Influence of spirituality on renal function of kidney transplant patients

This cross-sectional study included 81 kidney transplant patients who had undergone transplantation between 30 and 60 months previously. Patients were followed up for 12 months. The analysis was carried out in a large public hospital in the countryside of São Paulo, Brazil. Based on the Duke University Religion Index-religiosity and spirituality scale, we divided patients into two groups (spiritualized [n=52] and less spiritualized [n=29]), considering the median spirituality. For statistical analysis, we used inductive tests and analysis with linear mixed models, with a level of significance of 5% (p<0.05).

Results:

Clinical characteristics, immunosuppression, social support, adherence to drug therapy, quality of life, and depression did not differ between groups. Renal function after 12 months was significantly higher in the spiritualized group from 9 months on. After 12 months, the percentage of patients with creatinine clearance higher than 60 ml/min was 61.5% in the spiritualized group and 34.5% in the less spiritualized group (p=0.02). Multivariate analysis showed that the less spiritualized group had a 4.7 times greater risk [1.4 – 16.8] for worsening in renal function (p=0.01).

Conclusion:

More spiritualized patients had better renal function after 1 year of transplantation. This result was independent of clinical features, social support, and adherence to immunosuppressive therapy. A holistic approach in health with emphasis on spirituality is encouraged.

Keywords
Spirituality; Kidney transplantation; Chronic disease; Religion; Religion and medicine

Variables		Spiritualized (n=52)	Less spiritualized (n=29)	p-value
Women n(%)		31(59.6)	12(41.4)	0.16⁺ + Fisher's exact test;
Mean age (SD) (years)		43±11	41±15	0.61^& & Student t test;
Deceased donor n (%)		33(63.5)	20(69)	0.80⁺ + Fisher's exact test;
Median time of transplantation (months) Median (P)		6[2-24]	12[1-26]	0.98^# # Mann-Whitney test; SD - standard deviation; p - percentile 25% and 75%
Median panel (%) (P)		0[0-34]	0[0-1]	0.10^# # Mann-Whitney test; SD - standard deviation; p - percentile 25% and 75%
Median mismatches (P)		3[2-3]	3[2-4]	0.63^# # Mann-Whitney test; SD - standard deviation; p - percentile 25% and 75%
Retransplantation n (%)		2(3.9)	0(0)	0.53⁺ + Fisher's exact test;
Type of induction
	Without induction n (%)	10(19.2)	4(13.8)
	Basiliximab n (%)	27(51.9)	19(65.5)	0.49^* * Chi-squared test;
	Thymoglobulin n (%)	15(28.8)	6(20.7)
Used immunosuppression:
Tacrolimus n (%)		45(88.2)	29(100)	0.08⁺ + Fisher's exact test;
Everolimus or sirolimus n (%)		10(19.6)	4(13.8)	1⁺ + Fisher's exact test;
Azathioprine n (%)		1(2)	0(0)	1⁺ + Fisher's exact test;
Mycophenolate n (%)		46(90.2)	25(86.2)	0.71⁺ + Fisher's exact test;
Prednisone n (%)		51(100)	29(100)	1⁺ + Fisher's exact test;
Acute rejection n (%)		5(9.8)	2(7.1)	1⁺ + Fisher's exact test;
Median initial creatinine (mg/dL) (P)		1.3[1-1.9]	1.4[1.2-1.8]	0.13^# # Mann-Whitney test; SD - standard deviation; p - percentile 25% and 75%
Mean initial creatinine clearance (SD) (ml/min)		65.06±25.2	56.36±24.5	0.14^& & Student t test;
Evolution in 12 months
Loss of allografts n (%)		0(0)	2(6.9)	0.12⁺ + Fisher's exact test;
Baseline disease
	Diabetes	2(5.9)	4(8)	0.61^* * Chi-squared test;
	Hypertension	10(29.4)	9(18)
	Glomerulonephritis	8(23.5)	16(32)
	Undetermined	14(41.2)	21(42)
Deaths n (%)		1(1.9)	0(0)	1⁺ + Fisher's exact test;

