Anxiety-depression levels and coping strategies among renal transplant waitlisted and non-waitlisted hemodialysis patients

Anxiety-depression among renal transplant patients



Depression, Anxiety, Coping strategies, Hemodialysis, Renal transplantation


Background/Aim: Although hemodialysis provides prolonged survival, patients face major challenges, including conflicts about life decisions, limited physical, mental, and lifestyle activities, psychological distress, high prevalence of anxiety and depression symptoms, and compromised health-related quality of life. This study aimed to compare anxiety-depression levels and coping strategies between renal transplant waitlisted and non-waitlisted hemodialysis patients.

Methods: A total of 75 hemodialysis patients were enrolled in this case-control analytical study, including renal transplant waitlisted (n = 35) and non-waitlisted (n = 40) patients. Patients were asked to fill out a questionnaire including socio-demographic characteristics, duration of hemodialysis, the Hospital Anxiety and Depression Scale, and the Ways of Coping Questionnaire. Comparative analyses were performed via Student's t-test and Pearson Correlation test.

Results: The mean age was 57.1 (15.3) years; 56% were males, and being under hemodialysis treatment was 7.3 (5.9) years. Waitlisted and non-waitlisted patients were matched. Overall, 28 patients (37.3%) had anxiety, and 34 patients (45.3%) had depression. There was no significant difference between the two groups regarding depression scores. Anxiety was more common among non-waitlisted than waitlisted patients (P = 0.043). The fatalistic approach was the most common coping strategy applied, and there was a significant negative correlation between anxiety scores and the problem-solving approach (P = 0.034) and a significant positive correlation between depression scores and the helplessness approach (r = 0.234, P = 0.043).

Conclusion: Both waitlisted and non-waitlisted hemodialysis patients have significantly higher levels of depression, with anxiety being higher in non-waitlisted patients. Since coping strategies differed concerning anxiety and depression but not transplant candidacy, psychiatric evaluation and counseling would be essential in hemodialysis patients to control the stressors.


Download data is not yet available.


Sarnak MJ, Levey AS, Schoolwerth AC, Coresh J, Culleton B, Hamm LL, et al. Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Hypertension. 2003;42(5):1050-65. Epub 2003/11/08. doi: 10.1161/01.HYP.0000102971.85504.7c. PubMed PMID: 14604997. DOI:

Hagren B, Pettersen IM, Severinsson E, Lutzen K, Clyne N. Maintenance haemodialysis: patients' experiences of their life situation. J Clin Nurs. 2005;14(3):294-300. Epub 2005/02/15. doi: 10.1111/j.1365-2702.2004.01036.x. PubMed PMID: 15707439. DOI:

Davison SN. End-of-life care preferences and needs: perceptions of patients with chronic kidney disease. Clin J Am Soc Nephrol. 2010;5(2):195-204. Epub 2010/01/22. doi: 10.2215/CJN.05960809. PubMed PMID: 20089488; PubMed Central PMCID: PMCPMC2827591. DOI:

Ibrahim N, Chiew-Thong NK, Desa A, Razali R. Depression and coping in adults undergoing dialysis for end-stage renal disease. Asia Pac Psychiatry. 2013;5 Suppl 1:35-40. Epub 2013/07/24. doi: 10.1111/appy.12042. PubMed PMID: 23857835. DOI:

Suleymanlar G, Utas C, Arinsoy T, Ates K, Altun B, Altiparmak MR, et al. A population-based survey of Chronic REnal Disease In Turkey--the CREDIT study. Nephrol Dial Transplant. 2011;26(6):1862-71. Epub 2010/11/06. doi: 10.1093/ndt/gfq656. PubMed PMID: 21051501; PubMed Central PMCID: PMCPMC3107767. DOI:

Seyahi N, Ateş K, Süleymanlar G. Türkiye’de Renal Replasman Tedavilerinin Güncel Durumu: Türk Nefroloji Derneği Kayıt Sistemi 2016 Yılı Özet Raporu. Turkish Nephrology Dialysis Transplantation. 2018;27(2):133-9. doi: 10.5262/tndt.2018.3329. DOI:

Gurkan A, Pakyuz SC, Demir T. Stress Coping Strategies in Hemodialysis and Kidney Transplant Patients. Transplant Proc. 2015;47(5):1392-7. Epub 2015/06/22. doi: 10.1016/j.transproceed.2015.05.022. PubMed PMID: 26093726. DOI:

Cohen LM, Germain MJ, Poppel DM. Practical considerations in dialysis withdrawal: "to have that option is a blessing". JAMA. 2003;289(16):2113-9. Epub 2003/04/24. doi: 10.1001/jama.289.16.2113. PubMed PMID: 12709469. DOI:

Fabrazzo M, De Santo RM. Depression in chronic kidney disease. Semin Nephrol. 2006;26(1):56-60. Epub 2006/01/18. doi: 10.1016/j.semnephrol.2005.06.012. PubMed PMID: 16412828. DOI:

Kurella M, Kimmel PL, Young BS, Chertow GM. Suicide in the United States end-stage renal disease program. J Am Soc Nephrol. 2005;16(3):774-81. Epub 2005/01/22. doi: 10.1681/ASN.2004070550. PubMed PMID: 15659561. DOI:

Finkelstein FO, Wuerth D, Finkelstein SH. Health related quality of life and the CKD patient: challenges for the nephrology community. Kidney Int. 2009;76(9):946-52. Epub 2009/08/14. doi: 10.1038/ki.2009.307. PubMed PMID: 19675529. DOI:

Kimmel PL, Patel SS. Quality of life in patients with chronic kidney disease: focus on end-stage renal disease treated with hemodialysis. Semin Nephrol. 2006;26(1):68-79. Epub 2006/01/18. doi: 10.1016/j.semnephrol.2005.06.015. PubMed PMID: 16412831. DOI:

Ramirez SP, Macedo DS, Sales PM, Figueiredo SM, Daher EF, Araujo SM, et al. The relationship between religious coping, psychological distress and quality of life in hemodialysis patients. J Psychosom Res. 2012;72(2):129-35. Epub 2012/01/28. doi: 10.1016/j.jpsychores.2011.11.012. PubMed PMID: 22281454. DOI:

Pelletier-Hibbert M, Sohi P. Sources of uncertainty and coping strategies used by family members of individuals living with end stage renal disease. Nephrol Nurs J. 2001;28(4):411-9.

Lima AF, Gualda DM. [Oral history of life: in search of the meaning of hemodialysis in chronic renal patients]. Rev Esc Enferm USP. 2001;35(3):235-41. Epub 2002/11/16. doi: 10.1590/s0080-62342001000300006. PubMed PMID: 12432603. DOI:

Gudex CM. Health-related quality of life in endstage renal failure. Qual Life Res. 1995;4(4):359-66. Epub 1995/08/01. doi: 10.1007/BF01593889. PubMed PMID: 7550185. DOI:

Valderrabano F, Jofre R, Lopez-Gomez JM. Quality of life in end-stage renal disease patients. Am J Kidney Dis. 2001;38(3):443-64. Epub 2001/09/05. doi: 10.1053/ajkd.2001.26824. PubMed PMID: 11532675. DOI:

Christensen AJ, Benotsch EG, Wiebe JS, Lawton WJ. Coping with treatment-related stress: effects on patient adherence in hemodialysis. J Consult Clin Psychol. 1995;63(3):454-9. Epub 1995/06/01. doi: 10.1037//0022-006x.63.3.454. PubMed PMID: 7608358. DOI:

Mok E, Tam B. Stressors and coping methods among chronic haemodialysis patients in Hong Kong. J Clin Nurs. 2001;10(4):503-11. Epub 2002/02/02. doi: 10.1046/j.1365-2702.2001.00500.x. PubMed PMID: 11822498. DOI:

Lok P. Stressors, coping mechanisms and quality of life among dialysis patients in Australia. J Adv Nurs. 1996;23(5):873-81. Epub 1996/05/01. doi: 10.1046/j.1365-2648.1996.00893.x. PubMed PMID: 8732512. DOI:

Bertolin DC, Pace AE, Kusumota L, Haas V. [An association between forms of coping and the socio-demographic variables of people on chronic hemodialysis]. Rev Esc Enferm USP. 2011;45(5):1070-6. Epub 2011/10/28. doi: 10.1590/s0080-62342011000500006. PubMed PMID: 22031365. DOI:

Çetinkaya S, Nur N, Ayvaz A, Özdemir D. Bir üniversite hastanesinde hemodiyaliz ve sürekli ayaktan periton diyalizi hastalarında depresyon, anksiyete düzeyleri ve stresle başa çıkma tutumları. Nöropsikiyatri Arşivi. 2008;45(3):78-84.

