Bem-estar em doadores renais antes e após a doação renal
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Data
2021-05-28
Autores
Altran, Thainá Dejavite Previatto
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Universidade Estadual Paulista (Unesp)
Resumo
O transplante renal tem sido considerado como a melhor alternativa de tratamento para pacientes com doença renal crônica, podendo ser realizado com dois tipos de doadores, falecido ou vivo. Sabe-se que, os benefícios dispensados ao receptor pelo transplante com doador vivo e os riscos físicos acerca da doação são bem explorados, porém, são escassos estudos que abordam o bem-estar de doadores renais. Objetivo: Comparar os aspectos psicossociais combinados (ansiedade, depressão, apoio social e qualidade de vida), denominados escore de bem-estar, dos doadores renais antes da nefrectomia, após 3 e 12 meses da doação renal. Materiais e Métodos: Tratou-se de um estudo longitudinal, prospectivo e comparative, desenvolvido em um Hospital de Transplantes Terciário, com doadores renais cujas as doações ocorreram entre março de 2019 a março de 2020, quando a realização dos transplantes intervivos foi prejudicada pela pandemia. Foram aplicados os seguintes instrumentos padronizados: Inventário de Depressão de Beck (BDI), Inventário de Ansiedade Traço-Estado (IDATE), Medical Outcomes Study (MOS), Teste de Triagem do Envolvimento com Bebidas Alcóolicas, Cigarro e Fármacos (ASSIST) e Short Form Health Survey (SF-36). O bem-estar foi definido com a média de pontuação dos questionários normatizados para uma escala de 0 a 100 pontos. Foi feita a média do SF-36 e do MOS subtraído da média do BDI e IDATE. Para a análise dos dados, foi utilizada análise exploratória com a descrição das características da amostra de doadores renais quanto às características psicossociais e as medidas repetidas foram somadas no escore de bem-estar e comparadas ao longo do tempo com a análise de modelos lineares mistos. A variável dependente foi a medida do desfecho e o tempo foi usado como fator fixo. Foi adicionado um slope randômico para cada caso individual. A análise de cada escore individual foi analisada pelo teste de Kruskall-Wallis, porém, foi considerada desfecho secundário exploratório para evitar o erro das múltiplas comparações. Foi utilizado o software R versão 3.4.2. O nível de significância estatística foi p<0.05. Resultados: Foram analisados 22 doadores, sendo que destes, 13 deles completaram a terceira avaliação (12m). Tratou-se de uma população de idade média aproximada de 40 anos sendo os irmãos os principais doadores. No desfecho primário, nota-se uma tendência a uma redução do bem-estar aos três meses (-5.37 pontos, p=0.06), com normalização ao fim de 12 meses (-3.57 pontos, p=0.28). Na análise de subgrupo dos doadores, têm-se um total 59.1% dos daqueles que não tiveram eventos após a doação. Todavia, quatro doadores (18.2%) perderam o emprego possivelmente relacionado ao afastamento pela doação. Três doadores (13.6%) foram avaliados durante a pandemia. Dois receptores (9.1%) tiveram eventos desfavoráveis. A análise dos doadores separados pelos eventos (pandemia, desemprego, evolução desfavorável) mostrou que os doadores que tiveram eventos foram os que tiveram redução do escore de bem-estar. A presença de evento no doador (agrupando todas as categorias) mostrou uma queda do escore de bem-estar de -5.97 pontos, p=0.046. Conclusão: A doação renal foi segura com relação ao bem estar do doador após 12 meses, apesar da identificação de um grupo de doadores de maior risco que podem apresentar algum prejuízo do seu bem-estar após a doação. Esses doadores devem ser mais bem avaliados em estudos futuros.
