Psychological distress in adults after pediatric kidney replacement therapy

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This study aimed to describe psychological distress in adults after KRT during childhood in comparison to the Swiss general population and to evaluate associations with sociodemographic and clinical characteristics. Methods We sent a questionnaire to 143 people from the Swiss Pediatric Renal Registry (SPRR), who were alive, over 18 years old, starting KRT before the age of 18 years, and being German speaking. We measured psychological distress using the Brief Symptom Inventory 18 (BSI-18) and evaluated the Global Severity Index 18 (GSI-18), reflecting the overall level of distress, and the three subscales depression, somatization, and anxiety. We compared levels of psychological distress to norm data from the Swiss general population and used regression models to identify associations with sociodemographic and clinical characteristics. Results Eighty persons with a mean age of 39 years (SD 10.1) responded to the questionnaire (response rate 56%). Overall, the GSI-18 and all subscales of the BSI-18 were similar among study participants and the Swiss general population. Unemployed participants reported higher levels of somatization and were more likely to experience psychological distress. Participants using psychotropic drugs (antidepressants or sleep medication) reported higher levels of overall psychological distress, depression, and somatization. Conclusions Adults after KRT during childhood showed good long-term psychological well-being. These results are encouraging and underline the favorable outcome of these patients. So besides the excellent somatic outcome, these patients can achieve a psychological healthy life after diagnosis of chronic kidney failure. Psychological distress Pediatric kidney failure Kidney replacement therapy Brief Symptom Inventory Figures Figure 1 Introduction Kidney replacement therapy (KRT) for children and adolescents with chronic kidney failure steadily developed during the last decades and patient and graft survival rate improved significantly [ 1 , 2 ]. More recently, somatic long-term side effects following KRT had been recognized as a major burden [ 3 ]. Current treatment strategies aim to minimize well-known long-term complications such as cardiovascular diseases, malignancies, and growth retardation [ 3 ]. Despite those side effects, KRT seems to be an optimal treatment strategy with favourable somatic long-term outcome accompanied by good health-related quality of life (HRQoL) [ 4 , 5 ]. As the survival rate has improved considerably in recent years and many children and adolescents are reaching adulthood, more attention towards their adult life is needed. In a Swiss cohort, we recently assessed HRQoL of adults, who had started KRT during childhood. Participants reported lower physical, but similar mental HRQoL in comparison to the general population. However, we found that they were more likely to experience adverse social and professional outcomes [ 5 , 6 ]. There have been several studies on psychological distress in children and adolescents, both before, during and after transplantation [ 7 – 11 ]. Other publications have investigated the impact of other chronic diseases on psychological distress in children and adolescents (e.g., cancer, diabetes, liver transplantation, lung transplantation, heart transplantation) [ 12 – 14 ]. Additionally, psychological distress had also been studied in adults suffering from chronic kidney failure on dialysis or after being transplanted [ 15 ]. However, little is known about psychological distress in adult persons after successful pediatric kidney transplantation during childhood. We therefore aimed to describe psychological distress in adults from the Swiss Pediatric Renal Registry (SPRR) [ 16 ], who had received kidney replacement therapy during childhood. We aimed to compare the level of psychological distress with the Swiss general population and evaluated associations with sociodemographic and clinical characteristics. Methods Study population and design We included individuals registered in the SPRR. The SPRR exists since 1970 with the primary goal of collecting data on children with chronic kidney disease who underwent KRT [ 16 ]. For this study, we applied the following inclusion criteria: begin of KRT (kidney transplantation or initiation of chronic dialysis) before the age of 18 years; age over 18 years and; alive at the start of study and initially treated in a pediatric hospital in the German speaking part of Switzerland [ 5 ]. We included only patients from the German speaking part of Switzerland due to limited financial resources [ 6 ]. We sent participants a postal questionnaire between 2021 and 2022. Participants were given the option to respond either online or in paper format. We sent two reminders: One after one month and another two months after the initial mailing. The questionnaire was based on a pilot study of the SPRR and a survey by the Swiss Childhood Cancer Survivor study [ 17 ]. It included questions about kidney disease, including its type, age at onset and number of transplants. In addition, we collected data on HRQoL, psychological well-being, health behaviour, education, occupation, current medication, and other physical illnesses [ 5 ]. Evaluation of psychological distress In our study, we used the short version of the Brief Symptom Inventory (BSI), the BSI-18 [ 18 , 19 ]. The BSI-18 showed good validity and psychometric properties in several studies [ 20 , 21 ]. The BSI-18 comprises 18 items selected from the original 53 items of the BSI [ 22 ]. All these 18 items collectively form the Global Severity Index 18 (GSI-18). The BSI-18 includes three symptom subscales: Somatization, Depression, and Anxiety (6 items for each scale). The BSI assesses the perceived impairment caused by each symptom over the last seven days, with response options ranging from “Not at all” (0) to “Very strongly” (4) [ 18 ]. If a participant did not respond to one item within a scale, the missing item was imputed with the mean value of the available items, as previously done [ 23 ]. If more than one item per scale was missing, this person's data was excluded [ 17 ]. Three different sum scales can be calculated from the BSI-18: the Global Severity Index (GSI-18), reflecting the overall level of distress; the Positive Symptom Total (PST), indicating how many items were answered positively (i.e., at least 1 point on the scale of 0 to 4) and the Positive Symptom Distress Index (PSDI), which indicates the distress of these symptoms [ 18 ]. The PSDI is calculated by dividing the GSI sum score by the PST. The sum scores for the GSI-18, Somatization, Depression and Anxiety were converted to T scores (Mean = 50, SD = 10) [ 18 ]. Severe psychological distress is defined as a T score ≥ 63, which is above the 90th percentile of the normal population [ 18 ]. Sociodemographic and clinical variables We collected the following sociodemographic and clinical variables in the questionnaire [ 5 , 6 ]: Sociodemographic factors included gender (female/male), age (years), relationship status (being in a relationship: no/yes), living situation (living alone/living with others), occupational status (employed or studying/unemployed); and having children (no/yes). We obtained the following clinical variables from the SPRR: type of kidney disease categorized into congenital anomalies of the kidney and urinary tract (CAKUT), monogenetic diseases, and acquired diseases, age at start of KRT (< 10 years/≥10 years) and duration of the disease (< 25 years/≥25 years). We assessed the total number of transplants, current therapy for kidney disease (dialysis/transplant) and current medication, specifically focusing on psychotropic drugs, defined as antidepressants and sleep medication (no/yes). Statistical analysis We used STATA 16.1 (StataCorp LP, College Station, TX) to analyse our data. We calculated the three sum scales of the BSI-18 and the sum value of the GSI-18. We assessed the reliability of individual subscales, by computing Cronbach's alpha. Then we determined standardized T scores for individual subscales and the GSI-18 (mean T score = 50, SD = 10). We tested standardized T scores for normal distribution using the Shapiro-Wilk test. We first compared our mean sum scores with those of the Swiss general population using two-sided t-tests, both overall and stratified by gender [ 23 ]. We determined the proportion of participants suffering from severe psychological distress (T score ≥ 63) and compared it with the expected value of 10% from the norm population [ 18 ]. We adjusted all models to age and gender to evaluate associations between T score of the GSI-18 and the three symptom scales and sociodemographic or clinical factors, because age and gender may affect levels of psychological distress [ 24 , 25 ]. To explore the associations between severe psychological distress (T score GSI-18 ≥ 63)-, and clinical and sociodemographic factors we used univariable logistic regression models. Results Participants and their characteristics Of the 166 eligible participants, we contacted 143 with the questionnaire, and 80 answered the questionnaire (Fig. 1 ). The questionnaire was completed on paper by 66% and online by 34%. The mean age of the 80 participants was 39 years (SD 10.1) and 56% were male. Table 1 displays the clinical and sociodemographic characteristics of the study participants. Five participants had one item missing in BSI-18 scales, but none had > 1 missing item. Our comparison group was derived from a survey including 1238 Swiss citizens, representing the Swiss general population [ 23 ]. Comparison data were collected between May 2015 and June 2016. The comparison sample