Nephrology pre-dialysis care affects the psychological adjustment, not only blood pressure, anemia, and phosphorus control

Several studies have suggested that pre-dialysis care is associated with clinical outcomes. However, little has been reported on the influence of pre-dialysis care on the psychological adjustment to dialysis. The purpose of this study was to evaluate the impact of pre-dialysis care on psychological adjustment to dialysis and clinical characteristics. In this cross-sectional study, we enrolled 52 patients who started hemodialysis at our hospital. They were divided into two groups according to the time of referral to our hospital: the early referral group (over 1 year prior to first dialysis: 19 patients, mean age 69.3 +/- 11.1) and the late referral group (within 1 year prior to first dialysis: 33 patients, mean age 72.3 +/- 8.9). We measured the clinical characteristics and evaluated the psychological adjustment to dialysis by Shontz's stage theory. Compared with the late referral group, the early referral group had a significantly better clinical characteristics concerning blood pressure (140.2 +/- 23.7 vs. 156.9 +/- 23.3 mmHg, P = 0.0150), hemoglobin (10.3 +/- 1.5 vs. 9.4 +/- 1.0 g/dL, P = 0.0078), and phosphorus (4.5 +/- 1.5 vs. 5.5 +/- 1.3 mg/dL, P = 0.0166). In addition, psychological adjustment to dialysis evaluated by Shontz's stage theory was significantly better in the early referral group (P = 0.017). Our results indicate that nephrology pre-dialysis care affects not only blood pressure, anemia, and phosphorus control but also the psychological adjustment to dialysis.