Older kidney transplantation candidates' expectations of improvement in life and health following kidney transplantation: semistructured interviews with enlisted dialysis patients aged 65 years and older

Kjersti Lønning, Karsten Midtvedt, Kristian Heldal, Marit Helen Andersen, Kjersti Lønning, Karsten Midtvedt, Kristian Heldal, Marit Helen Andersen

Abstract

Objective: The aim was to study the expectations of improvement in life and health following kidney transplantation (KTx) in a population of wait-listed patients ≥65 years with end-stage kidney disease.

Design: Qualitative research with individual in-depth interviews.

Setting: Patients on dialysis enlisted for a KTx from a deceased donor were included from an ongoing study of older patients' perspectives on KTx. Qualitative face-to-face interviews were conducted in a safe and familiar setting, and were analysed thematically using the theoretical framework of lifespan.

Informants: Fifteen patients (median age 70 years, range 65-82) from all parts of Norway were interviewed. Informants were included consecutively until no new information was gained.

Results: Two main themes were evident: receiving a kidney is getting life back and grasp the chance. In addition, the themes 'hard to loose capacity and strength', 'reduced freedom' and 'life on hold' described the actual situation and thereby illuminated the informants' expectations. The informants tried to balance positive expectations and realism towards KTx, and they were hoping to become free from dialysis and to live a normal life.

Conclusion: This study shows that older KTx candidates comprise a heterogeneous group of patients who take individual approaches that allow them to maintain autonomy and control while waiting for a transplant. This study provides new knowledge about the older KTx candidates relevant for clinicians, patients and researchers.

Keywords: end stage kidney disease; older renal patients; patient perspective; qualitative research; renal transplantation.

Conflict of interest statement

Competing interests: None declared.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