was aged between 18 and 75 years (mean of 49 years, SD 15.2) and included 42% male and 58% female participants [ 23 ]. Table 1 Clinical and social characteristics of adults after kidney replacement therapy during childhood in Switzerland (N = 80) [ 2 ] n % Mean age at study in years (range) 39 (19–63) Gender Male 45 56 Female 35 44 Type of kidney disease Congenital anomalies kidney / urinary tract 29 36 Monogenetic hereditary 35 44 Acquired 16 20 Age at first KRT Mean in years (range) 10.3 (0-17.9) < 10 years 32 40 ≥ 10 years 48 60 Duration of KRT Mean in years (range) 28.3 (10.5–48.7) 1 35 44 Use of psychotropic drugs a No 68 85 Yes 11 14 Missing 1 1 Employment status Employed or studying 60 75 Unemployed 20 25 Partner/Relationship Yes 36 45 No 43 54 Missing 1 1 Living situation Living alone 26 33 Not living alone 54 67 Having children Yes 11 14 No 69 86 Abbreviations: KRT, kidney replacement therapy a antidepressants and sleeping medication BSI-18 scores and comparison to the Swiss general population In our study population the mean sum score for the GSI-18 was 5.5 (95% Confidence Interval [95% CI]: 4.1–6.9) compared to 5.7 (95% CI: 5.3–6.1) in the general Swiss population (Table 2 ). Mean sum scores of the subscales somatization, depression, and anxiety were similar between study participants and the general Swiss population (all p > 0.05). Among our study participants, 10% had a T score ≥ 63 in the GSI-18 (female: 11%; male: 9%), which is comparable to the general population (normative value: 10%) [ 23 ]. T score ≥ 63 for depression was 13% (female: 14%; male: 11%; normative value: 9%). Nine percent had a T score ≥ 63 for somatization (female: 14%; male: 4%; normative value: 9%), while 11% had a T score ≥ 63 for anxiety (female: 6%; male: 16%; normative value: 9%). Table 2 Psychological distress in adults after kidney replacement therapy (N = 80) and the Swiss general population (N = 1238): comparison of mean sum scores of all BSI domains Adults after KRT Swiss general population BSI Domain N Mean Score 95% CI N Mean Score 95% CI T score difference p -value Somatization All 80 1.61 1.16–2.06 1238 1.63 1.50–1.75 − 0.09 0.93 Male 45 1.60 1.02–2.18 517 1.41 1.22–1.59 0.57 0.57 Female 35 1.63 0.89–2.37 721 1.83 1.65–2.01 − 0.52 0.61 Depression All 80 2.11 1.47–2.76 1238 1.94 1.76–2.12 0.50 0.62 Male 45 1.91 1.16–2.67 517 1.79 1.53–2.05 0.26 0.79 Female 35 2.37 1.21–3.53 721 2.08 1.84–2.32 0.49 0.63 Anxiety All 80 1.78 1.24–2.30 1238 2.15 1.99–2.31 − 1.32 0.19 Male 45 1.84 1.31–2.56 517 1.87 1.64–2.10 − 0.07 0.94 Female 35 1.69 0.84–2.53 721 2.40 2.18–2.62 − 1.60 0.12 GSI-18 All 80 5.50 4.12–6.88 1238 5.71 5.32–6.10 − 0.29 0.77 Male 45 5.36 3.76–6.96 517 5.07 4.50–5.65 0.42 0.67 Female 35 5.69 3.19–8.18 721 6.31 5.68–6.84 − 0.49 0.63 Abbreviations: BSI, Brief Symptom Inventory; CI, Confidence Interval; GSI-18, Global Severity Index 18; KRT, kidney replacement therapy Associations between sociodemographic and clinical variables and BSI-18 Using multivariable linear regression models, we found that unemployed participants had a 6.1 points (95% CI: 1.0-11.2) higher T score for somatization compared to those employed or in education. No other significant associations were observed between the BSI-18 scores and sociodemographic factors (Table 3 ). Table 3 Associations between BSI-18 T scores and sociodemographic variables in adults after kidney replacement therapy during childhood: Multivariable linear regression models (N = 80) GSI-18 Somatization Depression Anxiety β (95% CI) p -value β (95% CI) p -value β (95% CI) p -value β (95% CI) p -value Gender Male (ref) Female 0.7 (-3.9, 5.3) 0.76 -0.1 (-4.6, 4.5) 0.98 1.9 (-2.7, 6.4) 0.42 -0.4 (-5.0, 4.2) 0.86 Age (years) -0.1 (-0.3, 0.2) 0.60 0.1 (-0.2, 0.3) 0.56 -0.1 (-0.3, 0.1) 0.40 -0.1 (-0.3, 0.1) 0.40 Employment status Employed or studying (ref) Unemployed 2.9 (-2.3, 8.1) 0.28 6.1 (1.0, 11.2) 0.02 3.5 (-1.7, 8.6) 0.19 -1.8 (-7.1, 3.4) 0.49 Relationship Single (ref) In a relationship -2.6 (-7.2, 2) 0.26 -0.1 (-4.7, 4.6) 0.98 -3.5 (-8.0, 1.1) 0.13 -2.5 (-7.1, 2.1) 0.27 Living situation Living alone (ref) Not living alone -2.0 (-6.9, 2.9) 0.42 -2.5 (-7.4, 2.4) 0.31 -2.3 (-7.1, 2.6) 0.35 -0.35 (-5.2, 4.6) 0.89 Children No (ref) Yes 0.1 (-6.7, 6.9) 0.98 4.2 (-2.5, 10.9) 0.22 -0.7 (-7.5, 6) 0.83 -2.4 (-9.1, 4.4) 0.49 Abbreviations: CI, Confidence Interval; GSI-18, Global Severity Index 18; KRT, kidney replacement therapy We found that participants using psychotropic drugs had higher T scores for the GSI-18 (β = 9.1, 95% CI: 2.4–15.8), somatization (β = 9.5, 95% CI: 2.8–16.2), and depression (β = 7.3, 95% CI: 0.6–14.1). No associations with other clinical characteristics were identified ( Table 4 ) . Table 4 Associations between BSI-18 T scores and clinical variables in adults after kidney replacement therapy during childhood: Multivariable linear regression models adjusted for age and gender (N = 80) GSI-18 Somatization Depression Anxiety β (95% CI) p -value β (95% CI) p -value β (95% CI) p -value β (95% CI) p -value Kidney disease Congential kidney diseases b (ref) Aquired kidney disease 4.7 (-1.1, 10.5) 0.11 -0.3 (-6.2, 5.6) 0.91 5.6 (-0.2, 11.3) 0.06 5.7 (-0.1, 11.4) 0.05 Number of transplants 3.1 (-0.6, 6.9) 0.10 1.8 (− 2, 5.6) 0.34 2.6 (-1.1, 6.3) 0.17 3.5 (-0.2, 7.2) 0.06 1 (ref) > 1 1.8 (-3.4, 7.1) 0.49 -0.4 (-5.6, 4.9) 0.89 1.75 (-3.5, 7) 0.51 2.9 (-2.3, 8.1) 0.27 Duration of KRT (years) -0.2 (-0.7, 0.3) 0.37 -0.3 (-0.8, 0.2) 0.25 -0.2 (-0.7, 0.3) 0.40 -0.1 (-0.6, 0.4) 0.73 Age at first KRT (years) 0.2 (-0.3, 0.7) 0.37 0.3 (-0.2, 0.8) 0.25 0.2 (-0.3, 0.7) 0.40 0.1 (-0.4, 0.6) 0.73 KRT at study Transplant (ref) Dialysis 1.3 (-6.0, 8.5) 0.73 -1.2 (-8.3, 6) 0.74 2.7 (-4.4, 9.9) 0.45 1.0 (-6.2, 8.2) 0.78 Use of psychotropic drugs No (ref) Yes 9.1 (2.4, 15.8) 0.01 9.5 (2.8, 16.2) 0.01 7.3 (0.6, 14.1) 0.03 6.7 (-0.1, 13.6) 0.05 Abbreviations: CI, Confidence Interval; GSI-18, Global Severity Index 18; KRT, kidney replacement therapy b congenital anomalies of the kidney and urinary tract (CAKUT) and monogenetic diseases 1. Heinzelmann, M.A., C.E. Kuehni, K. Roser, L. Mader, and G.F. Laube, Health-related quality of life in adults after pediatric kidney failure in Switzerland. Pediatr Nephrol, 2023. 38 (5): p. 1559–1568. 2. Laube, G.F., M.A. Heinzelmann, K. Roser, C.E. Kuehni, L. Mader, and g. Swiss Pediatric Renal Registry, Long-term social and professional outcomes in adults after pediatric kidney failure. Pediatr Nephrol, 2023. 38 (11): p. 3769–3777. Using the cut-off for severe psychological distress (T score GSI-18 ≥ 63), we found that unemployed persons were more likely to experience severe psychological distress compared to those who were employed or in education (odds ratio (OR) = 6.3, 95% CI 1.4–29.6). No other associations with clinical and sociodemographic factors were identified (supplementary table 1 ). Discussion This study found that adults after KRT during childhood in Switzerland did not have increased psychological distress compared to the general population. Only 10% of the study population had clinically relevant levels of psychological distress which is comparable to the Swiss general population. This suggests that in Switzerland, adults, who had received a kidney transplant during childhood, are not at increased risk for depression, somatization, or anxiety. Adults after KRT during childhood, who were unemployed and those treated with psychotropic drugs reported higher levels of psychological distress. Comparing our data with other studies is challenging, as the patient population varies between studies in terms of medical situation (chronic renal failure, dialysis or transplantation) and age at follow-up (children, adolescents or adults). Many previous studies focused on children and adolescents. A study including 28 patients aged 9–18 years with chronic kidney disease stage 1–4, not yet dialyzed or transplanted, reported more separation anxiety and depressive symptoms compared to healthy children, but resilience was similar in both groups [ 9 ]. An Egyptian study including 19 dialyzed children observed a high prevalence of psychiatric disorders (68.4%) and depression (26.3%) [ 7 ]. In a Peruvian evaluation of 67 children and adolescents (age 8–18 years) on dialysis, depressive symptoms occurred more frequently in females and were associated with weekly K t /V. But the type of dialysis showed no association with the occurrence of depressive symptoms [ 8 ]. This contrasts with our results, where there was no difference between male and female participants. However, comparability with our study is limited by different methods, outcome definitions, and the older age of our cohort. Only few studies focused on transplanted children and adolescents. An American study of 44 children aged 9–18 years found significant symptoms of depression in 30% with higher scores among patients aged ≥ 13 years. However, their study population was too small to compare different groups of kidney replacement status, although longstanding kidney disease was declared to be a risk factor for depression [ 11 ]. A very high depression rate of 64% in children and adolescents with various stages of KRT was described by Cuellar et al [ 26 ], whereas another study indicated a high prevalence of sleep disturbances ranging from 77 to 85% in children with KRT [ 10 ]. Taken together, there is some evidence in the literature that children with chronic kidney failure might express more symptoms of depression and therefore suffer from psychological distress. Our study indicates that early psychological problems might normalise with time after KRT. As far as we know our study is the first to analyze psychological distress using the BSI in adults who had undergone kidney replacement therapy during childhood in Switzerland. Two studies found that