Huang P, Huang HT, Ma J, Pang J, Zhang YY, Ma CH, Wang SD, Liang XZ, Wang J. Impact of anxiety symptoms on dialysis adherence and complication rates: A longitudinal observational study. World J Psychiatry 2024; 14(12): 1918-1924 [DOI: 10.5498/wjp.v14.i12.1918]
Corresponding Author of This Article
Jie Wang, Kidney System, Key Laboratory of Medical Research Basic Guarantee for Immune-Related Diseases Research of Guangxi, No. 18 Zhongshan 2nd Road, Youjiang District, Baise 533000, Guangxi Zhuang Autonomous Region, China. yyfywjj@126.com
Research Domain of This Article
Psychiatry
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Psychiatry. Dec 19, 2024; 14(12): 1918-1924 Published online Dec 19, 2024. doi: 10.5498/wjp.v14.i12.1918
Impact of anxiety symptoms on dialysis adherence and complication rates: A longitudinal observational study
Peng Huang, Hai-Ting Huang, Jing Ma, Jun Pang, Yu-Yuan Zhang, Chun-Hui Ma, Si-Dan Wang, Xiong-Zhuang Liang, Jie Wang
Peng Huang, Hai-Ting Huang, Jing Ma, Jun Pang, Yu-Yuan Zhang, Chun-Hui Ma, Si-Dan Wang, Jie Wang, Department of Nephrology, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise 533000, Guangxi Zhuang Autonomous Region, China
Xiong-Zhuang Liang, Department of Psychiatry, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise 533000, Guangxi Zhuang Autonomous Region, China
Jie Wang, Kidney System, Key Laboratory of Medical Research Basic Guarantee for Immune-Related Diseases Research of Guangxi, Baise 533000, Guangxi Zhuang Autonomous Region, China
Author contributions: Huang P, Liang XZ, and Wang J designed and are the guarantors of this study; Huang HT, Ma J, and Pang J participated in the data collection, analysis, and interpretation; Huang P drafted the initial version; Zhang YY, Ma CH, Wang SD, and Wang J made critical revisions to this article for important intellectual content. All authors participated in this study and jointly reviewed and edited the manuscript.
Supported by the Nature Science Foundation of Guangxi, No. 2017JJA0384.
Institutional review board statement: The study protocol was approved by the Institutional Review Board of Affiliated Hospital of Youjiang Medical University for Nationalities (approval number: YYFY-LL-2022-241).
Informed consent statement: All patients provided written informed consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No data available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jie Wang, Kidney System, Key Laboratory of Medical Research Basic Guarantee for Immune-Related Diseases Research of Guangxi, No. 18 Zhongshan 2nd Road, Youjiang District, Baise 533000, Guangxi Zhuang Autonomous Region, China. yyfywjj@126.com
Received: August 28, 2024 Revised: September 26, 2024 Accepted: November 6, 2024 Published online: December 19, 2024 Processing time: 91 Days and 2.5 Hours
Abstract
BACKGROUND
Anxiety is a common psychological comorbidity in patients undergoing dialysis, yet its impact on treatment adherence and complication rates remains understudied. We designed a longitudinal observational study to investigate these relationships, based on the hypothesis that higher anxiety symptoms would be associated with increased complication rates and negatively associated with adherence to the dialysis regimen.
AIM
To investigate the relationship between anxiety symptoms, dialysis adherence, and complication rates in patients undergoing dialysis over a 24-month period.
METHODS
This observational study analyzed data from 250 adult patients who underwent hemodialysis or peritoneal dialysis at three Affiliated Hospitals of Youjiang Medical University for Nationalities over a period of 24 months. Anxiety symptoms were assessed using the Hospital Anxiety and Depression Scale-Anxiety subscale at baseline and every 6 months. Dialysis adherence was evaluated through attendance records, interdialytic weight gain, and patient-reported medication adherence. We recorded complications (infections, cardiovascular events, and hospitalizations) and used mixed-effects models and survival analyses to infer associations between anxiety symptoms, adherence measures, and complication rates.
RESULTS
Higher anxiety symptoms were significantly associated with poorer dialysis adherence, including increased missed sessions [incidence rate ratio = 1.32, 95% confidence interval (CI): 1.18-1.47, P < 0.001], greater interdialytic weight gain (β = 0.24, 95%CI: 0.15-0.33, P < 0.001), and lower medication adherence (odds ratio = 0.85, 95%CI: 0.78-0.93, P < 0.001). Patients with clinically significant anxiety (Hospital Anxiety and Depression Scale-Anxiety subscale ≥ 8) had a higher risk of complications [hazard ratio (HR) = 1.68, 95%CI: 1.32-2.14, P < 0.001], particularly infections (HR = 1.89, 95%CI: 1.41-2.53, P < 0.001) and cardiovascular events (HR = 1.57, 95%CI: 1.18-2.09, P = 0.002). The relationship between anxiety and complications was partially mediated by adherence measures.
CONCLUSION
Anxiety symptoms in patients undergoing dialysis are associated with poorer treatment adherence and increased complication rates. Regular screening and targeted interventions to address symptoms may improve adherence and clinical outcomes.
Core Tip: This study highlights the significant impact of anxiety symptoms on adherence to treatment and complication rates in patients who undergo dialysis. The findings reveal that higher anxiety is associated with increased missed treatment sessions, greater interdialytic weight gain, and lower adherence to medication. Consequently, anxiety leads to a higher risk of infections, cardiovascular events, and hospitalization. Addressing anxiety through regular screening and targeted interventions could improve adherence and reduce complications, enhancing overall patient outcomes.
