Dyadic relationship conflict, gender, and mortality in urban hemodialysis patients

The effects of dyadic satisfaction and conflict have not been well defined in the hemodialysis (HD) population. The aim of this study was to determine whether the perception of decreased dyadic satisfaction was associated wit h mortality in patients treated with HD, and if so, whether there were diff erent relationships between risk factors, and differential outcomes in men and women. A total of 174 HD patients, primarily African-Americans. involve d in dyadic relationships for more than 6 mo had indices of dyadic satisfac tion, depression, perception of illness effects, social support, behavioral compliance with the dialysis prescription, and plasma interleukin-1 (IL-1) and beta-endorphin levels measured. Cox proportional hazards models assess ed relative mortality risks. Patients' dyadic satisfaction scores correlate d with P-endorphin levels. There was no correlation of IL-1 or beta-endorph in with any psychosocial or behavioral compliance measure in the group as a whole. Correlations between psychosocial, medical, and neuroimmunologic va riables were different in men and women. For women, dyadic satisfaction cor related with beta-endorphin levels, depression, and perception of illness. Women with higher dyadic satisfaction and decreased dyadic conflict were at decreased mortality risk, but dyadic adjustment indices were unassociated with differential survival in the larger group of men. Correlations between neuroendocrine and immune markers are different in African-American male a nd female HD patients. Greater dyadic satisfaction and lower dyadic conflic t are independently associated with decreased mortality in female African-A merican HD patients, of the same order of magnitude as medical risk factors . Such effects may be attributable to a relationship between dyadic satisfa ction and conflict and health-related behaviors, or through an effect on ne uroendocrine or immunologic status.