adults suffer from various states of depression when being dialyzed or after kidney transplantation depending on type of dialysis, type of transplant and duration of disease [ 27 , 28 ]. At a median age of 25.7 years, 25 out of 42 adults after pediatric transplantation stated that they felt anxiety or were depressed in a study from Kärrfelt et al. [ 29 ]. On the other hand, it was reported that psychological distress and post-traumatic stress disorder could result in “post traumatic growth”, defined as a positive and motivating psychological chance leading to positive coping strategies [ 15 ]. Comparisons with studies including other patient populations with childhood onset health conditions are difficult due to the inherent differences in the severity, prognosis, and long-term outcomes. A study including adolescents after heart, lung or liver transplantation indicated impairment in several areas such as anxiety, disappointment, or social adjustment. The individuals also reported about the obligation to show gratitude towards the donor, pressure to take good care of the transplant and, in the case of a living donation, fear for the donor due to the possible health risks [ 12 ]. Also children with type 1 and 2 diabetes seem to experience increased anxiety and depression [ 14 ]. Swiss childhood cancer survivors, also evaluated using the BSI, indicated a lower T score in the GSI, in obsessive-compulsive tendencies, anxiety and somatization compared with the German norm population. However, it was found that participants had a higher risk of suffering from severe psychological stress in comparison to the norm population [ 30 ]. Comparing these results with our study population indicates the difference between cancer survivors and patients with KRT. Cancer survivors usually are cured from their disease and might try to leave it behind, while individuals after kidney transplantation face a lifelong dependency on regular medical check-ups, medication to prevent graft rejection and a high probability of needing additional KRT again later in life. A limitation of our study is the relatively small sample size limiting statistical power for subgroup comparisons, especially regarding clinical and sociodemographic characteristics. Additionally, our study included only German speaking patients, so results may not be for all Switzerland. Furthermore, data were collected between 2021 and 2022 whereas data of the general Swiss population were obtained between 2015 and 2016. Differences caused by broader circumstances (e.g., COVID-19 pandemic) could not be avoided or accounted for. The strength of our study is the use of a representative comparison sample from the Swiss general population that completed the same questions on psychological distress. Further, our study included adult patients after KRT during childhood on average 39 years of age providing long-term follow-up information on this population. Another strength refers to the use of high-quality clinical information based on medical records from the SPRR. Chronic kidney disease in children and adults does have a massive long-term impact on patients which leads to a life-long dependence on medical support. This may intuitively interfere with their psychological well-being and affect social, educational, and family life. Our results therefore might surprise, but underline the fact, that kidney transplantation programs in children and adolescents are successful not only in terms of survival of patient and graft, controllable side effects of the treatment and HrQoL, but also in terms of psychological distress. Although carrying the burden of a chronic disease, adults after KRT during childhood appear to be psychologically well adjusted in Switzerland. This fact should encourage pediatric nephrologists to sustain their daily efforts treating these patients. Furthermore, it should motivate adult nephrologists who care for them later on in adulthood. In conclusion, our study indicates similar levels of psychological distress in 80 adults after pediatric kidney replacement therapy in comparison to the Swiss general population. Our data are encouraging for pediatric nephrologists and generally indicate favorable psychological outcomes in the long-term. Beside the well-known excellent somatic outcome, these patients can achieve a psychological healthy life many decades after diagnosis of chronic kidney failure. Abbreviations BSI = Brief Symptom Inventory CAKUT = Congenital Anomalies of the Kidney and Urinary Tract CI = Confidence Interval GSI = Global Severity Index HRQoL = health-related quality of life KRT = kidney replacement therapy PSDI = Positive Symptom Distress Index PST = Positive Symptom Total SCL-90 = Symptom Checklist-90 SPRR = Swiss Pediatric Renal Registry Declarations Competing Interests The authors declare no competing interests. Funding The study did not receive any funding. Data availability The data that support the information of this manuscript were accessed on secured servers of the Institute of Social and Preventive Medicine at the University of Bern. Data can only be made available for researchers who fulfil the respective legal requirements. All data requests should be communicated to the corresponding author. Ethics approval Ethical approval of the SPRR was granted by the Ethics Committee of the Canton of Bern (140/2015). Informed consent Informed consent was obtained from all individual participants included in the study. Author contributions All authors contributed to the study conception and design. Material preparation and data collection were performed by Guido F Laube, Marc-Andrea Heinzelmann and Luzius Mader. Data analysis was made by Nora F Laube. The first draft of the manuscript was written by Nora F Laube, and all authors commented on previous versions of the manuscript. All authors revised and approved the final manuscript. References Francis A, Johnson DW, Melk A, Foster BJ, Blazek K, Craig JC, Wong G (2020) Survival after Kidney Transplantation during Childhood and Adolescence. Clin J Am Soc Nephrol 15:392-400. 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J Affect Disord. Meachen S-J, Hanks RA, Millis SR, Rapport LJ (2008) The Reliability and Validity of the Brief Symptom Inventory−18 in Persons With Traumatic Brain Injury. Archives of Physical Medicine and Rehabilitation 89:958-965. Derogatis LR (1993) Brief symptom inventory (BSI), administration, scoring, and procedures manual (third ed.). , Minneapolis National Michel G, Bänziger J, Brodbeck J, Mader L, Kuehni C, Roser K (2024) Psychological distress in the Swiss general population. PlosOne, in press Byles JE, Gallienne L, Blyth FM, Banks E (2012) Relationship of age and gender to the prevalence and correlates of psychological distress in later life. Int Psychogeriatr 24:1009-1018. Matud MP, Diaz A, Bethencourt JM, Ibanez I (2020) Stress and Psychological Distress in Emerging Adulthood: A Gender Analysis. J Clin Med 9. Rodriguez Cuellar CI, García de la Puente S, Hernández Moraria J, Bojórquez Ochoa A, Filler G, Zaltzman Grishevich S (2019) High depression rates among pediatric renal replacement therapy patients: A cross-sectional study. Pediatr Transplant 23:e13591. Jones J, Damery S, Allen K, Nicholas J, Baharani J, Combes G (2020) 'You have got a foreign body in there': renal transplantation, unexpected mild-to-moderate distress and patients' support needs: a qualitative study. BMJ Open 10:e035627. Cardol CK, Meuleman Y, van Middendorp H, van der Boog PJM, Hilbrands LB, Navis G, Sijpkens YWJ, Sont JK, Evers AWM, van Dijk S (2023) Psychological Distress and Self-Management in CKD: A Cross-Sectional Study. Kidney Med 5:100712. Kärrfelt HM, Berg UB (2008) Long-term psychosocial outcome after renal transplantation during childhood. Pediatr Transplant 12:557-562. Michel G, Rebholz CE, von der Weid NX, Bergstraesser E, Kuehni CE (2010) Psychological distress in adult survivors of childhood cancer: the Swiss Childhood Cancer Survivor study. J Clin Oncol 28:1740-1748. Supplementary Files Supplementary.docx Cite Share Download PDF Status: Published Journal Publication published 05 Nov, 2024 Read the published version in Pediatric Nephrology → Version 1 posted Editorial decision: Major Revisions Needed 25 Jun, 2024 Reviewers agreed at journal 07 Jun, 2024 Reviewers invited by journal 04 Jun, 2024 Editor assigned by journal 04 Jun, 2024 First submitted to journal 04 Jun, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4527030","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":310642317,"identity":"82e16832-90c6-47ce-9c97-d5b3ccec67b6","order_by":0,"name":"Nora Laube","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4klEQVRIiWNgGAWjYNCCAgYGAwbmYwwPgGw2IGYmrMUAhNjSGBJI1MJjBtbCQEiLOXvvww8MBnaJ29l7vj1IbLNJ7JNuYPxcgEeLZc9xYwkGg+TEnT1ntxsktqUltskcYJaegc9JN9IYgFqYEzfcyN0mkdh2OLdNIoGNmQe/FuYfDAb1iRvuv3kG1PKfKC1sQFsOA23hYQNqOUCEljPH2CwSDI4b7+xJMzdIOJdc3yaR2CyNV8vxNuYbHyqqZbezH3724EOZnbH8jOSDn/FpAYMEVC5jAyENo2AUjIJRMAoIAABaq0lRab5NjwAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0009-0007-8396-5586","institution":"University of Bern: Universitat Bern","correspondingAuthor":true,"prefix":"","firstName":"Nora","middleName":"","lastName":"Laube","suffix":""},{"id":310642318,"identity":"7d908194-36fe-4eb8-85b9-8f0db7e0b966","order_by":1,"name":"Luzius Mader","email":"","orcid":"","institution":"University of Bern: Universitat Bern","correspondingAuthor":false,"prefix":"","firstName":"Luzius","middleName":"","lastName":"Mader","suffix":""},{"id":310642319,"identity":"647d97bf-6a00-42c3-898e-fbcde2ae2a4c","order_by":2,"name":"Marc-Andrea Heinzelmann","email":"","orcid":"","institution":"Kantonsspital Winterthur","correspondingAuthor":false,"prefix":"","firstName":"Marc-Andrea","middleName":"","lastName":"Heinzelmann","suffix":""},{"id":310642320,"identity":"6f9c6fc7-4b86-49b1-a968-5ab04b6788b2","order_by":3,"name":"Sandra