References

    1. Heldal K, Hartmann A, Grootendorst DC, et al. . Benefit of kidney transplantation beyond 70 years of age. Nephrol Dial Transplant 2010;25:1680–7. 10.1093/ndt/gfp681
    1. Cho H, Yu H, Shin E, et al. . Risk factors for graft failure and death following geriatric renal transplantation. PLoS One 2016;11:e0153410 10.1371/journal.pone.0153410
    1. Rao PS, Merion RM, Ashby VB, et al. . Renal transplantation in elderly patients older than 70 years of age: results from the scientific registry of transplant recipients. Transplantation 2007;83:1069–74. 10.1097/01.tp.0000259621.56861.31
    1. Hart A, Smith JM, Skeans MA, et al. . OPTN/SRTR 2015 annual data report: kidney. Am J Transplant 2017;17(Suppl 1):21–116. 10.1111/ajt.14124
    1. Branger P, Samuel U. Annual Report 2016, Eurotransplant Internationa Foundation. Austria: Eurotransplant International Foundation, 2017. Annual report.
    1. Heldal K, Leivestad T, Hartmann A, et al. . Kidney transplantation in the elderly--the Norwegian experience. Nephrol Dial Transplant 2008;23:1026–31. 10.1093/ndt/gfm719
    1. von der Lippe N, Waldum B, Brekke FB, et al. . From dialysis to transplantation: a 5-year longitudinal study on self-reported quality of life. BMC Nephrol 2014;15:191 10.1186/1471-2369-15-191
    1. Kostro JZ, Hellmann A, Kobiela J, et al. . Quality of life after kidney transplantation: a prospective study. Transplant Proc 2016;48:50–4. 10.1016/j.transproceed.2015.10.058
    1. Balogun SA, Balogun R, Philbrick J, et al. . Quality of life, perceptions, and health satisfaction of older adults with end-stage renal disease: a systematic review. J Am Geriatr Soc 2017;65:777–85. 10.1111/jgs.14659
    1. Cornella C, Brustia M, Lazzarich E, et al. . Quality of life in renal transplant patients over 60 years of age. Transplant Proc 2008;40:1865–6. 10.1016/j.transproceed.2008.05.050
    1. Lønning K, Midtvedt K, Bernklev T, et al. . Changes in health related quality of life in older candidates waiting for kidney transplantation. Nephrology 2017. 10.1111/nep.13117
    1. Pinter J, Hanson CS, Chapman JR, et al. . Perspectives of older kidney transplant recipients on kidney transplantation. Clin J Am Soc Nephrol 2017;12:443–53. 10.2215/CJN.05890616
    1. Pinter J, Hanson CS, Craig JC, et al. ‘I feel stronger and younger all the time’-perspectives of elderly kidney transplant recipients: thematic synthesis of qualitative research. Nephrol Dial Transplant 2016;31:1531–40. 10.1093/ndt/gfv463
    1. Wagner J, Hoppmann C, Ram N, et al. . Self-esteem is relatively stable late in life: the role of resources in the health, self-regulation, and social domains. Dev Psychol 2015;51:136–49. 10.1037/a0038338
    1. Hoppmann CA, Infurna FJ, Ram N, et al. . Associations Among Individuals’ Perceptions of Future Time, Individual Resources, and Subjective Well-Being in Old Age. J Gerontol B Psychol Sci Soc Sci 2017;72:388–99. 10.1093/geronb/gbv063
    1. Heckhausen J, Schulz R. A life-span theory of control. Psychol Rev 1995;102:284–304. 10.1037/0033-295X.102.2.284
    1. Orth U, Trzesniewski KH, Robins RW. Self-esteem development from young adulthood to old age: a cohort-sequential longitudinal study. J Pers Soc Psychol 2010;98:645–58. 10.1037/a0018769
    1. Schulz T, Niesing J, Homan van der Heide JJ, et al. . Changes of perceived control after kidney transplantation: a prospective study. J Adv Nurs 2017;73:1712–21. 10.1111/jan.13263
    1. Jansen DL, Rijken M, Heijmans M, et al. . Perceived autonomy and self-esteem in Dutch dialysis patients: the importance of illness and treatment perceptions. Psychol Health 2010;25:733–49. 10.1080/08870440902853215
    1. Brinkmann S, Kvale S. Interviews: learning the craft of qualitative research interviewing. 3rd edn Thousand Oaks, Calif: Sage, 2015.
    1. Liu J, Huang Z, Gilbertson DT, et al. . An improved comorbidity index for outcome analyses among dialysis patients. Kidney Int 2010;77:141–51. 10.1038/ki.2009.413
    1. Schipper K, Abma TA, Koops C, et al. . Sweet and sour after renal transplantation: a qualitative study about the positive and negative consequences of renal transplantation. Br J Health Psychol 2014;19:580–91. 10.1111/bjhp.12057
    1. Ekerdt DJ, Koss C. The task of time in retirement. Ageing Soc 2016;36:1295–311. 10.1017/S0144686X15000367
    1. Schulz T, Niesing J, Homan van der Heide JJ, et al. . Great expectations? Pre-transplant quality of life expectations and distress after kidney transplantation: a prospective study. Br J Health Psychol 2014;19:823–38. 10.1111/bjhp.12081
    1. Cleemput I, Kesteloot K, De Geest S, et al. . Health professionals’ perceptions of health status after renal transplantation: a comparison with transplantation candidates’ expectations. Transplantation 2003;76:176–82. 10.1097/01.TP.0000072807.46212.FA
    1. Kaufman SR, Shim JK, Russ AJ. Old age, life extension, and the character of medical choice. J Gerontol B Psychol Sci Soc Sci 2006;61:S175–84. 10.1093/geronb/61.4.S175
    1. von Soest T, Wagner J, Hansen T, et al. . Self-esteem across the second half of life: The role of socioeconomic status, physical health, social relationships, and personality factors. J Pers Soc Psychol 2018;114:945–58. 10.1037/pspp0000123
    1. Bergland A, Nicolaisen M, Thorsen K. Predictors of subjective age in people aged 40-79 years: a five-year follow-up study. The impact of mastery, mental and physical health. Aging Ment Health 2014;18:653–61. 10.1080/13607863.2013.869545
    1. Burns T, Fernandez R, Stephens M. The experiences of adults who are on dialysis and waiting for a renal transplant from a deceased donor: a systematic review. JBI Database System Rev Implement Rep 2015;13:169–211. 10.11124/jbisrir-2015-1973
    1. Charmaz K. The self as habit: the reconstruction of self in chronic illness. OTJR 2002;22(1_suppl):31S–41. 10.1177/15394492020220S105
    1. Drewelies J, Wagner J, Tesch-Römer C, et al. . Perceived control across the second half of life: the role of physical health and social integration. Psychol Aging 2017;32:76–92. 10.1037/pag0000143
    1. Orth U, Robins RW, Widaman KF. Life-span development of self-esteem and its effects on important life outcomes. J Pers Soc Psychol 2012;102:1271–88. 10.1037/a0025558

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren