Psychonephrology: psychological aspects in autosomal dominant polycistic kidney disease
Psiconefrología: aspectos psicológicos en la poliquistosis renal autosómica dominante
en nombre del Grupo de Investigación HIRICAREa, Grupo de Investigación HIRICAREb, T.S.. Pérez Domínguezb, A.. Rodríguez Pérezc, N.. Buset Ríosb, F.. Rodríguez Esparragónb, M.A.. García Bellod, P.. Pérez Borgese, Y.. Parodis Lópezf, J.C.. Rodríguez Péreze
a Unidad de Investigación de Nefrología, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria Las Palmas, Spain,
b Unidad de Investigación de Nefrología, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria Las Palmas,
c Departamento de Psicología Social, Cognitiva y Organizacional, Universidad de La Laguna, La Laguna, Tenerife,
d Unidad de Investigación de Nefrología, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria Las Palmas
e Servicio de Nefrología, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria Las Palmas,
f Centro de Hemodiálisis Baxter-RTS, Las Palmas de Gran Canaria Las Palmas,
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"apellidos" => "Rodríguez Pérez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "affe" ] ] ] ] "afiliaciones" => array:6 [ 0 => array:3 [ "entidad" => "Unidad de Investigación de Nefrología, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria Las Palmas, Spain, " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:3 [ "entidad" => "Unidad de Investigación de Nefrología, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria Las Palmas, " "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] 2 => array:3 [ "entidad" => "Departamento de Psicología Social, Cognitiva y Organizacional, Universidad de La Laguna, La Laguna, Tenerife, " "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "affc" ] 3 => array:3 [ "entidad" => "Unidad de Investigación de Nefrología, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria Las Palmas " "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "affd" ] 4 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria Las Palmas, " "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "affe" ] 5 => array:3 [ "entidad" => " Centro de Hemodiálisis Baxter-RTS, Las Palmas de Gran Canaria Las Palmas, " "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "afff" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Psiconefrología: aspectos psicológicos en la poliquistosis renal autosómica dominante" ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">INTRODUCTION</span></p><p class="elsevierStylePara">Autosomal dominant polycystic kidney disease (ADPKD) is a chronic renal disease that affects one in 400 people, and it is responsible for 6% of all cases of terminal kidney failure (TKF) in Spain.<span class="elsevierStyleSup">1</span> Furthermore, ADPKD sufferers have one of the highest anxiety and depression rates among kidney patients. According to a meta-analysis by Nejatisafa (2007),<span class="elsevierStyleSup">2</span> the combined prevalence estimates for depression and anxiety in patients with chronic renal failure (CRF) are 55.91 % and 46.72 %, respectively. This means that we are faced with an entity that affects patients' psychological and emotional state in addition to their physical condition.<span class="elsevierStyleSup">3</span></p><p class="elsevierStylePara">Studies of the psychological aspects of patients with chronic kidney disease (CKD) have multiplied in recent years, especially those intended to evaluate cognitive and emotional response as quality indicators for renal replacement therapies (haemodialysis, peritoneal dialysis and transplants).<span class="elsevierStyleSup">4</span> CKD takes a heavy biological, physical and psychological toll on the patients it affects. Patients’ perceptions of their quality of life will therefore be affected by psychological disorders such as anxiety and depression, conditions which are not only highly prevalent among the CKD population, but which are also associated with lower life expectancy. Studying the psychological variables of patients with a chronic disease is a relatively new undertaking. It requires more in-depth research into non-traditional risk factors such as anxiety, stress and depression. This line of research, known as psychonephrology, may provide new insight into the development and evolution of kidney disease.<span class="elsevierStyleSup">5,6</span></p><p class="elsevierStylePara">Psychonephrology studies the psychological problems that affect people with kidney disease, those on dialysis and those having undergone a transplant. We hope that the new discipline will provide a more precise picture of the consequences of CKD. Fortunately, this is not a recent initiative. The 1980s saw a surge in research into how social, economic and psychosocial factors affected CKD development and evolution.<span class="elsevierStyleSup">7</span> These studies focused on discovering which problems were associated with the disease, and in particular, on the reasons why these patients did not comply with treatment. Researchers observed that the most frequent psychological problems associated with kidney disease were depression and anxiety. In addition, these disorders lead to attitudes that decrease treatment effectiveness. Patients with CKD not only refused to accept their disease as a reality, but also tended to oppose changing their lifestyles.</p><p class="elsevierStylePara">If we undertake a literature review focusing on the psychological aspects of ADPKD, the first conclusion is that this area is largely unexplored and filled with immediate challenges. With this in mind, the Nephrology Service at Dr. Negrín University Hospital is firmly committed to the study of the psychological impact of CKD and ADPKD. The second conclusion taken from the publications we reviewed is that most are concerned with two aspects which we believe to be important: quality of life and the concurrence of anxiety and depression. In this article, we will provide a summary of the main studies on quality of life and anxiety/depression in CKD. Lastly, we will outline the different lines of research presented here.