Hunziker","email":"","orcid":"","institution":"University of Bern: Universitat Bern","correspondingAuthor":false,"prefix":"","firstName":"Sandra","middleName":"","lastName":"Hunziker","suffix":""},{"id":310642321,"identity":"857de13b-1e55-4ee9-aba6-cfc8cbd131fe","order_by":4,"name":"Gisela Michel","email":"","orcid":"","institution":"University of Lucerne: Universitat Luzern","correspondingAuthor":false,"prefix":"","firstName":"Gisela","middleName":"","lastName":"Michel","suffix":""},{"id":310642322,"identity":"34397767-5a17-4727-9e09-9bb20b7cb838","order_by":5,"name":"Claudia Kuehni","email":"","orcid":"","institution":"University of Bern: Universitat Bern","correspondingAuthor":false,"prefix":"","firstName":"Claudia","middleName":"","lastName":"Kuehni","suffix":""},{"id":310642323,"identity":"9f017257-608d-40ff-9ca7-949b3280a753","order_by":6,"name":"Guido Laube","email":"","orcid":"","institution":"University of Zurich: Universitat Zurich","correspondingAuthor":false,"prefix":"","firstName":"Guido","middleName":"","lastName":"Laube","suffix":""}],"badges":[],"createdAt":"2024-06-04 09:51:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4527030/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4527030/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00467-024-06571-7","type":"published","date":"2024-11-05T15:57:19+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":58760689,"identity":"271ee550-2fb0-4e77-9156-b76b85868560","added_by":"auto","created_at":"2024-06-20 18:51:22","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":184256,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlow Chart of the study population [1]\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAbbreviations: SPRR, Swiss Pediatric Renal Registry\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4527030/v1/d572c4425b5d1b9958bce224.png"},{"id":68750062,"identity":"7c21ce24-6d96-4f75-aec6-ff1725a48e41","added_by":"auto","created_at":"2024-11-11 16:09:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":960605,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4527030/v1/40d08aa3-9399-41b2-8413-0e3a29605663.pdf"},{"id":58760699,"identity":"cd1d430e-f7ae-40e8-ae27-20041467c6a3","added_by":"auto","created_at":"2024-06-20 18:51:23","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":20490,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementary.docx","url":"https://assets-eu.researchsquare.com/files/rs-4527030/v1/2b4b99ad2e6a3234c1ee3ba0.docx"}],"financialInterests":"","formattedTitle":"Psychological distress in adults after pediatric kidney replacement therapy","fulltext":[{"header":"Introduction","content":"\u003cp\u003eKidney replacement therapy (KRT) for children and adolescents with chronic kidney failure steadily developed during the last decades and patient and graft survival rate improved significantly [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. More recently, somatic long-term side effects following KRT had been recognized as a major burden [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Current treatment strategies aim to minimize well-known long-term complications such as cardiovascular diseases, malignancies, and growth retardation [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Despite those side effects, KRT seems to be an optimal treatment strategy with favourable somatic long-term outcome accompanied by good health-related quality of life (HRQoL) [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. As the survival rate has improved considerably in recent years and many children and adolescents are reaching adulthood, more attention towards their adult life is needed. In a Swiss cohort, we recently assessed HRQoL of adults, who had started KRT during childhood. Participants reported lower physical, but similar mental HRQoL in comparison to the general population. However, we found that they were more likely to experience adverse social and professional outcomes [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThere have been several studies on psychological distress in children and adolescents, both before, during and after transplantation [\u003cspan additionalcitationids=\"CR8 CR9 CR10\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Other publications have investigated the impact of other chronic diseases on psychological distress in children and adolescents (e.g., cancer, diabetes, liver transplantation, lung transplantation, heart transplantation) [\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Additionally, psychological distress had also been studied in adults suffering from chronic kidney failure on dialysis or after being transplanted [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. However, little is known about psychological distress in adult persons after successful pediatric kidney transplantation during childhood. We therefore aimed to describe psychological distress in adults from the Swiss Pediatric Renal Registry (SPRR) [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], who had received kidney replacement therapy during childhood. We aimed to compare the level of psychological distress with the Swiss general population and evaluated associations with sociodemographic and clinical characteristics.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eStudy population and design\u003c/p\u003e \u003cp\u003eWe included individuals registered in the SPRR. The SPRR exists since 1970 with the primary goal of collecting data on children with chronic kidney disease who underwent KRT [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. For this study, we applied the following inclusion criteria: begin of KRT (kidney transplantation or initiation of chronic dialysis) before the age of 18 years; age over 18 years and; alive at the start of study and initially treated in a pediatric hospital in the German speaking part of Switzerland [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. We included only patients from the German speaking part of Switzerland due to limited financial resources [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWe sent participants a postal questionnaire between 2021 and 2022. Participants were given the option to respond either online or in paper format. We sent two reminders: One after one month and another two months after the initial mailing. The questionnaire was based on a pilot study of the SPRR and a survey by the Swiss Childhood Cancer Survivor study [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. It included questions about kidney disease, including its type, age at onset and number of transplants. In addition, we collected data on HRQoL, psychological well-being, health behaviour, education, occupation, current medication, and other physical illnesses [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEvaluation of psychological distress\u003c/p\u003e \u003cp\u003eIn our study, we used the short version of the Brief Symptom Inventory (BSI), the BSI-18 [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The BSI-18 showed good validity and psychometric properties in several studies [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The BSI-18 comprises 18 items selected from the original 53 items of the BSI [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. All these 18 items collectively form the Global Severity Index 18 (GSI-18). The BSI-18 includes three symptom subscales: Somatization, Depression, and Anxiety (6 items for each scale). The BSI assesses the perceived impairment caused by each symptom over the last seven days, with response options ranging from \u0026ldquo;Not at all\u0026rdquo; (0) to \u0026ldquo;Very strongly\u0026rdquo; (4) [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. If a participant did not respond to one item within a scale, the missing item was imputed with the mean value of the available items, as previously done [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. If more than one item per scale was missing, this person's data was excluded [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Three different sum scales can be calculated from the BSI-18: the Global Severity Index (GSI-18), reflecting the overall level of distress; the Positive Symptom Total (PST), indicating how many items were answered positively (i.e., at least 1 point on the scale of 0 to 4) and the Positive Symptom Distress Index (PSDI), which indicates the distress of these symptoms [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The PSDI is calculated by dividing the GSI sum score by the PST.\u003c/p\u003e \u003cp\u003eThe sum scores for the GSI-18, Somatization, Depression and Anxiety were converted to T scores (Mean\u0026thinsp;=\u0026thinsp;50, SD\u0026thinsp;=\u0026thinsp;10) [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Severe psychological distress is defined as a T score\u0026thinsp;\u0026ge;\u0026thinsp;63, which is above the 90th percentile of the normal population [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSociodemographic and clinical variables\u003c/p\u003e \u003cp\u003eWe collected the following sociodemographic and clinical variables in the questionnaire [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]: Sociodemographic factors included gender (female/male), age (years), relationship status (being in a relationship: no/yes), living situation (living alone/living with others), occupational status (employed or studying/unemployed); and having children (no/yes). We obtained the following clinical variables from the SPRR: type of kidney disease categorized into congenital anomalies of the kidney and urinary tract (CAKUT), monogenetic diseases, and acquired diseases, age at start of KRT (\u0026lt;\u0026thinsp;10 years/\u0026ge;10 years) and duration of the disease (\u0026lt;\u0026thinsp;25 years/\u0026ge;25 years). We assessed the total number of transplants, current therapy for kidney disease (dialysis/transplant) and current medication, specifically focusing on psychotropic drugs, defined as antidepressants and sleep medication (no/yes).