The influence of patient's personality on adjustment to chronic dialysis

The aim of the present study is to gather data on the influence of certain personality factors an adjustment to chronic hemodialysis. One hundred thirty-six patients underwent predialysis personality assessment by clinical evaluation and all those who survived at least 6 months on dialysis were followed up. The follow-ups were carried out by a nephrologist and a psychiatrist 6 months (100 patients), 12 months (87 patients), 24 months (51 patients), and 36 months (28 patients) after commencement of dialysis. The main findings confirmed the assumption that it is possible to predict, at a highly significant statistical level, all of the major aspects of adjustment: compliance with the diet, rehabilitation, and the patients' psychological condition was reflected by four aspects--depression, suicidal tendencies, anxiety, and psychotic complications. A slight tendency was found to overestimate patients' adjustment potential. The possibility that this was due to stresses not taken into account, e.g., the threat of death, is discussed. Analysis of the limited data of our own unit compared with the rest of the group seems to indicate that our patients fulfilled their potential for adjustment to a higher degree than those in other units, especially in regard to compliance and lack of depression. The presence of a psychiatrist and a social worker on the team may have improved adjustment prospects. The question was raised whether this phenomenon is the result of psychotherapy with the patients or of indirect service, e.g., a psychiatrist on the team promoting the development of a realistic team attitude and reducing physicians' denial. Understanding the specific personality traits that cause specific maladjustment may provide a rational basis for focus-oriented psychotherapeutic intervention, while enabling the planning of optional treatment methods for terminal renal failure.