Folkman S, Lazarus RS. Coping as a Mediator of Emotion. Journal of Personality and Social Psychology. 1988;54(3):466-75. doi: Doi 10.1037/0022-3514.54.3.466. PubMed PMID: WOS:A1988M364000011. DOI:

Karanci NA, Alkan N, Aksit B, Sucuoglu H, Balta E. Gender differences in psychological distress, coping, social support and related variables following the 1995 Dinal (Turkey) earthquake. North American Journal of Psychology. 1999;1(2):189–204.

Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361-70. Epub 1983/06/01. doi: 10.1111/j.1600-0447.1983.tb09716.x. PubMed PMID: 6880820. DOI:

Aydemir Ö, Guvenir T, Kuey L, Kultur S. Validity and reliability of Turkish version of hospital anxiety and depression scale. Turk Psikiyatri Derg. 1997;8(4):280-7.

Chen YS, Wu SC, Wang SY, Jaw BS. Depression in chronic haemodialysed patients. Nephrology (Carlton). 2003;8(3):121-6. Epub 2004/03/12. doi: 10.1046/j.1440-1797.2003.00147.x. PubMed PMID: 15012727. DOI:

Roesch SC, Weiner B. A meta-analytic review of coping with illness: do causal attributions matter? J Psychosom Res. 2001;50(4):205-19. Epub 2001/05/23. doi: 10.1016/s0022-3999(01)00188-x. PubMed PMID: 11369026. DOI:

Kimmel PL. Depression in patients with chronic renal disease - What we know and what we need to know. J Psychosom Res. 2002;53(4):951-6. doi: 10.1016/S0022-3999(02)00310-0. DOI:

Levy NB. What is psychonephrology? Journal of Nephrology. 2008;21:S51-3. PubMed Central PMCID: PMC18446732

Barros A, Costa BE, Mottin CC, d'Avila DO. Depression, quality of life, and body composition in patients with end-stage renal disease: a cohort study. Braz J Psychiatry. 2016;38(4):301-6. Epub 2016/02/13. doi: 10.1590/1516-4446-2015-1681. PubMed PMID: 26870913; PubMed Central PMCID: PMCPMC7111352. DOI:

Smith MD, Hong BA, Robson AM. Diagnosis of depression in patients with end-stage renal disease. Comparative analysis. Am J Med. 1985;79(2):160-6. Epub 1985/08/01. doi: 10.1016/0002-9343(85)90004-x. PubMed PMID: 3895906. DOI:

Chilcot J, Davenport A, Wellsted D, Firth J, Farrington K. An association between depressive symptoms and survival in incident dialysis patients. Nephrol Dial Transplant. 2011;26(5):1628-34. Epub 2010/10/06. doi: 10.1093/ndt/gfq611. PubMed PMID: 20921294. DOI:

Andrade CP, Cruz MC, Urrutia M, Pereira O, Draibe SA, Nogueira-Martins LA, et al. Evaluation of depressive symptoms in patients with chronic renal failure. J Nephrol. 2010;23(2):168-74. Epub 2010/02/02. PubMed PMID: 20119932.

Barros A, da Costa BE, Poli-de-Figueiredo CE, Antonello IC, d'Avila DO. Nutritional status evaluated by multi-frequency bioimpedance is not associated with quality of life or depressive symptoms in hemodialysis patients. Ther Apher Dial. 2011;15(1):58-65. Epub 2011/01/29. doi: 10.1111/j.1744-9987.2010.00874.x. PubMed PMID: 21272254. DOI:

Takaki J, Nishi T, Shimoyama H, Inada T, Matsuyama N, Kumano H, et al. Possible interactive effects of demographic factors and stress coping mechanisms on depression and anxiety in maintenance hemodialysis patients. J Psychosom Res. 2005;58(3):217-23. Epub 2005/05/04. doi: 10.1016/j.jpsychores.2004.09.003. PubMed PMID: 15865945. DOI:

Yeh SC, Chou HC. Coping strategies and stressors in patients with hemodialysis. Psychosom Med. 2007;69(2):182-90. Epub 2007/02/10. doi: 10.1097/PSY.0b013e318031cdcc. PubMed PMID: 17289821. DOI:

Akman B, Ozdemir FN, Sezer S, Micozkadioglu H, Haberal M. Depression levels before and after renal transplantation. Transplant Proc. 2004;36(1):111-3. Epub 2004/03/12. doi: 10.1016/j.transproceed.2003.11.021. PubMed PMID: 15013316. DOI:

Wyld M, Morton RL, Hayen A, Howard K, Webster AC. A systematic review and meta-analysis of utility-based quality of life in chronic kidney disease treatments. PLoS Med. 2012;9(9):e1001307. Epub 2012/09/18. doi: 10.1371/journal.pmed.1001307. PubMed PMID: 22984353; PubMed Central PMCID: PMCPMC3439392. DOI:

