PSYCHOLOGIC FUNCTIONING, QUALITY-OF-LIFE, AND BEHAVIORAL COMPLIANCE IN PATIENTS BEGINNING HEMODIALYSIS

Psychologic and demographic characteristics have been shown to correla te with behavioral compliance in studies of prevalent hemodialysis (HD ) patients. Few data, however, exist on the psychologic characteristic s or their relationship to compliance in patients initiating HD treatm ent, or incident patients. Our previous work with prevalent HD patient s showed an interrelationship among social support, perception of the effects of illness, and depression measured by a standardized depressi on index and a cognitive depression index deleting somatic symptoms, T o compare psychosocial and behavioral compliance parameters in inciden t and prevalent patients, 99 incident HD patients undergoing dialysis for less than 6 months were assessed by using a variety of questionnai res, The patients' mean standardized depression index score was in the range of mild depression. There was no difference in mean age, Karnof sky functional status, perception of effects of illness or standardize d or cognitive depression scores between incident patients and 149 pre valent patients treated with HD for 6 to 246 months, Satisfaction with life scores and perception of sexual adjustment were better, but Kt/V (quantitative measure of the amount of dialysis provided) and protein catabolic rate were lower in incident than in prevalent patients, Soc ial support and perception of illness scores correlated with depressio n measures in incident patients, findings that were similar to prevale nt patients. Incident (as did prevalent) patients showed striking biva riate correlations between the psychosocial and depression variables, but fewer correlations between psychologic and compliance measures, Bo th standard compliance parameters, such as mean predialysis serum phos phorus and potassium concentration, and behavioral compliance were bet ter in incident than in prevalent patients, Worsened sexual adjustment , functional status, and increased severity of illness were correlated with improved behavioral compliance in incident patients, Behavioral compliance styles correlated with different social support and severit y of medical illness variables in incident and prevalent patients, whe n assessed by multiple linear regression analysis. These different pat terns suggest the existence of different mechanisms of adaptation in t he groups. Measures focused on increasing delivery of dialysis and enh ancing social support in urban African-American patients starting HD t herapy may be useful in improving compliance with the dialysis prescri ption, and indirectly improving survival.