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">QUALITY OF LIFE</span><span class="elsevierStyleBold">                           </span></p><p class="elsevierStylePara">Studying a patient's quality of life involves striving to add more “life” per year, and not just adding more years to life expectancy (WHO, 2000). In this respect, Kaplan (1985)<span class="elsevierStyleSup">8</span> states that health policies should have a double focus: increasing lifespan and improving quality of life. This requires paying more attention to perceptive processes and to the subjective explanation of the new reality of CKD and the impact it has on a patient’s psychological and physical condition.</p><p class="elsevierStylePara">To a great extent, quality of life is a subjective assessment made by a patient based on the different physical, psychological, social and environmental factors that affect his or her health. The physical factors comprise the symptoms of the disease and the treatment side-effects. The psychological factors include mental disorders. However, patients’ surroundings, that is, their relationships with others and the social support they receive, plus the environmental factors of the residential and hospital space, also determine how well patients react and adjust to their disease.</p><p class="elsevierStylePara">The importance of these factors obliges to monitor and measure quality of life in order to plan a more overarching approach to caring for the patient. This evaluation should be a very useful instrument for predicting potential adverse consequences as the disease progresses, and to evaluate the effectiveness of the treatment.<span class="elsevierStyleSup">9</span> The variables most commonly associated with subjective well-being in scientific literature are physical symptoms, anxiety, depression, social support and the impact of the disease.<span class="elsevierStyleSup">10-12</span></p><p class="elsevierStylePara">ADPKD is an untreatable disease, and it is therefore possible that a diagnosis of ADPKD would affect a patient’s psychological well-being, as is the case with other incurable hereditary diseases such as Huntington’s disease. In addition, ADPKD presents with a series of associated complications which may also affect subjective well-being. These complications include chronic pain, hypertension, the development of cysts in other organs and gastrointestinal complications. All of the above, added to the hereditary and chronic nature of this disorder, have an obvious effect on the patient’s quality of life.</p><p class="elsevierStylePara">However, one of our main problems when evaluating quality of life in CKD patients is the lack of studies on these patients during disease progression but before kidney failure. Although it is possible for drastic changes in life expectancy and lifestyle to occur, to date we have only been able to show (as in Perlman et al 2005) that the subjective well-being of patients without renal replacement therapy is greater than that of dialysis patients, but lower than that of the normal population.<span class="elsevierStyleSup">13</span></p><p class="elsevierStylePara">Something quite different occurs in patients who undergo transplants. According to various studies, these patients are the ones presenting the best indicators for quality of life and impact of the disease compared to those who receive haemodialysis (HD) treatment.<span class="elsevierStyleSup">14,15</span> In addition, the levels of subjective well-being in kidney transplant patients are similar to those among the general population. What is truly surprising is that the level of psychosocial dysfunction in kidney transplant patients is twice the level of their physical dysfunction. This indicates that they have more psychological problems. However, these studies also suggest that kidney transplants have more advantages and that comparing the two types of dialysis does not always provide significant results.<span class="elsevierStyleSup">16</span> According to some authors, the quality of life of patients undergoing outpatient peritoneal dialysis (OPD) is higher than that of patients undergoing inpatient HD.<span class="elsevierStyleSup">17,18</span> However, this conclusion is not solidly founded. There are also studies that point to similar levels of subjective well-being in both dialysis groups.<span class="elsevierStyleSup">19</span> This similarity disappears when we focus on the degree to which health problems limit daily life activities. In effect, the score on the SF-36, a questionnaire measuring eight generic concepts having to do with health (Physical Functioning, Role-Physical, Bodily Pain, General Health, Social Functioning, Role-Emotional and Mental Health), is significantly lower for individuals undergoing outpatient PD.<span class="elsevierStyleSup">20</span></p><p class="elsevierStylePara">In any case, the important conclusion when we compare both types of treatment is that both have a negative impact on quality of life. Nonetheless, the percentage of the score related to adverse affects associated with the progression of kidney failure and the percentage of the score stemming from the stress of beginning dialysis have not yet been calculated.</p><p class="elsevierStylePara">An even more uncertain picture is offered by studying ADPKD in patients who have not yet suffered kidney failure. The few public observations that have been obtained show that ADPKD patients have quality-of-life scores that are similar to those in the general population.<span class="elsevierStyleSup">21</span> In the same study, Ritz et al highlight that the scores for subjective well-being are similar to those obtained by patients affected by other chronic diseases. They also state that complications associated with ADPKD, such as haematuria, calcifications and infections related to the increase in kidney size, are unrelated to the degree to which poor health limits daily activities and to the overall mental health assessment.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">ANXIETY AND DEPRESSION</span></p><p class="elsevierStylePara">The subjective quality life of the CKD patient depends greatly on the incidence of psychological disorders such as anxiety and depression, which are also highly prevalent in this disease.