Mental Health and Behavioral Barriers in Access to Kidney Transplantation: A Canadian Cohort Study

Abstract

Background: A history of mental health (MH) disorders or nonadherence (NA) may be barriers to completing the work-up (WU) and/or undergoing kidney transplantation (KT) but this has not been well documented. In this work, we analyzed the relationship between a history of MH disorders or NA and the likelihood of completing the WU or undergoing KT.

Methods: Patients referred for KT to the Toronto General Hospital from January 1, 2003, to December 31, 2012, and who completed a social work assessment, were included (n = 1769). The association between the history of MH disorders or NA and the time from referral to WU completion or KT were examined using Cox proportional hazards models.

Results: A history of MH disorders or NA was present in 24% and 18%, respectively. Patients with MH disorders had a 17% lower adjusted hazard of completing the WU within 2 years of referral (HR 0.83; 95% confidence interval [95% CI], 0.71-0.97). Similarly, patients with a history of NA had a 21% lower hazard of completing the WU (hazard ratio [HR], 0.79; 95% CI, 0.66-0.94). The adjusted HR for KT was 0.88 (95% CI, 0.74-1.05) and 0.79 (95% CI, 0.64-0.97) for MH disorders and NA, respectively.

Conclusions: These findings suggest that a history of MH disorders or NA is a potential barrier to KT. Whether targeted psychosocial support can improve access to KT for these patients requires further study.