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Yuan C, Chang F, Zhai H, Du J, Lu D, Ma H, Wu X, Gao P, Ni L. Integrative approaches to depression in end-stage renal disease: insights into mechanisms, impacts, and pharmacological strategies. Front Pharmacol 2025; 16:1559038. [PMID: 40297143 PMCID: PMC12034933 DOI: 10.3389/fphar.2025.1559038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2025] [Accepted: 03/20/2025] [Indexed: 04/30/2025] Open
Abstract
Depression is a frequently overlooked psychiatric symptom in patients with end-stage renal disease (ESRD), seriously affecting their quality of life, risk of death, adherence to treatment, cognitive abilities, and overall health outcomes. The study investigates the prevalence of depression is in ESRD patients, along with the methods for assessment, diagnostic guidelines, underlying factors, consequences, and management strategies. The Beck Depression Inventory (BDI), with an optimal diagnostic cutoff score greater than 14, has been identified as the most accurate for diagnosing depression in ESRD, while emerging tools such as vacancy-driven high-performance metabolic assays show promise for evaluation. Depression contributes to adverse health outcomes by increasing risks of treatment withdrawal, suicide, and cognitive impairment, as well as serving as a predictor of mortality and poor treatment adherence. Even though tricyclic antidepressants and selective serotonin reuptake inhibitors are commonly used, the effectiveness of treatment remains unpredictable because clinical studies often have limitations such as small sample sizes, no randomization, and missing control groups. Innovative approaches, such as nanomaterials and traditional Chinese medicine, have shown therapeutic potential with reduced side effects. Future research should focus on specific high-risk populations, particularly older adults and women under the age of 45, to better tailor interventions. The goal of this research is to improve understanding of depression in ESRD, leading to better patient care, improved quality of life, and superior clinical results.
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Affiliation(s)
- Cheng Yuan
- Department of Oncology, Yichang Central People's Hospital, The First College of Clinical Medical Science, China Three Gorges University, Yichang, Hubei, China
| | - Fengpei Chang
- Department of Nephrology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
- Department of Nephrology, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Hongfu Zhai
- Department of Nephrology, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Jiayin Du
- Department of Nephrology, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Danqin Lu
- Department of Nephrology, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Haoli Ma
- Department of Biological Repositories, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xiaoyan Wu
- Department of Nephrology, Zhongnan Hospital, Wuhan University, Wuhan, China
- Department of General Practice, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ping Gao
- Department of Nephrology, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Lihua Ni
- Department of Nephrology, Zhongnan Hospital, Wuhan University, Wuhan, China
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Lefrère A, Burtey S, Bobot S, Belzeaux R, Bobot M. Depression in chronic kidney disease: Particularities, specific mechanisms and therapeutic considerations, a narrative review. Behav Brain Res 2025; 483:115467. [PMID: 39923943 DOI: 10.1016/j.bbr.2025.115467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2024] [Revised: 12/27/2024] [Accepted: 01/30/2025] [Indexed: 02/11/2025]
Abstract
INTRODUCTION Depression is highly prevalent during chronic kidney disease (CKD) with studies suggesting prevalence rates ranging from approximately one-quarter to half of CKD patients. CKD and depression have a bidirectional relationship, each disorder aggravating the other, leading to more complex and challenging patient management. Depression during CKD is multifactorial and is associated with increased risk of adverse events and hospitalization. METHODS We conducted a narrative review of experimental and observational studies in animals and humans, as well as meta-analyses, to explore specific mechanisms of depression in CKD and its treatment. RESULTS In depression the gut-brain axis is central. CKD leads to an accumulation of gut-derived uremic toxins. One key factor is the accumulation of tryptophan-derived uremic toxins like kynurenines or indoxyl sulfate, whose serum concentration increases progressively with the stage of CKD (up to 100-fold in stage 5), and which plays an important role in depression mechanisms, by activating aryl hydrocarbon receptor, decreasing brain concentrations of serotonin by approximately 40 %, increasing brain inflammation, via activation of microglia and astrocytes and release of TNFα, IL-6 and NO. Randomized controlled studies found limited or no benefits of antidepressants for depressive symptoms in CKD and hemodialysis patients. CONCLUSION Chronic inflammation, in relation to uremic toxin accumulation during CKD, seems to be a complex but important mechanism for treatment resistance in depression. Future research should consider inhibitors of uremic toxins inhibitors and anti-inflammatory molecules as potential therapeutic agents, to improve the prognosis of depression in CKD patients.