\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eWe used STATA 16.1 (StataCorp LP, College Station, TX) to analyse our data. We calculated the three sum scales of the BSI-18 and the sum value of the GSI-18. We assessed the reliability of individual subscales, by computing Cronbach's alpha. Then we determined standardized T scores for individual subscales and the GSI-18 (mean T score\u0026thinsp;=\u0026thinsp;50, SD\u0026thinsp;=\u0026thinsp;10). We tested standardized T scores for normal distribution using the Shapiro-Wilk test.\u003c/p\u003e \u003cp\u003eWe first compared our mean sum scores with those of the Swiss general population using two-sided t-tests, both overall and stratified by gender [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWe determined the proportion of participants suffering from severe psychological distress (T score\u0026thinsp;\u0026ge;\u0026thinsp;63) and compared it with the expected value of 10% from the norm population [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. We adjusted all models to age and gender to evaluate associations between T score of the GSI-18 and the three symptom scales and sociodemographic or clinical factors, because age and gender may affect levels of psychological distress [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTo explore the associations between severe psychological distress (T score GSI-18\u0026thinsp;\u0026ge;\u0026thinsp;63)-, and clinical and sociodemographic factors we used univariable logistic regression models.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eParticipants and their characteristics\u003c/p\u003e \u003cp\u003eOf the 166 eligible participants, we contacted 143 with the questionnaire, and 80 answered the questionnaire (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The questionnaire was completed on paper by 66% and online by 34%. The mean age of the 80 participants was 39 years (SD 10.1) and 56% were male. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e displays the clinical and sociodemographic characteristics of the study participants. Five participants had one item missing in BSI-18 scales, but none had\u0026thinsp;\u0026gt;\u0026thinsp;1 missing item. Our comparison group was derived from a survey including 1238 Swiss citizens, representing the Swiss general population [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Comparison data were collected between May 2015 and June 2016. The comparison sample was aged between 18 and 75 years (mean of 49 years, SD 15.2) and included 42% male and 58% female participants [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical and social characteristics of adults after kidney replacement therapy during childhood in Switzerland (N\u0026thinsp;=\u0026thinsp;80) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMean age at study in years (range)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39 (19\u0026ndash;63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of kidney disease\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCongenital anomalies kidney / urinary tract\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMonogenetic hereditary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAcquired\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge at first KRT\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean in years (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.3 (0-17.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDuration of KRT\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean in years (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.3 (10.5\u0026ndash;48.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;25 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;25 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of KRT at study\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTransplantation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDialysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMissing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of transplants\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUse of psychotropic drugs\u003c/b\u003e\u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMissing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEmployment status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmployed or studying\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePartner/Relationship\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMissing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLiving situation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLiving alone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot living alone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHaving children\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eAbbreviations: KRT, kidney replacement therapy\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003ea\u003c/sup\u003eantidepressants and sleeping medication\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eBSI-18 scores and comparison to the Swiss general population\u003c/p\u003e \u003cp\u003eIn our study population the mean sum score for the GSI-18 was 5.5 (95% Confidence Interval [95% CI]: 4.1\u0026ndash;6.9) compared to 5.7 (95% CI: 5.3\u0026ndash;6.1) in the general Swiss population (Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Mean sum scores of the subscales somatization, depression, and anxiety were similar between study participants and the general Swiss population (all p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Among our study participants, 10% had a T score\u0026thinsp;\u0026ge;\u0026thinsp;63 in the GSI-18 (female: 11%; male: 9%), which is comparable to the general population (normative value: 10%) [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. T score\u0026thinsp;\u0026ge;\u0026thinsp;63 for depression was 13% (female: 14%; male: 11%; normative value: 9%). Nine percent had a T score\u0026thinsp;\u0026ge;\u0026thinsp;63 for somatization (female: 14%; male: 4%; normative value: 9%), while 11% had a T score\u0026thinsp;\u0026ge;\u0026thinsp;63 for anxiety (female: 6%; male: 16%; normative value: 9%).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePsychological distress in adults after kidney replacement therapy (N\u0026thinsp;=\u0026thinsp;80) and the Swiss general population (N\u0026thinsp;=\u0026thinsp;1238): comparison of mean sum scores of all BSI domains\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eAdults after KRT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003eSwiss general population\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eBSI Domain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMean Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eT score difference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSomatization\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.16\u0026ndash;2.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1238\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.50\u0026ndash;1.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.02\u0026ndash;2.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e517\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.22\u0026ndash;1.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.89\u0026ndash;2.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e721\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.65\u0026ndash;2.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDepression\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.47\u0026ndash;2.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1238\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.76\u0026ndash;2.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.62\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.16\u0026ndash;2.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e517\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.53\u0026ndash;2.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.21\u0026ndash;3.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e721\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.84\u0026ndash;2.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.63\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAnxiety\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.24\u0026ndash;2.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1238\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.99\u0026ndash;2.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;1.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.31\u0026ndash;2.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e517\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.64\u0026ndash;2.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.84\u0026ndash;2.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e721\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.18\u0026ndash;2.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;1.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGSI-18\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.12\u0026ndash;6.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1238\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.32\u0026ndash;6.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;0.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.77\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.76\u0026ndash;6.