Depression, Anxiety, Activities of Daily Living, and Quality of Life Scores in Patients Undergoing Renal Replacement Therapies N.M. Alavi, Z. Aliakbarzadeh, and K. Sharifi ABSTRACT The aim of this study was to investigate anxiety, depression, quality of life (QOL), and activities of daily living (ADL) among our hemodialysis and renal transplant subjects. Psychological disorders were prevalent among patients with end-stage renal disease (ESRD), adversely affecting QOL and ADL. All patients 18 years under renal replacement therapy were asked to participate in the study. Patients completed 4 questionnaires including the Symptom Checklist-90 subscales of depression and anxiety, the Nottingham Extended ADL scale, and the Duke Health Profile questionnaire. We examined a total of 100 transplant and 63 hemodialysis patients. Transplant patients were significantly younger, better educated, and with lower morbidity than the hemodialysis patients. Transplant patients also showed less depression and anxiety as well as better ADL and physical health. Of the variance in anxiety scores, 12.2% was explained by gender and the presence of cardiac disease (P  .022). For depression, replacement therapy and gender explained 16.4% of the variance (P  .004). Replacement therapy accounted for 35.3% of the variance of the ADL score (P  .001), while together with the additional factors of age, gender, and education these 52.8% (P  .007) was accounted for. For the general health score, gender, and cardiac disease explained 11.6% of the variance (P  .001). This study demonstrated that depression and anxiety are more prevalent among hemodialysis patients compared with kidney transplant subjects; the method of treatment was a major contributor to the variance in ADL and depression scores among ESRD patients. E ND-STAGE RENAL DISEASE (ESRD) is a major health problem in Iran with a prevalence of 253 per million population. Of these patients, 52% undergo hemo- dialysis and 47% are treated by transplantation; a further 1% receive peritoneal dialysis. 1 A compensated and regu- lated, living-unrelated donor renal transplantation program was adopted in 1988. 2 Volunteers who were willing to donate registered at the Society for Supporting Dialysis and Transplantation Patients, a liaison agency between poten- tial donors and recipients. The donors are paid a reward from government funds and receive a gift from the recipient as well. 3 As a result, the number of renal transplants performed substantially increased such that in 1999, the renal transplant waiting list was completely eliminated. By the end of 2006, a total of 21,251 renal transplants had been performed 3641 from living-related, 16,544 from living- unrelated, and 1066 from deceased-donors. 2 There is a concerted effort to expand the cadaveric transplantation program, as well as hemodialysis and peritoneal dialysis units. Fortunately, all these services are provided free of charge to patients. 4 Psychological disorders are prevalent among ESRD pa- tients. 5,6 Depression is frequently encountered with an esti- mated prevalence of 25%–30%. 7 Over the past 20 years, the epidemiology, consequences, and treatment of depression in patients with renal disease has become an important issue. 8 Depression can lead to noncompliance to therapy and may ultimately affect patient survival. 7 Several studies have linked psychological depression with mortality among ESRD pa- tients, making early diagnosis and treatment essential. 9 Renal transplantation is the treatment of choice for ESRD. 10 In comparison with hemodialysis, this procedure From the Department of Medical Nursing, Kashan University of Medical Sciences and Health Care, Kashan, Isfahan, Iran. Address reprint requests to Dr N.M. Alavi, Kashan University of Medical Sciences and Healthcare, Ghotb Ravandi Highway, Kashan, Isfahan, Iran. E-mail: masudialavi_N@kaums.ac.ir © 2009 by Elsevier Inc. All rights reserved. 0041-1345/09/$–see front matter 360 Park Avenue South, New York, NY 10010-1710 doi:10.1016/j.transproceed.2009.06.217 Transplantation Proceedings, 41, 3693–3696 (2009) 3693