<span class="elsevierStyleSup">22,23</span></p><p class="elsevierStylePara">People with chronic diseases are subjected to more stressful situations than the normal population is. This is especially true for patients with more symptomatic disorders, those suffering from diseases that require unpleasant treatments and all patients who must learn to accept lifestyle changes in general. This prospect of uncertainty, which is typical of CKD, gives rise to an uncomfortable feeling of alarm<span class="elsevierStyleSup">24-26 </span>which can be perceived from the early stages of disease, when the patient is diagnosed, and continues to kidney failure and the onset of dialysis. With this in mind, it is normal for patients to feel distressed and uneasy when they are on the waiting list for a transplant.</p><p class="elsevierStylePara">Experts in this field of study have mainly focused on two objectives. The first is to determine the specific sources of stress for kidney patients. Many studies find that dietary restrictions, sexual dysfunction, changes in social and family relationships, loss of image and the work and economic issues account for most of the dysfunctional responses by patients.</p><p class="elsevierStylePara">On the other hand, researchers have taken care to determine the anxiety levels associated with different types of renal replacement therapy and related elements. Most of these studies recognise that treatment time, physical complications, age, sex, marital status, social support and employment can all be sources of anxiety.</p><p class="elsevierStylePara">Gala et al compared different types of treatment and discovered that patients on HD had higher scores for anxiety than those on outpatient PD.<span class="elsevierStyleSup">27</span> This result stems from the fact that outpatient PD patients enjoy more control and independence. Furthermore, this sensation of control increases the patient's satisfaction and quality of life. However, we should point out that the training that this technique requires can cause some patients to suffer from anxiety and fear of learning, which would cause them to prefer HD.</p><p class="elsevierStylePara">The study by Gala et al<span class="elsevierStyleSup">27</span> also shows that patients who have undergone transplants have similar scores to those who are on dialysis. This means that they suffer from new types of insecurity having to do with hospital discharge and fear of transplant rejection. Engel contributes another factor that can cause anxiety: detachment on the part of the family that believes that the patient now leads a completely normal life.<span class="elsevierStyleSup">28</span> All of the above factors cause anxiety disorders to spike when patients are discharged and a prevalence of between 3 % and 33 % during the first years following the transplant.<span class="elsevierStyleSup">29</span></p><p class="elsevierStylePara">One factor that plays an important role in the anxiety experienced by patients with kidney failure is the family environment. In this respect, studies show a large correlation between family support and the patient’s psychological adjustment.<span class="elsevierStyleSup">30</span> A supportive family is an important source of well-being and adjustment for the patient, as shown by Christensen et al<span class="elsevierStyleSup">30</span> in their study of the effect of perceived family support, state of deterioration, and emotional adjustment in a sample of 57 transplant patients. According to their results, the most severely affected patients perceived less family support, meaning decreased family cohesion and interaction with more conflict, and their levels of depression and anxiety were higher than those in patients with more family support. The effect of family support was not significant for less symptomatic patients, however.</p><p class="elsevierStylePara">The second important psychological aspect that we must consider, “depression”, is associated with the onset of a feeling of loss experienced by many patients with kidney failure as they discover that they are losing independence, their physical abilities are decreasing and there are noticeable differences in their family and job roles.</p><p class="elsevierStylePara">Depression has a marked effect on the evolution and development of chronic diseases. This effect manifests as a decrease in self-care habits, poor treatment compliance, indifferent compliance with diet and decreased immunological state, and even abnormal family and marital relationships.<span class="elsevierStyleSup">31</span> All of the above indicators maximise the association between depression and mortality in patients on dialysis.<span class="elsevierStyleSup">32,33</span></p><p class="elsevierStylePara">We have no precise data on the prevalence of major depression in patients with kidney failure, but different observations estimate it at approximately 25 %.<span class="elsevierStyleSup">34</span> We do know, however, that the prevalence tends to drop to 6 % in patients who begin outpatient PD, while 8 % tend to suffer from dysthymia. Recently, Abdel-Kader et al compared a group of HD patients with another group of CKD patients without kidney failure and found that the prevalence of depression was similar in both groups.<span class="elsevierStyleSup">35</span> This is because despite having a better quality of life, patients in outpatient PD have worse psychological adjustment. Griffin et al also showed that 39.7 % of patients treated with outpatient PD versus 25.7% of patients undergoing HD had significant levels of depression, and that patients in outpatient PD had higher levels of anxiety.<span class="elsevierStyleSup">36</span> As shown by Watnick et al, the symptoms of depression and anxiety are even more common at the onset of dialysis treatment.<span class="elsevierStyleSup">37</span> In this respect, Lopes et al found that responses to simple depression indicators, such as “do you feel so dispirited and sad that nothing motivates you?" or "do you feel dispirited and sad?" were associated with a higher risk of mortality and hospitalisation among patients on dialysis.<span class="elsevierStyleSup">38</span> This correlation has been found for other groups in addition to patients receiving renal replacement therapy. In a more recent study, Kellerman et al examined the correlation between depression in early stages of the disease and mortality. They found that patients who scored one standard deviation above the mean had an estimated mortality rate 21.4 % above average.