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Affiliation(s)
- Antoine Lefrère
- Pôle de Psychiatrie, Assistance Publique Hôpitaux de Marseille, Marseille, France; Institut de Neurosciences de la Timone, Aix-Marseille Univ, UMR CNRS, France
| | - Stéphane Burtey
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, AP-HM, Marseille, France; Aix Marseille Univ, INSERM 1263, INRAE 1260, C2VN, Marseille, France
| | - Stanislas Bobot
- Psychologie de la Santé, Université Toulouse Jean Jaurès, Toulouse, France
| | - Raoul Belzeaux
- IGF, Université de Montpellier, CNRS, INSERM, Montpellier, France; CHU Montpellier, Department of psychiatry, Université∼ de Montpellier, CNRS, INSERM, Montpellier, France; Fondation Fondamental, Créteil F-94010, France
| | - Mickaël Bobot
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, AP-HM, Marseille, France; Aix Marseille Univ, INSERM 1263, INRAE 1260, C2VN, Marseille, France; CERIMED, Aix-Marseille Univ, Marseille, France.
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Kapadi R, Elander J, Burton AE, Taylor J, Coyne E, Selby NM, Taal MW, Mitchell K, Stalker C. An exploration of successful psychosocial adjustment to long-term in-centre haemodialysis. Psychol Health 2025; 40:394-409. [PMID: 37415316 DOI: 10.1080/08870446.2023.2231007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVES Haemodialysis extends life for people with end-stage kidney disease (ESKD) worldwide, but it imposes significant psychosocial burdens and there is little evidence about successful adjustment. This study aimed to improve understanding of successful psychosocial adjustment to in-centre haemodialysis (ICHD; dialysis in a hospital or satellite unit). METHODS Individual semi-structured interviews were conducted with a purposive sample of 18 people with ESKD who had all received in-centre haemodialysis in the UK for at least 90 days in the last two years. An inductive thematic analysis was employed to identify themes from the verbatim interview transcripts. RESULTS There were four themes: 1) reaching a state of acceptance, which described the importance of accepting the necessity of dialysis; 2) taking an active role in treatment, which described how being actively involved in treatment gave participants greater feelings of autonomy and control; 3) utilising social support networks, which described the benefits of instrumental and emotional support; and 4) building emotional resilience, which described the importance of optimism and positivity. CONCLUSIONS The themes demonstrated elements of successful adjustment that could be targeted by interventions to promote psychological flexibility and positive adjustment among people receiving in-centre haemodialysis worldwide.