Variables		Spiritualized (n=52)	Less spiritualized (n=29)	p-value
Formal education n (%)
	Illiterate	0(0)	0(0)
	Elementary	22(42.3)	10(34.5)	0.74^* * Chi-squared test;
	High School	24(46.2)	16(55.2)
	Higher education or above	6(11.5)	3(10.3)
Religion n(%)
	Atheist	0(0)	0(0)
	Catholic	29(55.8)	19(65.5)	0.34^* * Chi-squared test;
	Protestant	22(42.3)	8(27.6)
	Spiritualist	0(0)	1(3.4)
	Others	1(1.9)	1(3.4)
Religiosity/Spirituality Median (P)
	Non-organizational religion.	2[1-3]	2[2-4]	0.001^# # Mann-Whitney test; SD - standard deviation; p - percentile 25% and 75%
	Organizational religion	2[2-2]	2[2-5]	0.01^# # Mann-Whitney test; SD - standard deviation; p - percentile 25% and 75%
	Spiritualism	3[3-4]	6[5-6]	0.0001^# # Mann-Whitney test; SD - standard deviation; p - percentile 25% and 75%
	Median depression (P)	7[4-11]	10[4-17]	0.42^# # Mann-Whitney test; SD - standard deviation; p - percentile 25% and 75%
Anxiety
	Trait	40±8	42±9	0.24^& & Student t test;
Mean (SD)
	State	40±8	42±9	0.40^& & Student t test;
Quality of life
	Physical	67.8[58.9-75.5]	67.8[53.6-75]	0.58^# # Mann-Whitney test; SD - standard deviation; p - percentile 25% and 75%
Median (P)
	Psychological	75[68.7-83.3]	75[66.36-83.3]	0.50^# # Mann-Whitney test; SD - standard deviation; p - percentile 25% and 75%
	Social relationships	75[66.6-83.3]	75[66.6-83.3]	0.66^# # Mann-Whitney test; SD - standard deviation; p - percentile 25% and 75%
	Environment	67,2[57.8-75]	68.7[62.5-5]	0.78^# # Mann-Whitney test; SD - standard deviation; p - percentile 25% and 75%
Social support
	Material	95[75-100]	95[90-100]	0.72^# # Mann-Whitney test; SD - standard deviation; p - percentile 25% and 75%
Median (P)
	Affective	100[90-100]	95[85-100]	0.34^# # Mann-Whitney test; SD - standard deviation; p - percentile 25% and 75%
	Social interaction	90[70-97.5]	80[67.5-100]	0.98^# # Mann-Whitney test; SD - standard deviation; p - percentile 25% and 75%
	Emotional	93[73-100]	80[70-100]	0.49^# # Mann-Whitney test; SD - standard deviation; p - percentile 25% and 75%
	Adherence to immunosuppressive	0[0-0]	0[0-1]	0.48^# # Mann-Whitney test; SD - standard deviation; p - percentile 25% and 75%
	therapy Median(P)
Non-adherence (BAASIS > 0) n(%)		10(19.2)	8(27.6)	0.41⁺ + Fisher's exact test;

Variables		Spiritualized (n=52) Mean (SD)^a a Analysis of linear mixed models;	Less spiritualized (n=29) Mean (SD)^a a Analysis of linear mixed models;
Creatinine (mg/dL)
	Baseline	1.58±0.76	2.05±2.09
	Month 3	1.57±0.75	1.76±0.80
	Month 6	1.60±0.75	1.61±0.40
	Month 9	1.61±0.86	1.65±0.57
	Month 12	1.47±0.64	1.95±1.7
Creatinine clearance (ml/min)
	Baseline	65.06±25.2	56.36±24.5
	Month 3	64.29±25.4	57.97±18.4
	Month 6	62.47±24.3	59.13±17.1
	Month 9	64.44±27.0	60.00±18.6^* * p<0.009 x spiritualized group;
	Month 12	67.13±26.9	56.66±20.9^* * p<0.009 x spiritualized group;
Creatinine clearance > 60 ml/min at the end of 12 months. n(%)^B b Fisher's exact test; SD - standard deviation;		32(61.5%)	10(34.5%)^ p=0,02

Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
E-mail: actapaulista@unifesp.br

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[1] Corresponding author Armando dos Santos Trettene, Rua Silvio Marchione, 3-20, 17012-900, Bauru, SP, Brazil. armandotrettene@usp.br