<span class="elsevierStyleSup">39</span> </p><p class="elsevierStylePara">According to Lew and Piraino, the decrease in depression prevalence among patients undergoing outpatient PD is due to patients’ having adapted well to the treatment, and also to the fact that symptoms of depression are associated with a high risk of mortality.<span class="elsevierStyleSup">40</span> Low scores in perceived-well being plus depression are related to poor nutritional state, anaemia, decreased kidney function, and higher hospitalisation rates. In addition, higher depression indices themselves are related to a higher risk of peritonitis, which is likely due to poorer self-care habits and reduced immune defence.</p><p class="elsevierStylePara">In addition to the factors indicated above, there are others that help explain symptoms of depression in patients with kidney failure. These include the medication used, the stress associated with the disease, hospitalisation, concomitant infections and the simple fact of not feeling well. Consequently, depression, hopelessness, and feeling unwell decrease quality of life among patients undergoing renal replacement therapy.<span class="elsevierStyleSup">41</span></p><p class="elsevierStylePara">In short, our data is sufficient to consider that anxiety and depression disorders are entities that present with kidney disease<span class="elsevierStyleSup">42,43 </span>and have a significant impact on the treatment provided by nephrologists. Little is known to date regarding a more comprehensive way to approach the problem, but some studies provide clues to obtaining better results. One such study by Care et al<span class="elsevierStyleSup">44</span> found that patients who are treated for depression are more able to cope with the stress of a transplant and at less risk for suffering problems that could interfere with self-care than those who do not receive treatment. Another study also found that untreated depression increases the risk of using maladaptive coping strategies.<span class="elsevierStyleSup">45</span></p><p class="elsevierStylePara">It is therefore necessary to carry out more empirical studies that take the early stages of the disease into account and include detailed records of the psychological conditions that present with kidney failure. Even at a time when research on the effect of depression on survival provides inconsistent data, enough evidence exists for us to consider this psychological problem associated with other biomedical factors.</p><p class="elsevierStylePara">To the best of our knowledge, only one study explores the psychological aspects of ADPKD, and it finds a significant, positive correlation between depression and that disease.<span class="elsevierStyleSup">46</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">CONCLUSIONS</span></p><p class="elsevierStylePara">In recent decades, different studies have suggested that CKD patients have a lower quality of life and higher prevalence of anxiety and depression disorders than the general population. In addition, suffering from one of these psychological disorders in the early stages of CKD is a predictor of higher risk of mortality once patients enter the more advanced stages of kidney disease. Although the correlation between mortality and symptoms of depression is unclear, it is possible this is the result of misleading factors in the samples, particularly, the death of the most depressed patients. In any case, psychosocial factors, subjective well-being and the development and progress of the disease are clearly inter-related in a way that requires more study.</p><p class="elsevierStylePara">Considering that results are scarce, particularly for ADPKD, and given the prevalence of this disease in the population (1/400), we must undertake research exploring the psychological aspects that contribute to the poorer quality of life experienced by these patients and their increased risk of starting dialysis earlier and having a shorter life expectancy.</p><p class="elsevierStylePara">On the other hand, some scientists suggest that the high prevalence of depression among CKD patients is mediated by a factor that must be considered in future investigations. They are referring to the similarities between the physical symptoms shared by patients with depression and those on dialysis as a result of their nephrological condition: pain, gastrointestinal disorders, weight gain, sleep disturbances, and fatigue.<span class="elsevierStyleSup">46</span> Given that these coinciding symptoms can lead to overestimation of the prevalence of this psychological problem in patients with kidney disease, more rigour and precision will be needed in order to make a valid diagnosis. To that end, we are using the hospital anxiety and depression questionnaire<span class="elsevierStyleSup">47</span> in our study. It does not contemplate physical symptoms in the overall score to diagnose depression; rather, it includes the cognitive symptoms characteristic of this mood disorder.</p><p class="elsevierStylePara">As for subjective well-being, Rizk et al warn, as other authors who study kidney disease, that the SF-36 survey is not sensitive enough to detect an unsatisfactory quality of life in patients with ADPKD.<span class="elsevierStyleSup">21</span> With this evaluation in mind, our study makes use of the KDQOL questionnaire, including a section specifically designed to measure quality of life in kidney disease.</p><p class="elsevierStylePara">We are convinced that biopsychosocial research can offer better care for the psychological problems and complexities associated with a kidney patient’s condition. The results of this line of work will have implications on the field of nephrology. Early identification of psychological problems and their context can reduce disparities in the development and progression of kidney disease in both the short and the long term. Even more importantly, it could improve the quality of life of patients.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><span class="elsevierStyleBold">ACKNOWLEDGEMENTS</span></p><p class="elsevierStylePara">This article was completed thanks to financing for the research project "<span class="elsevierStyleItalic">Análisis Genético y Evaluación Psicosocial de pacientes con Poliquistosis Renal Autosómica Dominante en la Provincia de Las Palmas</span>” (genetic analysis and psychosocial evaluation of patients with autosomal dominant polycystic kidney disease in Las Palmas province) provided by Caja Insular de Ahorros de Canarias (savings bank) and the Mapfre Guanarteme foundation.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Grants:</span> Research project financed by Caja Insular de Ahorros de Canarias and the Mapfre Guanarteme foundation.</p>" "pdfFichero" => "P1-E528-S3198-A10847-EN.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:6 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec439435" "palabras" => array:1 [ 0 => "Calidad de vida" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec439437" "palabras" => array:1 [ 0 => "Poliquistosis renal autosómica dominante" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec439439" "palabras" => array:1 [ 0 => "Enfermedad renal crónica" ] ] 3 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec439441" "palabras" => array:1 [ 0 => "Psiconefrología" ] ] 4 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec439443" "palabras" => array:1 [ 0 => "Depresión" ] ] 5 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec439445" "palabras" => array:1 [ 0 => "Ansiedad" ] ] ] "en" => array:6 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec439436" "palabras" => array:1 [ 0 => "Quality of life" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec439438" "palabras" => array:1 [ 0 => "Autosomal polycystic kidney disease" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec439440" "palabras" => array:1 [ 0 => "Chronic kidney disease" ] ] 3 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec439442" "palabras" => array:1 [ 0 => "Psychonephrology" ] ] 4 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec439444" "palabras" => array:1 [ 0 => "Depression" ] ] 5 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec439446" "palabras" => array:1 [ 0 => "Anxiety" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<p class="elsevierStylePara">La carga biológica, física y psíquica que caracteriza a las enfermedades renales crónicas repercute en la calidad de vida de las personas que las padecen. Y a esto se suman los trastornos psicológicos, como la ansiedad y la depresión, que tienen una alta prevalencia en esta población de pacientes. Por ello, sorprende la ausencia de datos e investigaciones que aborden las repercusiones psicológicas, incluso en aquellas personas que padecen enfermedades renales de larga duración como es la poliquistosis renal autosómica dominante (PQRAD). En este artículo se apoya el desarrollo de la psiconefrología como disciplina que aporta una visión más amplia del impacto de los procesos cognitivos y emocionales en los enfermos renales con su consecuente aplicación práctica. Con este propósito, se presenta una revisión de las principales líneas de investigación dedicadas a delimitar las características psicológicas del paciente con enfermedad renal crónica (ERC) en general y con PQRAD en particular. En primer lugar, se presenta una breve radiografía de la ERC y de la PQRAD desde la psiconefrología. En segundo lugar, se introducirá el concepto de calidad de vida como uno de los pilares de la salud que se ve afectado cuando una persona recibe un diagnóstico de ERC y PQRAD. En tercer lugar, se hará una exposición de los principales estudios relacionados con la ansiedad y la depresión, dos de los trastornos psicológicos más comunes en este escenario. Finalmente, se presenta una síntesis de las distintas líneas de investigación realizadas.</p>" ] "en" => array:1 [ "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleItalic">The biological, physical and psychological burden of a chronic disease has an impact on the quality of life of people who suffer from it. The perception of quality of life is affected by psychological disorders such as anxiety and depression that have a high prevalence in people with chronic kidney disease (CKD). These factors are also linked to lower life expectancy. It is therefore surprising that the psychological aspects of people with autosomal dominant polycystic kidney disease (ADPKD) have received so little attention in the medical literature, despite their importance for the overall health of these patients. The relatively new discipline called psychonephrology provides a broader view of the impact that these aspects have on individuals with chronic kidney disease, with a consequent practical application. In this article, we examine the consequences and prevalence of psychological problems that can be related to CKD and ADPKD. Firstly, we will focus on the field of CKD and ADPKD within the scope of psychonephrology. Secondly, the article introduces the concept of quality of life as a basic pillar of health that is affected when a person is diagnosed with CKD. Thirdly, we will present a summary of the main research related to anxiety and depression disorders in CKD and ADPKD. The article will conclude by synthesising findings from the different lines of research undertaken.</span></p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:47 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Torres Galván MJ, Rodríguez Pérez JC, Hernández Socorro CR, Anabitarte A, Caballero A, Vázquez C, et al.\u{A0}Diagnóstico molecular de la Poliquistosis Renal Autosómica Dominantes en la Comunidad Autónoma de Canarias. Nefrologia 2006;26(6):666-72. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17227243" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Nejastisafa AA. Prevalence of depression and anxiety in medical and surgical inpatients: a systematic review.\u{A0}Iran J Psychiatry 2007;2(4):181-5." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Levenson J, Glocheski S. Psychological factors affecting end-stage renal disease. Psychosomatics 1991;32(4):382-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/1961849" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Kimmel PL, Cohen SD, Peterson RA. Depression in patients with chronic renal disease: where are we going? J Ren Nutr 2008;18(1):99-103. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18089453" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Levy, N. Psychonephrology 2: Psychological problems in kidney failure and their treatment. New York: Plenum Medical Book Company; 1983, 296 p. ISBN: 030-6411-54-7." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Marta N. Psychonephrology: An emerging field. Prim Psychiatry 2008;15(1):43-4." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Bruce MA,\u{A0}Beech BM,\u{A0}Sims M,\u{A0}Brown TN,\u{A0}Wyatt SB,\u{A0}Taylor HA, et al.\u{A0}Social environmental stressors, psychological factors, and kidney disease. J Investig Med\u{A0}2009;57(4):583-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19240646" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 7 => array:3 [ "identificador" => "bib8" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Kaplan RM. Quality of life measurement. In: Karoly P, ed.\u{A0}Measurement strategies in health psychology. New York: Wiley; 1985." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 8 => array:3 [ "identificador" => "bib9" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Lopes AA, Bragg-Gresham JL, Satayathum S, McCullough K, Pifer T, Goodkin DA, et al;\u{A0}Dialysis outcomes and practice patterns study (DOPPS). Health-related quality of life and associated outcomes among hemodialysis patients of different ethnicities in the United States. Am J Kidney Dis 2003;41:605-15. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12612984" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 9 => array:3 [ "identificador" => "bib10" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Chapman MM, Meyer KB. Assessing health status in a dialysis clinic.\u{A0}Am J Health Syst Pharm 1995;52(14 Suppl 3):S31-2. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7552917" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 10 => array:3 [ "identificador" => "bib11" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Christensen AJ, Smith TW. Personality and patient adherence: correlates of the five-factor model in renal dialysis. J Behav Med 1995;18(3):305-13. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7674294" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 11 => array:3 [ "identificador" => "bib12" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Lindquist R, Carlsson M, Sjoden PO.\u{A0}Perceived consequences of being a renal failure patient. Nephrol Nurs J 2000;27(3):291-8." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 12 => array:3 [ "identificador" => "bib13" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Perlman RL,\u{A0}Finkelstein FO,\u{A0}Liu L,\u{A0}Roys E,\u{A0}Kiser M,\u{A0}Eisele G,\u{A0}et al.\u{A0}Quality of life in chronic kidney disease (CKD): a cross-sectional analysis in the Renal Research Institute-CKD study. Am J Kidney Dis 2005;45(4):658-66. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15806468" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 13 => array:3 [ "identificador" => "bib14" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Rebollo J, Bobes M, González P, Saiz P, Ortega F. Factores asociados a la calidad de vida relacionada con la salud (CVRS) de los pacientes en terapia renal sustitutiva (TRS). Nefrologia 2000;20(2):171-81. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10853199" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 14 => array:3 [ "identificador" => "bib15" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Simmons RG, Anderson BA, Kamstra BA. Comparison of quality of life on continuous ambulatory peritoneal dialysis, haemodialysis and after transplantation. Am J Kidney Dis 1984;4(3):253-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/6388319" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 15 => array:3 [ "identificador" => "bib16" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Lye L, Chan C, Leong A,\u{A0}Van Des S. Quality of life in patients undergoing renal replacement therapy. Kidney Int 1997;40:242-50." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 16 => array:3 [ "identificador" => "bib17" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Salek S. Quality of life assessment in patients on peritoneal dialysis: a review of the state of the art. Periton Dial Int 1996;16(Suppl.1):398-401." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 17 => array:3 [ "identificador" => "bib18" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Walters BA, Hays RD, Spritzer KL, Fridman M, Carter WB. Health-related quality of life, depressive symptoms, anemia, and malnutrition at hemodialysis initiation. Am J Kidney Dis 2002;40:1185-94. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12460037" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 18 => array:3 [ "identificador" => "bib19" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "García H, Calvanesem N. Calidad de vida percibida, depresión y ansiedad en pacientes con tratamiento sustitutivo de la función renal. Psicología y Salud 2008;18(1):5-15." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 19 => array:3 [ "identificador" => "bib20" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Mittal SK, Ahern L, Flaster E, Mittal VS, Maesaka JK, Fishbane S. Self-assessed quality of life in peritoneal dialysis patients. Am J Nephrol 2001;21(3): 215-20. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11423691" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 20 => array:3 [ "identificador" => "bib21" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Rizk D, Jurkovitz C, Veledar E, Bagby S, Baumgarten DA,\u{A0}Rahbari-Oskoui F, et al.\u{A0}Quality of life in autosomal dominant polycystic kidney disease patients not yet on dialysis. Clin J Am Soc Nephrol 2009;4:560-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19261830" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 21 => array:3 [ "identificador" => "bib22" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Lock P. Stressors, coping mechanisms and quality of life among dialysis patients in Australia. J Adv Nurs 1996;23(5):873-81. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8732512" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 22 => array:3 [ "identificador" => "bib23" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Walters BA, Hays RD, Spritzer KL, FridmanM, Carter WB. Health-related quality of life, depressive symptoms, anemia, and malnutrition at hemodialysis initiation. Am J Kidney Dis 2002;40:1185-94. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12460037" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 23 => array:3 [ "identificador" => "bib24" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Moreno E, Arenas MD, Porta E, Escalant L, Cantó MJ, Castell G, et al.