Psychological aspects of dialysis: does cognitive appraisal determine the overall outcome?

49 Introduction End‐stage renal disease (ESRD) is a growing medical and social concern.1 The phe‐ nomenon of population aging in the developed countries and an increased prevalence of comor‐ bidities have resulted in a greater incidence of ESRD.2,3 Advances in medical technology and health management with subsequent prolonga‐ tion of the status quo, further support this ten‐ dency and allow a patient with ESRD to live a lon‐ ger and more active life. Transplantation, contin‐ uous ambulatory peritoneal dialysis (CAPD), and hemo dialysis (HD) are the current options for re‐ nal replacement therapy (RRT) in patients with ESRD. The demand for transplantation has al‐ ways been greater than the number of donor kid‐ neys, which limited the availability of this treat‐ ment option.4 Thus, dialysis remains the main‐ stay of RRT. HD requires that a patient is period‐ ically connected to the artificial kidney machine, which involves hospital stays of 3 to 5 h, 3 to 4 times a week. In contrast, patients on CAPD uti‐ lize their own peritoneum as a dialysis membrane. Patients administer the dialysis fluid themselves using a preimplanted peritoneal catheter. This brief description already implies that different stressors and psycho logical outcomes will accom‐ pany both types of RRT.5 An inter esting question is whether any of the RRT modalities is superior in terms of providing optimal psycho logical ad‐ justment and outcome. Should a physician take into account psycho logical aspects when decid‐ ing which therapy to use in a particular patient? The question seems to be valid, considering that a good health‐related quality of life (HRQoL) dur‐ ing dialysis therapy is strongly emphasized in the total assessment of RRT benefit. In this re‐ view, we present a few psycho logical aspects re‐ lated to stress management during dialysis.