Psychonephrology in Japan

Abstract

Psychonephrology is the field of study encompassing nephrology, psychiatry, and psychosomatic medicine, which is based on the concept of consultation-liaison within the biopsychosocial model of mind-body unity. The Japanese Society for Psychonephrology was founded in Japan in 1990 to resolve psychological problems in dialysis patients and renal transplant patients, for whom survival time has increased. Patients with chronic kidney disease (CKD) face various psychological burdens during the time leading up to the initiation of renal replacement therapy (RRT) or through to the continuation of RRT. Patients with CKD may experience high levels of stress, poor physical conditions, medication side effects, as well as adjustment disorders and anxiety/depression. Additionally, close relationships between these patients and their family and medical staff can cause psychological stress in these other individuals. The three main domains in psychonephrology concern psychological care for patients, which includes drug therapy, psychotherapy, and environmental adjustments; interventions for psychosomatic disorders; and mental health care for staff involved in RRT. Interdisciplinary collaboration among psychiatrists, psychotherapists, nephrologists, transplant surgeons, and paramedics to resolve patients' problems has been promoted. Future developments in psychonephrology include adhering to patients' desires regarding discontinuation/withholding of dialysis and palliative care and shared decision-making during the time leading up to RRT. Further development of psychonephrology in Japan will help to maintain higher levels of quality of life in CKD patients and provide relief for their psychological issues.