\u{A0}Estudio de la prevalencia de trastornos ansiosos y depresivos en pacientes en hemodiálisis.\u{A0}Rev Soc Esp Enferm Nefrol 2004;4(7):17-25." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 24 => array:3 [ "identificador" => "bib25" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Kimmel PL, Thamer M, Richard CM, Ray NF. Psychiatric illness in patients with end-stage renal disease. Am J Med 1998;105(3):214-21. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9753024" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 25 => array:3 [ "identificador" => "bib26" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Everett KD, Brantley PJ, Sletten C, Jones GN, McKinight GT. The relation of stress and depression to interdialytic weight gain in haemodialysis patients. Behav Med 1995;21(1):25-30. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7579772" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 26 => array:3 [ "identificador" => "bib27" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Gala C, Pezzullo M, De Vecchi A, Conte G, Invernizzi G. Depression and quality of life in different types of dialysis. Med Ser Res 1990;18:35-6." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 27 => array:3 [ "identificador" => "bib28" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Engle D. Psychosocial aspects of the organ transplant experience: What has been established and what we need for the future.\u{A0}J Clin Psychol 2001;57:521-49. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11255205" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 28 => array:3 [ "identificador" => "bib29" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Pérez MA, Martín AR, Galán AR. Problemas psicológicos asociados. Int J Clin Health Psychol 2005;5(1):99-114." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 29 => array:3 [ "identificador" => "bib30" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Christensen AJ, Ehlers SL. Psychological factors in end-stage renal disease: an emerging context for behavioral medicine research. J Consult Clin Psychol 2002;70(3):712-24. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12090378" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 30 => array:3 [ "identificador" => "bib31" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Hill CA,\u{A0}Christensen AJ. Affiliative need, different types of social support, and physical symptoms. J Appl Soc Psychol 1989;19:1351-70." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 31 => array:3 [ "identificador" => "bib32" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Kimmel PL, Peterson RA. Depression in end stage renal disease patients: Tools, correlates, outcomes and needs.\u{A0}Semin Dial 2005;18:91-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15771651" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 32 => array:3 [ "identificador" => "bib33" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Kimmel PL, Peterson RA, Weihs KL, Simmens SJ, Alleyne S, Cruz I, et al.\u{A0}Multiple measurements of depression predict mortality in a longitudinal study of chronic hemodialysis patients. Kidney Int 2000;57:2093-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10792629" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 33 => array:3 [ "identificador" => "bib34" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Levy NB, Blumenfield M, Beasley CH, Dubey AK, Solomon RI, Todd R, et al.\u{A0}Fluoxetine in depressed patients with renal failure and in depressed patients with normal kidney function. General Hospital Psychiatry 1996;18:8-13. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8666216" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 34 => array:3 [ "identificador" => "bib35" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Abdel-Kader K, Unruh ML, Weisbord SD. Symptom burden, depression, and quality of life in chronic and end-stage kidney disease. Clin J Am Soc Nephrol 2010;5(9):1566-73.\u{A0} <a href="http://www.ncbi.nlm.nih.gov/pubmed/20507954" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 35 => array:3 [ "identificador" => "bib36" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Griffin KW,\u{A0}Wadhwa NK,\u{A0}Friend R,\u{A0}Suh H,\u{A0}Howell N,\u{A0}Cabralda T,\u{A0}et al.\u{A0}Comparison of quality of life in hemodialysis and peritoneal dialysis patients. Adv Perit Dial\u{A0}1994;10:104-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7999804" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 36 => array:3 [ "identificador" => "bib37" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Watnick S,\u{A0}Kirwin P,\u{A0}Mahnensmith R,\u{A0}Concato J. The prevalence and treatment of depression among patients starting dialysis. Am J Kidney Dis\u{A0}2003;41(1):105-10. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12500227" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 37 => array:3 [ "identificador" => "bib38" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Lopes AA, Bragg-Gresham JL, Young E, Goodkin DA, Mapes DL, Combe C, et al.; Dialysis Outcomes and Practice Patterns Study (DOPPS). Depression as a predictor of mortality and hospitalization among hemodialysis patients in the United States of Europe. Kidney Int 2002;62(1):199-207. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12081579" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 38 => array:3 [ "identificador" => "bib39" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Kellerman QD, Christensen AJ, Baldwin AS, Baldwin WJ. Association between depressive symptoms and mortality risk in chronic kidney disease. Health Psychol 2010;29(6):594-600. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20939641" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 39 => array:3 [ "identificador" => "bib40" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Lew SQ, Piraino B. Quality of life and psychological issues in peritoneal dialysis patients. Semin Dial 2005;18(2):119-23. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15771655" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 40 => array:3 [ "identificador" => "bib41" "etiqueta" => "41" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Christensen AJ, Ehlers SL. Psychological factors in end- stage renal disease: An emerging context for behavioral medicine research. J Consult Clin Psychol 2002;70:712-24. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12090378" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 41 => array:3 [ "identificador" => "bib42" "etiqueta" => "42" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Álvarez F, Fernández M, Vázquez A, Mon C, Sánchez, R, Rebollo P. Síntomas físicos y trastornos emocionales en pacientes en programa de hemodiálisis periódicas.\u{A0}Nefrologia 2001;21(2):191-9." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 42 => array:3 [ "identificador" => "bib43" "etiqueta" => "43" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Kimmel PL, Weihs K, Peterson RA. Survival in haemodialysis patients: The role of depression. J Am Soc Nephrol 1993;4(1):12-27. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8400064" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 43 => array:3 [ "identificador" => "bib44" "etiqueta" => "44" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Care A, DiMartini C, Crone M, Fireman M, Dew MA. Psychiatric aspects of organ transplantation in critical care. Crit Care Clin 2008;24(4):949-81." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 44 => array:3 [ "identificador" => "bib45" "etiqueta" => "45" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Lowry MR, Atcherson E. Characteristics of patients with depressive disorder on entry into home hemodialysis. J Nerv Ment Dis 1979;167(12):748-51. <a href="http://www.ncbi.nlm.nih.gov/pubmed/512646" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 45 => array:3 [ "identificador" => "bib46" "etiqueta" => "46" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Kimmel PL, Peterson RA. Depression in patients with end stage renal disease treated with dialysis: Has the time to treat arrived?\u{A0}Clin J Am Soc Nephrol 2006;1:349-52. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17699229" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 46 => array:3 [ "identificador" => "bib47" "etiqueta" => "47" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 1983;67:361-70. <a href="http://www.ncbi.nlm.nih.gov/pubmed/6880820" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003100000006/v0_201502091623/X2013251411000188/v0_201502091623/en/main.assets" "Apartado" => array:4 [ "identificador" => "35441" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Originals" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003100000006/v0_201502091623/X2013251411000188/v0_201502091623/en/P1-E528-S3198-A10847-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251411000188?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 10 | 8 | 18 |
| 2024 October | 67 | 63 | 130 |
| 2024 September | 64 | 43 | 107 |
| 2024 August | 80 | 64 | 144 |
| 2024 July | 46 | 37 | 83 |
| 2024 June | 69 | 57 | 126 |
| 2024 May | 94 | 43 | 137 |
| 2024 April | 51 | 36 | 87 |
| 2024 March | 52 | 25 | 77 |
| 2024 February | 60 | 51 | 111 |
| 2024 January | 55 | 37 | 92 |
| 2023 December | 55 | 31 | 86 |
| 2023 November | 70 | 43 | 113 |
| 2023 October | 55 | 49 | 104 |
| 2023 September | 44 | 36 | 80 |
| 2023 August | 45 | 24 | 69 |
| 2023 July | 49 | 47 | 96 |
| 2023 June | 60 | 36 | 96 |
| 2023 May | 61 | 47 | 108 |
| 2023 April | 52 | 39 | 91 |
| 2023 March | 48 | 43 | 91 |
| 2023 February | 48 | 47 | 95 |
| 2023 January | 50 | 33 | 83 |
| 2022 December | 44 | 54 | 98 |
| 2022 November | 44 | 54 | 98 |
| 2022 October | 57 | 91 | 148 |
| 2022 September | 54 | 35 | 89 |
| 2022 August | 61 | 60 | 121 |
| 2022 July | 51 | 69 | 120 |
| 2022 June | 49 | 62 | 111 |
| 2022 May | 61 | 55 | 116 |
| 2022 April | 57 | 61 | 118 |
| 2022 March | 56 | 44 | 100 |
| 2022 February | 62 | 87 | 149 |
| 2022 January | 267 | 55 | 322 |
| 2021 December | 41 | 40 | 81 |
| 2021 November | 61 | 50 | 111 |
| 2021 October | 57 | 40 | 97 |
| 2021 September | 42 | 47 | 89 |
| 2021 August | 39 | 42 | 81 |
| 2021 July | 38 | 34 | 72 |
| 2021 June | 36 | 32 | 68 |
| 2021 May | 51 | 58 | 109 |
| 2021 April | 86 | 66 | 152 |
| 2021 March | 53 | 56 | 109 |
| 2021 February | 62 | 32 | 94 |
| 2021 January | 44 | 29 | 73 |
| 2020 December | 33 | 27 | 60 |
| 2020 November | 34 | 9 | 43 |
| 2020 October | 28 | 18 | 46 |
| 2020 September | 37 | 5 | 42 |
| 2020 August | 32 | 19 | 51 |
| 2020 July | 36 | 16 | 52 |
| 2020 June | 36 | 25 | 61 |
| 2020 May | 42 | 15 | 57 |
| 2020 April | 34 | 27 | 61 |
| 2020 March | 42 | 10 | 52 |
| 2020 February | 55 | 24 | 79 |
| 2020 January | 58 | 28 | 86 |
| 2019 December | 56 | 23 | 79 |
| 2019 November | 61 | 28 | 89 |
| 2019 October | 86 | 21 | 107 |
| 2019 September | 50 | 27 | 77 |
| 2019 August | 53 | 23 | 76 |
| 2019 July | 38 | 21 | 59 |
| 2019 June | 54 | 16 | 70 |
| 2019 May | 44 | 27 | 71 |
| 2019 April | 63 | 34 | 97 |
| 2019 March | 53 | 25 | 78 |
| 2019 February | 35 | 42 | 77 |
| 2019 January | 51 | 23 | 74 |
| 2018 December | 113 | 40 | 153 |
| 2018 November | 146 | 20 | 166 |
| 2018 October | 114 | 13 | 127 |
| 2018 September | 72 | 23 | 95 |
| 2018 August | 52 | 13 | 65 |
| 2018 July | 40 | 23 | 63 |
| 2018 June | 59 | 17 | 76 |
| 2018 May | 61 | 10 | 71 |
| 2018 April | 58 | 10 | 68 |
| 2018 March | 47 | 24 | 71 |
| 2018 February | 36 | 11 | 47 |
| 2018 January | 43 | 19 | 62 |
| 2017 December | 48 | 11 | 59 |
| 2017 November | 62 | 5 | 67 |
| 2017 October | 34 | 11 | 45 |
| 2017 September | 31 | 6 | 37 |
| 2017 August | 35 | 17 | 52 |
| 2017 July | 37 | 11 | 48 |
| 2017 June | 30 | 17 | 47 |
| 2017 May | 36 | 9 | 45 |
| 2017 April | 34 | 13 | 47 |
| 2017 March | 29 | 10 | 39 |
| 2017 February | 23 | 17 | 40 |
| 2017 January | 22 | 16 | 38 |
| 2016 December | 47 | 19 | 66 |
| 2016 November | 54 | 11 | 65 |
| 2016 October | 76 | 15 | 91 |
| 2016 September | 144 | 12 | 156 |
| 2016 August | 184 | 12 | 196 |
| 2016 July | 161 | 14 | 175 |
| 2016 June | 151 | 0 | 151 |
| 2016 May | 164 | 0 | 164 |
| 2016 April | 176 | 0 | 176 |
| 2016 March | 157 | 0 | 157 |
| 2016 February | 125 | 0 | 125 |
| 2016 January | 95 | 0 | 95 |
| 2015 December | 138 | 0 | 138 |
| 2015 November | 111 | 0 | 111 |
| 2015 October | 113 | 0 | 113 |
| 2015 September | 88 | 0 | 88 |
| 2015 August | 73 | 0 | 73 |
| 2015 July | 68 | 0 | 68 |
| 2015 June | 59 | 0 | 59 |
| 2015 May | 65 | 0 | 65 |
| 2015 April | 7 | 0 | 7 |
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