Kidney transplantation has been considered the best treatement alternative for pacients with chronic renal disease, being realized with two types of donors, deceased or alive. It is known that the benefits dispensed to the recipient by the transplant with live donor and the physical risks about the donation are well exploited, however, there are few studies addressing the well-being of future donors. Objective: Compare the combined psychosocial aspects (anxiety, depression, social support and quality of life), named well-being score, of renal donors before nefrectomy, after 3 and 12 months of renal donation. Materials and Methods: This was a longitudinal, prospective and comparative study developed in a Tertiary Transplant Hospital with kidney donors whose donations occurred between March 2019 and March 2020, when the performance of living transplants was hampered by the pandemic. The following standardized instruments were applied: Beck Depression Inventory (BDI), State Trait Anxiety Inventory (STAI), Medical Outcomes Study (MOS), Alcohol, Cigarette and Drug Alcohol Involvement Screening Test (ASSIST) and Short Form Health Survey (SF-36). Well-being was defined with the average score of the standardized questionnaires for a scale from 0 to 100 points. The mean of SF-36 and MOS was done with the mean subtraction of BDI and IDATE. For data analysis, exploratory analysis was used with the description of the characteristics of the sample of renal donors regarding psychosocial characteristics and repeated measures were added to the well-being score and compared over time with the analysis of mixed linear models. The dependent variable was the measure of the outcome and time was used as a fixed factor. A random slope was added for each individual case. The analysis of each individual score was analyzed by the Kruskall-Wallis test, however, was considered exploratory secondary outcome to avoid the error of multiple comparisons. Software R version 3.4.2 was used. The level of statistical significance was p<0.05. Outcomes: Twenty-two donors were analyzed, of which 13 of them completed the third evaluation (12m). This was an average age population of approximately 40 years, and siblings were the main donors. In the primary outcome, there was a tendency to a reduction in well-being at three months (-5.37 points, p=0.06), with normalization after 12 months (-3.57 points, p=0.28). In the subgroup analysis of donors, a total of 59.1% of those who did not have events after donation are found. However, four donors (18.2%) lost their jobs possibly related to the removal by donation. Three donors (13.6%) evaluated during the pandemic. Two recipients (9.1%) had unfavorable events. The analysis of donors separated by events (pandemic, unemployment, unfavorable evolution) showed that the donors who had events were the ones who had a reduction in the well-being score. The presence of an event in the donor (grouping all categories) showed a fall in the well-being score of -5.97 points, p=0.046. Conclusions: Renal donation was safe in relation to the donor's well-being after 12 months, despite the identification of a group of higher-risk donors who may have some impairment of their well-being after the donation. These donors should be better evaluated in future studies.
Kidney transplantation has been considered the best treatement alternative for pacients with chronic renal disease, being realized with two types of donors, deceased or alive. It is known that the benefits dispensed to the recipient by the transplant with live donor and the physical risks about the donation are well exploited, however, there are few studies addressing the well-being of future donors. Objective: Compare the combined psychosocial aspects (anxiety, depression, social support and quality of life), named well-being score, of renal donors before nefrectomy, after 3 and 12 months of renal donation. Materials and Methods: This was a longitudinal, prospective and comparative study developed in a Tertiary Transplant Hospital with kidney donors whose donations occurred between March 2019 and March 2020, when the performance of living transplants was hampered by the pandemic. The following standardized instruments were applied: Beck Depression Inventory (BDI), State Trait Anxiety Inventory (STAI), Medical Outcomes Study (MOS), Alcohol, Cigarette and Drug Alcohol Involvement Screening Test (ASSIST) and Short Form Health Survey (SF-36). Well-being was defined with the average score of the standardized questionnaires for a scale from 0 to 100 points. The mean of SF-36 and MOS was done with the mean subtraction of BDI and IDATE. For data analysis, exploratory analysis was used with the description of the characteristics of the sample of renal donors regarding psychosocial characteristics and repeated measures were added to the well-being score and compared over time with the analysis of mixed linear models. The dependent variable was the measure of the outcome and time was used as a fixed factor. A random slope was added for each individual case. The analysis of each individual score was analyzed by the Kruskall-Wallis test, however, was considered exploratory secondary outcome to avoid the error of multiple comparisons. Software R version 3.4.2 was used. The level of statistical significance was p<0.05. Outcomes: Twenty-two donors were analyzed, of which 13 of them completed the third evaluation (12m). This was an average age population of approximately 40 years, and siblings were the main donors. In the primary outcome, there was a tendency to a reduction in well-being at three months (-5.37 points, p=0.06), with normalization after 12 months (-3.57 points, p=0.28). In the subgroup analysis of donors, a total of 59.1% of those who did not have events after donation are found. However, four donors (18.2%) lost their jobs possibly related to the removal by donation. Three donors (13.6%) evaluated during the pandemic. Two recipients (9.1%) had unfavorable events. The analysis of donors separated by events (pandemic, unemployment, unfavorable evolution) showed that the donors who had events were the ones who had a reduction in the well-being score. The presence of an event in the donor (grouping all categories) showed a fall in the well-being score of -5.97 points, p=0.046. Conclusions: Renal donation was safe in relation to the donor's well-being after 12 months, despite the identification of a group of higher-risk donors who may have some impairment of their well-being after the donation. These donors should be better evaluated in future studies.
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Palavras-chave
Sistemas de apoio psicossocial, Transplante renal, Doadores vivos, Psychosocial support systems, Kidney transplantation, Living donors