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e517\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.50\u0026ndash;5.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.19\u0026ndash;8.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e721\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.68\u0026ndash;6.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.63\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003eAbbreviations: BSI, Brief Symptom Inventory; CI, Confidence Interval; GSI-18, Global Severity Index 18; KRT, kidney replacement therapy\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAssociations between sociodemographic and clinical variables and BSI-18\u003c/p\u003e \u003cp\u003eUsing multivariable linear regression models, we found that unemployed participants had a 6.1 points (95% CI: 1.0-11.2) higher T score for somatization compared to those employed or in education. No other significant associations were observed between the BSI-18 scores and sociodemographic factors (Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociations between BSI-18 T scores and sociodemographic variables in adults after kidney replacement therapy during childhood: Multivariable linear regression models (N\u0026thinsp;=\u0026thinsp;80)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eGSI-18\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eSomatization\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003eAnxiety\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eβ (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eβ (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eβ (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eβ (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.7 (-3.9, 5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.1 (-4.6, 4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.9 (-2.7, 6.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.4 (-5.0, 4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.1 (-0.3, 0.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.1 (-0.2, 0.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.1 (-0.3, 0.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.1 (-0.3, 0.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEmployment status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployed or studying (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.9 (-2.3, 8.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e6.1 (1.0, 11.2)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.02\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.5 (-1.7, 8.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-1.8 (-7.1, 3.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRelationship\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIn a relationship\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-2.6 (-7.2, 2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.1 (-4.7, 4.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-3.5 (-8.0, 1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-2.5 (-7.1, 2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLiving situation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiving alone (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot living alone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-2.0 (-6.9, 2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-2.5 (-7.4, 2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-2.3 (-7.1, 2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.35 (-5.2, 4.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChildren\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.1 (-6.7, 6.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.2 (-2.5, 10.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.7 (-7.5, 6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-2.4 (-9.1, 4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003eAbbreviations: CI, Confidence Interval; GSI-18, Global Severity Index 18; KRT, kidney replacement therapy\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWe found that participants using psychotropic drugs had higher T scores for the GSI-18 (β\u0026thinsp;=\u0026thinsp;9.1, 95% CI: 2.4\u0026ndash;15.8), somatization (β\u0026thinsp;=\u0026thinsp;9.5, 95% CI: 2.8\u0026ndash;16.2), and depression (β\u0026thinsp;=\u0026thinsp;7.3, 95% CI: 0.6\u0026ndash;14.1). No associations with other clinical characteristics were identified \u003cem\u003e(\u003c/em\u003eTable \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u003cem\u003e)\u003c/em\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociations between BSI-18 T scores and clinical variables in adults after kidney replacement therapy during childhood: Multivariable linear regression models adjusted for age and gender (N\u0026thinsp;=\u0026thinsp;80)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eGSI-18\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eSomatization\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003eAnxiety\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eβ (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eβ (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eβ (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eβ (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eKidney disease\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCongential kidney diseases\u003csup\u003eb\u003c/sup\u003e (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAquired kidney disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.7 (-1.1, 10.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.3 (-6.2, 5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.6 (-0.2, 11.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.7 (-0.1, 11.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of transplants\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.1 (-0.6, 6.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.8 (\u0026minus;\u0026thinsp;2, 5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.6 (-1.1, 6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.5 (-0.2, 7.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1 (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.8 (-3.4, 7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.4 (-5.6, 4.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.75 (-3.5, 7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.9 (-2.3, 8.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDuration of KRT (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.2 (-0.7, 0.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.3 (-0.8, 0.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.2 (-0.7, 0.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.1 (-0.6, 0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.73\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge at first KRT (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.2 (-0.3, 0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.3 (-0.2, 0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.2 (-0.3, 0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.1 (-0.4, 0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.73\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eKRT at study\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransplant (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDialysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.3 (-6.0, 8.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-1.2 (-8.3, 6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.7 (-4.4, 9.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.0 (-6.2, 8.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUse of psychotropic drugs\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e9.1 (2.4, 15.8)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e9.5 (2.8, 16.2)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e7.3 (0.6, 14.1)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.03\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6.7 (-0.1, 13.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003eAbbreviations: CI, Confidence Interval; GSI-18, Global Severity Index 18; KRT, kidney replacement therapy\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003csup\u003eb\u003c/sup\u003econgenital anomalies of the kidney and urinary tract (CAKUT) and monogenetic diseases\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003e1. Heinzelmann, M.A., C.E. Kuehni, K. Roser, L. Mader, and G.F. Laube, \u003cem\u003eHealth-related quality of life in adults after pediatric kidney failure in Switzerland.\u003c/em\u003e Pediatr Nephrol, 2023. \u003cb\u003e38\u003c/b\u003e(5): p. 1559\u0026ndash;1568.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003e2. Laube, G.F., M.A. Heinzelmann, K. Roser, C.E. Kuehni, L. Mader, and g. Swiss Pediatric Renal Registry, \u003cem\u003eLong-term social and professional outcomes in adults after pediatric kidney failure.\u003c/em\u003e Pediatr Nephrol, 2023. \u003cb\u003e38\u003c/b\u003e(11): p. 3769\u0026ndash;3777.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eUsing the cut-off for severe psychological distress (T score GSI-18\u0026thinsp;\u0026ge;\u0026thinsp;63), we found that unemployed persons were more likely to experience severe psychological distress compared to those who were employed or in education (odds ratio (OR)\u0026thinsp;=\u0026thinsp;6.3, 95% CI 1.4\u0026ndash;29.6). No other associations with clinical and sociodemographic factors were identified \u003cem\u003e(supplementary table \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003c/em\u003e).