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Affiliation(s)
- Romaana Kapadi
- School of Psychology, University of Derby, Derby, UK
- School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent, UK
| | - James Elander
- School of Psychology, University of Derby, Derby, UK
| | - Amy E Burton
- School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent, UK
| | - Jennifer Taylor
- School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent, UK
| | - Emma Coyne
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Nicholas M Selby
- Centre for Kidney Research and Innovation, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Renal Medicine, Royal Derby Hospital, Derby, UK
| | - Maarten W Taal
- Centre for Kidney Research and Innovation, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Renal Medicine, Royal Derby Hospital, Derby, UK
| | | | - Carol Stalker
- School of Psychology, University of Derby, Derby, UK
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Song Q, Yuan T, Xu Z, Xu Y, Wu M, Hou J, Fei J, Mei S. Post-traumatic growth, depression and anxiety among hemodialysis patients: a latent profile analysis. PSYCHOL HEALTH MED 2025:1-19. [PMID: 39898690 DOI: 10.1080/13548506.2025.2458251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 01/18/2025] [Indexed: 02/04/2025]
Abstract
Hemodialysis is the primary life-sustaining treatment for patients with end-stage kidney disease, which can result in a range of negative reactions (e.g. depression and anxiety) and positive change (e.g. post-traumatic growth, PTG). To further understand the post-traumatic response patterns of patients who are going through hemodialysis, dividing them into homogeneous subgroups helps to uncover hidden information. This cross-sectional study evaluated 274 patients (172 males and 102 females) undergoing hemodialysis at a tertiary hospital between October and November 2022. Latent profile analysis (LPA) was used to identify subgroups of patients based on their PTG, depression, and anxiety. The results identified three profiles: post-traumatic depression (n = 90, 32.9%), general moderate growth (n = 116, 42.3%) and high appreciation-power (n = 68, 24.8%). The classification quality was good (Entropy = 0.86). Univariate and multiple logistic regression analysis were conducted to test potential influencing factors. Furthermore, Back propagation (BP) neural network model was employed to examine the ranking of influencing factors across different profiles. Perceived health control (100.0%), social network (83.4%), meaning in life (70.2%), self-disclosure (64.4%), self-rated health (45.0%), and exercise (31.4%) were identified as differential predictors of profile members (all p < 0.05), listed in order base on their degrees of influence. The findings revealed the heterogeneity of post-traumatic response patterns in hemodialysis patients, categorizing their post-traumatic responses into three distinct patterns. In the future, in the treatment and care of hemodialysis patients, it will be more meaningful to provide targeted interventions for the different characteristics of patients' PTG, depression and anxiety.
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Affiliation(s)
- Qianqian Song
- School of Public Health, Jilin University, Changchun, China
| | | | - Zhonggao Xu
- Department of Nephrology, the First Hospital of Jilin University, Changchun, China
| | - Ying Xu
- Department of Nephrology, the First Hospital of Jilin University, Changchun, China
| | - Meiyan Wu
- Department of Nephrology, the First Hospital of Jilin University, Changchun, China
| | - Jie Hou
- Department of Nephrology, the First Hospital of Jilin University, Changchun, China
| | - Junsong Fei
- School of Public Health, Jilin University, Changchun, China
| | - Songli Mei
- Department of Social Medicine and Health Management, School of Public Health, Jilin University, Changchun, China
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Chilcot J, Pearce CJ, Hall N, Busby AD, Hawkins J, Vraitch B, Rathjen M, Hamilton A, Bevin A, Mackintosh L, Hudson JL, Wellsted D, Jones J, Sharma S, Norton S, Ormandy P, Palmer N, Farrington K. The identification and management of depression in UK Kidney Care: Results from the Mood Maps Study. J Ren Care 2024; 50:297-306. [PMID: 38341770 DOI: 10.1111/jorc.12489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/08/2024] [Accepted: 01/22/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND Depression is common in people with chronic kidney disease, yet little is known about how depression is identified and managed as part of routine kidney care. OBJECTIVES The primary objective was to survey all UK adult kidney centres to understand how depression is identified and managed. A secondary objective was to broadly describe the variability in psychosocial care. DESIGN Online survey. METHODS The survey comprised of three sections: (1) general kidney care, (2) psychological provision and (3) social work provision. RESULTS 48/68 (71%) of centres responded to the general survey with 20 and 13 responses from psychological and social work module respectively. Only 31.4% reported having both in centre psychological and social work practitioners. Three centres reported no access to psychosocial provision. Of the 25 centres who reported on pathways, 36.0% reported having internal pathways for the identification and management of depression. Within services with psychological provision, screening for depression varied across modality/group (e.g., 7.1% in mild/moderate chronic kidney disease vs. 62.5% in kidney donors). Cognitive Behavioural Therapy and Acceptance and Commitment Therapy were the most common interventions offered. Most psychosocial services were aware of the National Institute for Health and Care Excellence guidelines for managing depression in long-term conditions (n = 18, 94.7%) yet few fully utilised (n = 6, 33.3%). Limited workforce capacity was evident. CONCLUSIONS There is considerable variability in approaches taken to identify and treat depression across UK kidney services, with few services having specific pathways designed to detect and manage depression. Workforce capacity remains a significant issue.
