A new study evaluates important aspects of psychological health in young adults with kidney failure. The findings, which appear in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN), point to the need for additional efforts to address the wellbeing of these patients

In addition to affecting their physical health, kidney failure affects the psychosocial health of young people. With this in mind, Alexander Hamilton, MD (University of Bristol, UK) and his colleagues conducted a study to determine which factors influence mental well-being and medication adherence in young adults who have received a kidney transplant or are undergoing dialysis.

After analyzing data from the UK Renal Registry and online surveys completed by 417 young adults in the UK with transplants and 173 on dialysis, the investigators found that well-being was positively associated with extraversion, openness, independence, and social support, and negatively associated with neuroticism, negative body image, stigma, psychological morbidity, and dialysis.

Psychological morbidity and dialysis treatment

Higher medication adherence was associated with living with parents, conscientiousness, physician access satisfaction, patient activation, age, and male sex, and lower adherence with comorbidity, dialysis, education, ethnicity, and psychological morbidity.

"Worse outcomes for mental wellbeing and medication adherence were both associated with psychological morbidity and dialysis treatment, whereas social support and living with parents were associated with better outcomes. These findings are important because mental health problems appear under-recognized and may be treatable," said Dr. Hamilton.

"Our results suggest a possible role for routine measurement of psychological health in young people, to avoid missing opportunities to identify and improve mental health. This could help identify those at higher risk of poor outcomes for close monitoring, greater psychosocial support, or targeted interventions."

Dr. Hamilton added that there has been much focus both on programs to improve the transition from pediatric to adult care for kidney failure patients. "It is vital to understand which factors influence well-being and medication adherence because by defining these we can seek interventions to improve areas of deficit," he said. "These areas really matter to patients."

In an accompanying Caregiver Perspective, Pam Duquette and Kelly Helm note that "clinics must create an environment where psychological health is consistently monitored and addressed, and patients and their caregivers are given tools to advocate for themselves. This study is a wonderful start and can be used as a stepping stone to further understand how a patient's environment affects their future care."

Also, an accompanying Patient Perspective by Amanda Grandinetti, MPH, stresses that differentiation in the nephrology care that adolescents and young adults receive from the adult population is critical.