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study found that adults after KRT during childhood in Switzerland did not have increased psychological distress compared to the general population. Only 10% of the study population had clinically relevant levels of psychological distress which is comparable to the Swiss general population. This suggests that in Switzerland, adults, who had received a kidney transplant during childhood, are not at increased risk for depression, somatization, or anxiety. Adults after KRT during childhood, who were unemployed and those treated with psychotropic drugs reported higher levels of psychological distress.\u003c/p\u003e \u003cp\u003eComparing our data with other studies is challenging, as the patient population varies between studies in terms of medical situation (chronic renal failure, dialysis or transplantation) and age at follow-up (children, adolescents or adults). Many previous studies focused on children and adolescents. A study including 28 patients aged 9\u0026ndash;18 years with chronic kidney disease stage 1\u0026ndash;4, not yet dialyzed or transplanted, reported more separation anxiety and depressive symptoms compared to healthy children, but resilience was similar in both groups [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. An Egyptian study including 19 dialyzed children observed a high prevalence of psychiatric disorders (68.4%) and depression (26.3%) [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In a Peruvian evaluation of 67 children and adolescents (age 8\u0026ndash;18 years) on dialysis, depressive symptoms occurred more frequently in females and were associated with weekly K\u003csub\u003et\u003c/sub\u003e/V. But the type of dialysis showed no association with the occurrence of depressive symptoms [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. This contrasts with our results, where there was no difference between male and female participants. However, comparability with our study is limited by different methods, outcome definitions, and the older age of our cohort.\u003c/p\u003e \u003cp\u003eOnly few studies focused on transplanted children and adolescents. An American study of 44 children aged 9\u0026ndash;18 years found significant symptoms of depression in 30% with higher scores among patients aged\u0026thinsp;\u0026ge;\u0026thinsp;13 years. However, their study population was too small to compare different groups of kidney replacement status, although longstanding kidney disease was declared to be a risk factor for depression [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. A very high depression rate of 64% in children and adolescents with various stages of KRT was described by \u003cem\u003eCuellar et al\u003c/em\u003e [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], whereas another study indicated a high prevalence of sleep disturbances ranging from 77 to 85% in children with KRT [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTaken together, there is some evidence in the literature that children with chronic kidney failure might express more symptoms of depression and therefore suffer from psychological distress. Our study indicates that early psychological problems might normalise with time after KRT.\u003c/p\u003e \u003cp\u003eAs far as we know our study is the first to analyze psychological distress using the BSI in adults who had undergone kidney replacement therapy during childhood in Switzerland. Two studies found that adults suffer from various states of depression when being dialyzed or after kidney transplantation depending on type of dialysis, type of transplant and duration of disease [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. At a median age of 25.7 years, 25 out of 42 adults after pediatric transplantation stated that they felt anxiety or were depressed in a study from \u003cem\u003eK\u0026auml;rrfelt et al.\u003c/em\u003e [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. On the other hand, it was reported that psychological distress and post-traumatic stress disorder could result in \u0026ldquo;post traumatic growth\u0026rdquo;, defined as a positive and motivating psychological chance leading to positive coping strategies [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eComparisons with studies including other patient populations with childhood onset health conditions are difficult due to the inherent differences in the severity, prognosis, and long-term outcomes. A study including adolescents after heart, lung or liver transplantation indicated impairment in several areas such as anxiety, disappointment, or social adjustment. The individuals also reported about the obligation to show gratitude towards the donor, pressure to take good care of the transplant and, in the case of a living donation, fear for the donor due to the possible health risks [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Also children with type 1 and 2 diabetes seem to experience increased anxiety and depression [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Swiss childhood cancer survivors, also evaluated using the BSI, indicated a lower T score in the GSI, in obsessive-compulsive tendencies, anxiety and somatization compared with the German norm population. However, it was found that participants had a higher risk of suffering from severe psychological stress in comparison to the norm population [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Comparing these results with our study population indicates the difference between cancer survivors and patients with KRT. Cancer survivors usually are cured from their disease and might try to leave it behind, while individuals after kidney transplantation face a lifelong dependency on regular medical check-ups, medication to prevent graft rejection and a high probability of needing additional KRT again later in life.\u003c/p\u003e \u003cp\u003eA limitation of our study is the relatively small sample size limiting statistical power for subgroup comparisons, especially regarding clinical and sociodemographic characteristics. Additionally, our study included only German speaking patients, so results may not be for all Switzerland. Furthermore, data were collected between 2021 and 2022 whereas data of the general Swiss population were obtained between 2015 and 2016. Differences caused by broader circumstances (e.g., COVID-19 pandemic) could not be avoided or accounted for.\u003c/p\u003e \u003cp\u003eThe strength of our study is the use of a representative comparison sample from the Swiss general population that completed the same questions on psychological distress. Further, our study included adult patients after KRT during childhood on average 39 years of age providing long-term follow-up information on this population. Another strength refers to the use of high-quality clinical information based on medical records from the SPRR.\u003c/p\u003e \u003cp\u003eChronic kidney disease in children and adults does have a massive long-term impact on patients which leads to a life-long dependence on medical support. This may intuitively interfere with their psychological well-being and affect social, educational, and family life. Our results therefore might surprise, but underline the fact, that kidney transplantation programs in children and adolescents are successful not only in terms of survival of patient and graft, controllable side effects of the treatment and HrQoL, but also in terms of psychological distress. Although carrying the burden of a chronic disease, adults after KRT during childhood appear to be psychologically well adjusted in Switzerland. This fact should encourage pediatric nephrologists to sustain their daily efforts treating these patients. Furthermore, it should motivate adult nephrologists who care for them later on in adulthood.\u003c/p\u003e \u003cp\u003eIn conclusion, our study indicates similar levels of psychological distress in 80 adults after pediatric kidney replacement therapy in comparison to the Swiss general population. Our data are encouraging for pediatric nephrologists and generally indicate favorable psychological outcomes in the long-term. Beside the well-known excellent somatic outcome, these patients can achieve a psychological healthy life many decades after diagnosis of chronic kidney failure.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eBSI = Brief Symptom Inventory\u003c/p\u003e\n\u003cp\u003eCAKUT = Congenital Anomalies of the Kidney and Urinary Tract\u003c/p\u003e\n\u003cp\u003eCI = Confidence Interval\u003c/p\u003e\n\u003cp\u003eGSI = Global Severity Index\u003c/p\u003e\n\u003cp\u003eHRQoL = health-related quality of life\u003c/p\u003e\n\u003cp\u003eKRT = kidney replacement therapy\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePSDI = Positive Symptom Distress Index\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePST = Positive Symptom Total\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSCL-90 = Symptom Checklist-90\u003c/p\u003e\n\u003cp\u003eSPRR = Swiss Pediatric Renal Registry\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch3\u003eCompeting Interests\u003c/h3\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003ch3\u003eFunding\u003c/h3\u003e\n\u003cp\u003eThe study did not receive any funding.\u003c/p\u003e\n\u003ch3\u003eData availability\u003c/h3\u003e\n\u003cp\u003eThe data that support the information of this manuscript were accessed on secured servers of the Institute of Social and Preventive Medicine at the University of Bern. Data can only be made available for researchers who fulfil the respective legal requirements. All data requests should be communicated to the corresponding author.\u003c/p\u003e\n\u003ch3\u003eEthics approval\u003c/h3\u003e\n\u003cp\u003eEthical approval of the SPRR was granted by the Ethics Committee of the Canton of Bern (140/2015).