A systematic review regarding the association of illness perception and survival among end-stage renal disease patients.

BACKGROUND End-stage renal disease (ESRD) patients have increased mortality and morbidity. According to Leventhal's self-regulation model, these patients mentally develop illness representations and coping strategies in order to better understand their condition. Mental representations seem to be an important factor for clinical and psychosocial outcomes. We aimed to systematically review all available data regarding the association between illness perception and survival/mortality among ESRD patients receiving dialysis treatment. METHODS This is a systematic review of prospective observational studies, evaluating illness perception and its association with survival/mortality in ESRD dialysis stage patients. We searched CENTRAL in the Cochrane Library until August 2012, MEDLINE from 1950, EMBASE from 1980, PsychINFO from 1967 and additional sources to identify all records evaluating illness perception and clinical outcomes in this population. Two authors assessed potential citations for eligibility and quality and extracted all data. The studied intervention was the application of the most commonly used questionnaires for assessing illness perception. The main outcomes were survival and mortality. RESULTS We identified five studies evaluating the relationship between illness perception and survival/mortality in ESRD patients receiving dialysis treatment. All included studies were prospective observational ones. Four studies showed that a negative perception of illness is associated with increased risk of death and one study failed to find any association between illness perception and mortality. This is the first systematic search that analysed the existing data showing an association between illness representation and survival/mortality among these patients. The main limitation of this review includes the design of the included studies (prospective observational studies without a non-exposed control group). CONCLUSIONS This study implies that patient's outcome may be improved by changes in illness perception and designing appropriate interventions. We conclude that these findings constitute an important indication for future research in this field (high-quality randomized trials) and for future implementation of effective interventions that could improve this patients' outcome.