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                                                   t is with great delight that I welcome such a valuable addition
                                                  to this well-established series of information books for patients
                                                  who are living with Chronic Kidney Disease (CKD), and their
                                              Ifamilies. Living a healthy life with any chronic illness requires
                                              courage, stamina, enhanced self-management skills and good
                                              relationships with health care givers. Add to this the particular
                                              demands of chronic renal failure, with associated challenges ranging
                                              from adjusting to the rigors of dialysis, to waiting for the phone to
                                              ring to say a suitable kidney is available, and it is clear that providing
                                              support for the associated emotional journey is important to
                                              integrate in all areas and stages of renal care.

                                              The emotional and mental health demands of CKD and/or
                                              transplantation are considerable. Patients who have already
                                              endured chronic ill health have an unpredictable wait for a donor
        organ, during which time they face a significant decline in health. Once a donor is found, they are
        confronted with a major surgical procedure. They must then commit to a life-long regime of
        immunosuppressive medication and be perpetually vigilant to symptoms of possible infection or graft
        rejection. Many transplant recipients have significant difficulties adapting to life post-transplant,
        particularly the major adjustments which may be required in marital, family and occupational roles.

        In a minority of patients, the stress of living with Chronic Renal Failure and/or transplantation can trigger
        psychiatric disorder, most commonly depression, anxiety or adjustment disorders. Depression can lead to
        problems such as poor appetite, weight loss, withdrawal, lack of motivation and poor compliance with
        medical treatment, which can increase the risk of physical complications.

        The importance of supporting patients with these co-morbid, treatable health conditions cannot be
        underestimated. We now have excellent interventions available to treat these disorders, both in helping
        to develop more adaptive coping strategies around lifestyle management, along with medication if needed.
        No patient should have to cope with additional suffering that can be alleviated by good multidisciplinary
        team care.

        This book has been developed by experts in the field. It encourages communication of the important
        emotional factors intrinsic to this challenging journey. Along with helping patients, carers and staff to
        accept that all significant health problems have both a physical and mental health component, it
        encourages a language around acknowledging this to ones self, sharing it with others and finding
        strategies to help manage difficulties. We know that this improves not just the patient’s quality of life but
        has direct implications for improving physical and mental health outcomes.

                                                                                           Dr Siobhan MacHale
                                                                               Consultant Liaison Psychiatrist,
                                                                  Renal Transplant Team, Beaumont Hospital

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