, and frequent communication from their kidney and transplant specialists. Limitations This convenience sample of individuals willing to share their experiences through a telephone hotline may not generalize to all dialysis and transplant patients; stressors related to the COVID-19 pandemic for these patients continue to change. Conclusions As the impact of the pandemic continues, needs-based interventions tailored for the kidney and transplant community, including access to mental health resources, education, and support for care transitions, should continue.
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[Long-term physical and psychological consequences of chronic kidney disease]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2022; 65:488-497. [PMID: 35312814 PMCID: PMC8935884 DOI: 10.1007/s00103-022-03515-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 02/23/2022] [Indexed: 11/28/2022]
Abstract
Aufgrund der verbesserten Behandlungsoptionen können Patient:innen mit chronischen Nierenerkrankungen heute deutlich länger überleben als noch vor 10 Jahren. Das Überleben ist für die Betroffenen jedoch immer mit einem Verlust an Lebensqualität verbunden. In diesem Beitrag wird eine kurze Übersicht über die körperlichen und psychischen Erkrankungsfolgen, Begleiterkrankungen und Therapienebenwirkungen bei chronischen Nierenerkrankungen gegeben. Auf bisher bekannte Auswirkungen der COVID-19-Pandemie wird hingewiesen. Abschließend wird aufgezeigt, wie die Langzeitbehandlung weiterentwickelt werden sollte, um die Lebensqualität der Patient:innen zu erhöhen. Funktionseinschränkungen der Niere haben aufgrund der Kontamination des Blutes mit harnpflichtigen Substanzen (Urämie) schwere Auswirkungen auf den Gesamtorganismus. Zusätzlich sind die Patient:innen von Nebenwirkungen betroffen, die im Zusammenhang mit der medikamentösen Therapie, Dialyse oder Nierentransplantation auftreten können. Patient:innen und Angehörige sind einer großen psychischen Belastung ausgesetzt. Infektionen mit SARS-CoV‑2 können die Nierenfunktion beeinträchtigen und auch die Prognose einer bereits bestehenden Erkrankung verschlechtern. Die ganzheitliche Versorgung der Patient:innen mit chronischen Nierenerkrankungen muss neben der medizinischen Versorgung auch die psychologischen und psychosozialen Aspekte berücksichtigen. Nephrologie und Psychonephrologie müssen Hand in Hand weiterentwickelt werden, um die medizinische Versorgung und Lebensqualität der betroffenen Patient:innen zu verbessern.
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