Karaminia R, Tavallaii SA, Lorgard-Dezfuli-Nejad M, Moghani Lankarani M, Hadavand Mirzaie H, Einollahi B, et al. Anxiety and depression: a comparison between renal transplant recipients and hemodialysis patients. Transplant Proc. 2007;39(4):1082-4. Epub 2007/05/26. doi: 10.1016/j.transproceed.2007.03.088. PubMed PMID: 17524897. DOI:

Petrie K. Psychological well-being and psychiatric disturbance in dialysis and renal transplant patients. Br J Med Psychol. 1989;62 ( Pt 1)(1):91-6. Epub 1989/03/01. doi: 10.1111/j.2044-8341.1989.tb02814.x. PubMed PMID: 2650731. DOI:

Cinar S, Barlas GU, Alpar SE. Stressors and Coping Strategies in Hemodialysis Patients. Pak J Med Sci. 2009;25(3):447-52.

Hiçdurmaz D, Öz F. Coping styles of patients taking hemodialysis and continuous ambulatory peritoneal dialysis treatment. Hacettepe University Faculty of Health Sciences Nursing Journal. 2009;16(3):1-16.

Baykan H, Yargic I. Depression, Anxiety Disorders, Quality of Life and Stress Coping Strategies in Hemodialysis and Continuous Ambulatory Peritoneal Dialysis Patients. Klinik Psikofarmakoloji Bulteni-Bulletin of Clinical Psychopharmacology. 2012;22(2):167-76. doi: DOI 10.5455/bcp.20120412022430. PubMed PMID: WOS:000308118800007. DOI:

Welch JL, Austin JK. Stressors, coping and depression in haemodialysis patients. J Adv Nurs. 2001;33(2):200-7. Epub 2001/02/13. doi: 10.1046/j.1365-2648.2001.01654.x. PubMed PMID: 11168703. DOI:

Cormier-Daigle M, Stewart M. Support and coping of male hemodialysis-dependent patients. Int J Nurs Stud. 1997;34(6):420-30. Epub 1998/04/29. doi: 10.1016/s0020-7489(97)00035-7. PubMed PMID: 9559392. DOI:

Koenig HG. Religion, spirituality, and medicine: research findings and implications for clinical practice. South Med J. 2004;97(12):1194-200. Epub 2005/01/14. doi: 10.1097/01.SMJ.0000146489.21837.CE. PubMed PMID: 15646757. DOI:

Koenig HG, George LK, Titus P. Religion, spirituality, and health in medically ill hospitalized older patients. J Am Geriatr Soc. 2004;52(4):554-62. Epub 2004/04/07. doi: 10.1111/j.1532-5415.2004.52161.x. PubMed PMID: 15066070. DOI:

Matthews DA, McCullough ME, Larson DB, Koenig HG, Swyers JP, Milano MG. Religious commitment and health status: a review of the research and implications for family medicine. Arch Fam Med. 1998;7(2):118-24. Epub 1998/03/31. doi: 10.1001/archfami.7.2.118. PubMed PMID: 9519914. DOI:

Folkman S, Lazarus RS. An analysis of coping in a middle-aged community sample. J Health Soc Behav. 1980;21(3):219-39. Epub 1980/09/01. PubMed PMID: 7410799. DOI:

Stroebe M, Schut H. The dual process model of coping with bereavement: rationale and description. Death Stud. 1999;23(3):197-224. Epub 2000/06/10. doi: 10.1080/074811899201046. PubMed PMID: 10848151. DOI:

Ano GG, Vasconcelles EB. Religious coping and psychological adjustment to stress: a meta-analysis. J Clin Psychol. 2005;61(4):461-80. Epub 2004/10/27. doi: 10.1002/jclp.20049. PubMed PMID: 15503316. DOI:

Bardwell WA, Ancoli-Israel S, Dimsdale JE. Types of coping strategies are associated with increased depressive symptoms in patients with obstructive sleep apnea. Sleep. 2001;24(8):905-9. Epub 2002/01/05. doi: 10.1093/sleep/24.8.905. PubMed PMID: 117661607. DOI:






Research Article

How to Cite

Cigerli O, Kaplan AK, Parildar H. Anxiety-depression levels and coping strategies among renal transplant waitlisted and non-waitlisted hemodialysis patients: Anxiety-depression among renal transplant patients. J Surg Med [Internet]. 2022 Dec. 28 [cited 2024 Apr. 19];6(12):999-1003. Available from: