Chronic insomnia in kidney transplant recipients.

BACKGROUND: Recent studies confirmed that sleep disorders have a significant impact on various aspects of health in patients at different stages of chronic kidney disease. At the same time, there is an almost complete lack of information on the prevalence and correlates of insomnia in kidney transplant recipients. METHODS: In a cross-sectional study, the Athens Insomnia Scale was used to assess the prevalence of insomnia in a large sample of kidney transplant recipients compared with wait-listed dialysis patients and also a matched group obtained from a nationally representative sample of the Hungarian population. RESULTS: The prevalence of insomnia was 15% in wait-listed patients, whereas it was only 8% in transplant recipients (P < 0.001), which, in turn, was not different from the prevalence of this sleep problem in the sample of the general population (8%). Prevalences of insomnia in the transplant group were 5%, 7%, and 14% for the groups with glomerular filtration rates (GFRs) greater than 60 mL/min (> 1.00 mL/s), 30 to 60 mL/min (0.50 to 1.00 mL/s), and less than 30 mL/min (< 0.5 mL/s), respectively (P < 0.01). However, estimated GFR was no longer associated significantly with insomnia in the transplant population after statistical adjustment for several covariates. In a multivariate model, insomnia was significantly and independently associated with treatment modality (transplantation versus wait listing), as well as the presence of depression, restless legs syndrome, and high risk for obstructive sleep apnea syndrome, and with self-reported comorbidity. CONCLUSION: The prevalence of insomnia was substantially less in the transplant group than in wait-listed dialysis patients and similar to that observed in the general population. Because this condition potentially is treatable, attention should be directed to the appropriate diagnosis and management of insomnia in the kidney transplant recipient population.

Validation of the Kidney Disease Quality of Life-Short Form questionnaire in kidney transplant patients.

OBJECTIVE: The aim of this study was to determine the basic psychometric properties, reliability, and validity of the Kidney Disease Quality of Life-Short Form (KDQOL-SF) questionnaire in kidney transplant patients. METHODS: The reliability and validity of the instrument were determined in 418 kidney transplant patients followed in a single outpatient transplant centre. RESULTS: Internal consistency of all the Medical Outcome Study Short Form 36 (SF-36) domains was very good, and the Cronbach's alpha value was above .70 for all but three of the disease-specific subscales. We found significant, moderate to strong negative correlations between most of the KDQOL-SF domains and the Center for Epidemiologic Studies-Depression (CES-D) scores. Finally, substantial differences in KDQOL-SF scores were seen between groups of transplanted patients who were expected to be clinically different, supporting the discriminant validity of the KDQOL-SF instrument. CONCLUSION: We propose that the KDQOL-SF is a reliable and valid tool and most of its subscales can be used to assess health-related quality of life (HRQOL) in kidney transplant patients and to compare HRQOL between different end stage renal disease (ESRD) patient populations.