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Dyadic Relationship Conflict, Gender, and Mortality in Urban Hemodialysis Patients

PAUL L. KIMMEL^*, ROLF A. PETERSON^§, KAREN L. WEIHS, NICOLE SHIDLER^§, SAMUEL J. SIMMENS, SYLVAN ALLEYNE^||, ILLUMINADO CRUZ^¶, JACK A. YANOVSKI^#, JUDITH H. VEIS^** and TERRY M. PHILLIPS^*

^* Department of Medicine, George Washington University Medical Center, Washington, D.C.
Department of Psychiatry and Behavioral Sciences, George Washington University Medical Center, Washington, D.C.
School of Public Health, George Washington University Medical Center, Washington, D.C.
^§ Department of Psychology, George Washington University, Washington, D.C.
^|| Department of Human Development and Psychoeducational Studies, Howard University Medical Center, Washington, D.C.
^¶ Department of Medicine, Howard University Medical Center, Washington, D.C.
^# Section on Women's Health, Developmental Endocrinology Branch, National Institute of Child Health and Development, National Institutes of Health, Bethesda Maryland
^** Department of Medicine, Washington Hospital Center, Washington, D.C.

Correspondence to Dr. Paul L. Kimmel, Division of Renal Diseases and Hypertension, Department of Medicine, George Washington University Medical Center, 2150 Pennsylvania Avenue, N.W., Washington, DC 20037. Phone: 202-994-4244; Fax: 202-994-2972.

Abstract. The effects of dyadic satisfaction and conflict have not been well defined in the hemodialysis (HD) population. The aim of this study was to determine whether the perception of decreased dyadic satisfaction was associated with mortality in patients treated with HD, and if so, whether there were different relationships between risk factors, and differential outcomes in men and women. A total of 174 HD patients, primarily African-Americans, involved in dyadic relationships for more than 6 mo had indices of dyadic satisfaction, depression, perception of illness effects, social support, behavioral compliance with the dialysis prescription, and plasma interleukin-1 (IL-1) and ß-endorphin levels measured. Cox proportional hazards models assessed relative mortality risks. Patients' dyadic satisfaction scores correlated with ß-endorphin levels. There was no correlation of IL-1 or ß-endorphin with any psychosocial or behavioral compliance measure in the group as a whole. Correlations between psychosocial, medical, and neuroimmunologic variables were different in men and women. For women, dyadic satisfaction correlated with ß-endorphin levels, depression, and perception of illness. Women with higher dyadic satisfaction and decreased dyadic conflict were at decreased mortality risk, but dyadic adjustment indices were unassociated with differential survival in the larger group of men. Correlations between neuroendocrine and immune markers are different in African-American male and female HD patients. Greater dyadic satisfaction and lower dyadic conflict are independently associated with decreased mortality in female African-American HD patients, of the same order of magnitude as medical risk factors. Such effects may be attributable to a relationship between dyadic satisfaction and conflict and health-related behaviors, or through an effect on neuroendocrine or immunologic status.

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Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673