\u003c/p\u003e\n\u003ch3\u003eInformed consent\u003c/h3\u003e\n\u003cp\u003eInformed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003ch3\u003eAuthor contributions\u0026nbsp;\u003c/h3\u003e\n\u003cp\u003eAll authors contributed to the study conception and design. Material preparation and data collection were performed by Guido F Laube, Marc-Andrea Heinzelmann and Luzius Mader. Data analysis was made by Nora F Laube. The first draft of the manuscript was written by Nora F Laube, and all authors commented on previous versions of the manuscript. All authors revised and approved the final manuscript.\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eFrancis A, Johnson DW, Melk A, Foster BJ, Blazek K, Craig JC, Wong G (2020) Survival after Kidney Transplantation during Childhood and Adolescence. Clin J Am Soc Nephrol 15:392-400.\u003c/li\u003e\n\u003cli\u003eMcDonald SP, Craig JC, Australian, New Zealand Paediatric Nephrology A (2004) Long-term survival of children with end-stage renal disease. N Engl J Med 350:2654-2662.\u003c/li\u003e\n\u003cli\u003eGroothoff JW, Offringa M, Grootenhuis M, Jager KJ (2018) Long-term consequences of renal insufficiency in children: lessons learned from the Dutch LERIC study. Nephrol Dial Transplant 33:552-560.\u003c/li\u003e\n\u003cli\u003eFalger J, Latal B, Landolt MA, Lehmann P, Neuhaus TJ, Laube GF (2008) Outcome after renal transplantation. Part I: intellectual and motor performance. 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Swiss Med Wkly 150:w20300.\u003c/li\u003e\n\u003cli\u003eKuehni CE, Rueegg CS, Michel G, Rebholz CE, Strippoli MP, Niggli FK, Egger M, von der Weid NX (2012) Cohort profile: the Swiss childhood cancer survivor study. Int J Epidemiol 41:1553-1564.\u003c/li\u003e\n\u003cli\u003eFranke G (2000) Franke, G.H. (2000). BSI. Brief Symptom Inventory - Deutsche Version. Manual. G\u0026ouml;ttingen: Beltz.\u003c/li\u003e\n\u003cli\u003eDerogatis LR (2000) BSI-18 Administration, Scoring, and Procedures Manual, Minneapolis.\u003c/li\u003e\n\u003cli\u003eQuintana GR, Ponce FP, Escudero-Past\u0026eacute;n JI, Santib\u0026aacute;\u0026ntilde;ez-Palma JF, Nagy L, Ko\u0026oacute;s M, Kraus SW, Demetrovics Z, Potenza MN, Ballester-Arnal R, Batthy\u0026aacute;ny D, Bergeron S, Billieux J, Briken P, Burkauskas J, C\u0026aacute;rdenas-L\u0026oacute;pez G, Carvalho J, Castro-Calvo J, Chen L, Ciocca G, Corazza O, Csako RI, Fernandez DP, Fernandez EF, Fujiwara H, Fuss J, Gabrhel\u0026iacute;k R, Gewirtz-Meydan A, Gjoneska B, Gola M, Grubbs JB, Hashim HT, Islam MS, Ismail M, Jim\u0026eacute;nez-Mart\u0026iacute;nez MC, Jurin T, Kalina O, Klein V, K\u0026ouml;ltő A, Lee CT, Lee SK, Lewczuk K, Lin CY, Lochner C, L\u0026oacute;pez-Alvarado S, Lukavsk\u0026aacute; K, Mayta-Trist\u0026aacute;n P, Miller DJ, Orosov\u0026aacute; O, Orosz G, Quintero Garzola GC, Ramos-Diaz J, Rigaud K, Rousseau A, Scanavino MT, Schulmeyer MK, Sharan P, Shibata M, Shoib S, Sigre-Leir\u0026oacute;s V, Sniewski L, Spasovski O, Steibliene V, Stein DJ, \u0026Uuml;nsal BC, Vaillancourt-Morel MP, Van Hout MC, Bőthe B (2024) Cross-cultural validation and measurement invariance of anxiety and depression symptoms: A study of the Brief Symptom Inventory (BSI) in 42 countries. J Affect Disord.\u003c/li\u003e\n\u003cli\u003eMeachen S-J, Hanks RA, Millis SR, Rapport LJ (2008) The Reliability and Validity of the Brief Symptom Inventory\u0026minus;18 in Persons With Traumatic Brain Injury. Archives of Physical Medicine and Rehabilitation 89:958-965.\u003c/li\u003e\n\u003cli\u003eDerogatis LR (1993) Brief symptom inventory (BSI), administration, scoring, and procedures manual (third ed.). , Minneapolis National \u003c/li\u003e\n\u003cli\u003eMichel G, B\u0026auml;nziger J, Brodbeck J, Mader L, Kuehni C, Roser K (2024) Psychological distress in the Swiss general population. PlosOne, in press\u003c/li\u003e\n\u003cli\u003eByles JE, Gallienne L, Blyth FM, Banks E (2012) Relationship of age and gender to the prevalence and correlates of psychological distress in later life. Int Psychogeriatr 24:1009-1018.\u003c/li\u003e\n\u003cli\u003eMatud MP, Diaz A, Bethencourt JM, Ibanez I (2020) Stress and Psychological Distress in Emerging Adulthood: A Gender Analysis. J Clin Med 9.\u003c/li\u003e\n\u003cli\u003eRodriguez Cuellar CI, Garc\u0026iacute;a de la Puente S, Hern\u0026aacute;ndez Moraria J, Boj\u0026oacute;rquez Ochoa A, Filler G, Zaltzman Grishevich S (2019) High depression rates among pediatric renal replacement therapy patients: A cross-sectional study. Pediatr Transplant 23:e13591.\u003c/li\u003e\n\u003cli\u003eJones J, Damery S, Allen K, Nicholas J, Baharani J, Combes G (2020) \u0026apos;You have got a foreign body in there\u0026apos;: renal transplantation, unexpected mild-to-moderate distress and patients\u0026apos; support needs: a qualitative study. BMJ Open 10:e035627.\u003c/li\u003e\n\u003cli\u003eCardol CK, Meuleman Y, van Middendorp H, van der Boog PJM, Hilbrands LB, Navis G, Sijpkens YWJ, Sont JK, Evers AWM, van Dijk S (2023) Psychological Distress and Self-Management in CKD: A Cross-Sectional Study. Kidney Med 5:100712.\u003c/li\u003e\n\u003cli\u003eK\u0026auml;rrfelt HM, Berg UB (2008) Long-term psychosocial outcome after renal transplantation during childhood. Pediatr Transplant 12:557-562.\u003c/li\u003e\n\u003cli\u003eMichel G, Rebholz CE, von der Weid NX, Bergstraesser E, Kuehni CE (2010) Psychological distress in adult survivors of childhood cancer: the Swiss Childhood Cancer Survivor study. J Clin Oncol 28:1740-1748.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"pediatric-nephrology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pnep","sideBox":"Learn more about [Pediatric Nephrology](http://link.springer.com/journal/467)","snPcode":"467","submissionUrl":"https://www.editorialmanager.com/pnep/default2.aspx","title":"Pediatric Nephrology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Psychological distress, Pediatric kidney failure, Kidney replacement therapy, Brief Symptom Inventory","lastPublishedDoi":"10.21203/rs.3.rs-4527030/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4527030/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThere is limited information about psychological distress in adults who underwent kidney replacement therapy (KRT) during childhood. This study aimed to describe psychological distress in adults after KRT during childhood in comparison to the Swiss general population and to evaluate associations with sociodemographic and clinical characteristics.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe sent a questionnaire to 143 people from the Swiss Pediatric Renal Registry (SPRR), who were alive, over 18 years old, starting KRT before the age of 18 years, and being German speaking. We measured psychological distress using the Brief Symptom Inventory 18 (BSI-18) and evaluated the Global Severity Index 18 (GSI-18), reflecting the overall level of distress, and the three subscales depression, somatization, and anxiety. We compared levels of psychological distress to norm data from the Swiss general population and used regression models to identify associations with sociodemographic and clinical characteristics.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eEighty persons with a mean age of 39 years (SD 10.1) responded to the questionnaire (response rate 56%). Overall, the GSI-18 and all subscales of the BSI-18 were similar among study participants and the Swiss general population. Unemployed participants reported higher levels of somatization and were more likely to experience psychological distress. Participants using psychotropic drugs (antidepressants or sleep medication) reported higher levels of overall psychological distress, depression, and somatization.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eAdults after KRT during childhood showed good long-term psychological well-being. These results are encouraging and underline the favorable outcome of these patients. So besides the excellent somatic outcome, these patients can achieve a psychological healthy life after diagnosis of chronic kidney failure.\u003c/p\u003e","manuscriptTitle":"Psychological distress in adults after pediatric kidney replacement therapy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-20 18:50:28","doi":"10.21203/rs.3.rs-4527030/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major Revisions Needed","date":"2024-06-25T11:43:22+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"","date":"2024-06-07T07:52:11+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-06-04T22:04:13+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-04T16:50:52+00:00","index":"","fulltext":""},{"type":"submitted","content":"Pediatric Nephrology","date":"2024-06-04T05:50:44+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"pediatric-nephrology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pnep","sideBox":"Learn more about [Pediatric Nephrology](http://link.springer.com/journal/467)","snPcode":"467","submissionUrl":"https://www.editorialmanager.com/pnep/default2.aspx","title":"Pediatric Nephrology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"733182ec-e3e1-4e32-87a8-879bbc9911e1","owner":[],"postedDate":"June 20th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-11-11T16:04:24+00:00","versionOfRecord":{"articleIdentity":"rs-4527030","link":"https://doi.org/10.1007/s00467-024-06571-7","journal":{"identity":"pediatric-nephrology","isVorOnly":false,"title":"Pediatric Nephrology"},"publishedOn":"2024-11-05 15:57:19","publishedOnDateReadable":"November 5th, 2024"},"versionCreatedAt":"2024-06-20 18:50:28","video":"","vorDoi":"10.1007/s00467-024-06571-7","vorDoiUrl":"https://doi.org/10.1007/s00467-024-06571-7","workflowStages":[]},"version":"v1","identity":"rs-4527030","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4527030","identity":"rs-4527030","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}