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Affiliation(s)
- Joseph Chilcot
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Christina J Pearce
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Natalie Hall
- Centre for Health Services and Clinical Research, School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, UK
| | - Amanda D Busby
- Centre for Health Services and Clinical Research, School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, UK
| | - Janine Hawkins
- Centre for Health Services and Clinical Research, School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, UK
| | - Balvinder Vraitch
- Renal Department, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom, United Kingdom
| | - Mandy Rathjen
- Renal Department, Edinburgh Royal Infirmary, Edinburgh, United Kingdom, United Kingdom
| | - Alexander Hamilton
- Exeter Kidney Unit, Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter, Devon, UK
- Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - Amanda Bevin
- Kent & Canterbury Kidney Care Centre, Kent & Canterbury Hospital, Canterbury, UK
| | - Lucy Mackintosh
- Centre for Health Services and Clinical Research, School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, UK
| | - Joanna L Hudson
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - David Wellsted
- Centre for Health Services and Clinical Research, School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, UK
| | - Julia Jones
- Centre for Research in Public Health and Community Care, School of Health and Social Work, University of Hertfordshire, Hatfield, UK
| | - Shivani Sharma
- Centre for Health Services and Clinical Research, School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, UK
| | - Sam Norton
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Paula Ormandy
- School of Health and Society, University of Salford, Salford, UK
| | | | - Ken Farrington
- Centre for Health Services and Clinical Research, School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, UK
- Renal Medicine, Lister Hospital, Stevenage, UK
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Smylie P, Prasad B. Five Things to Know About Depression in Hemodialysis. Can J Kidney Health Dis 2024; 11:20543581241264465. [PMID: 39205861 PMCID: PMC11350542 DOI: 10.1177/20543581241264465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Accepted: 06/03/2024] [Indexed: 09/04/2024] Open
Affiliation(s)
- Peter Smylie
- College of Medicine, University of Saskatchewan, Regina, Canada
| | - Bhanu Prasad
- Division of Nephrology, Department of Medicine, Saskatchewan Health Authority, Regina, Canada
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Shyamala MA, Ali A, Ajith M. Depression and Quality of Life Among Haemodialysis Patients. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:S2880-S2882. [PMID: 39346365 PMCID: PMC11426592 DOI: 10.4103/jpbs.jpbs_548_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 05/21/2024] [Accepted: 05/28/2024] [Indexed: 10/01/2024] Open
Abstract
Introduction Depression is likely to be the most common psychopathology in haemodialysis patients. It might affect their adherence to treatment and is associated with increased morbidity and mortality. However, the prevalence of depression in haemodialysis patients has not been definitively determined, and it is generally underdiagnosed and undertreated. Chronic renal failure (CRF) patients have diminished quality of life (QOL) scores compared with healthy persons. Moreover, patients on haemodialysis might have worse QOL than those on peritoneal dialysis. Objectives To assess the level of depression and quality of life among haemodialysis patients. Methodology The research design adopted for this study was quantitative method. The population includes patient undergoing haemodialysis in SMCH. The sample size was 60 selected through convenience sampling technique on the basis of criteria. Result The findings revealed that 30 (50%) had severe depression, 26 (43.34%) had moderate depression, and 2 (3.33%) had borderline clinical depression and extreme depression, respectively. The mean score of overall quality of life score among haemodialysis patients was 34.66 ± 7.16. Conclusion The analysis revealed that haemodialysis patients had severe to moderate depression, which in turn reduces the quality of life of the haemodialysis patients.
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Affiliation(s)
- M Aruna Shyamala
- Department of Child Health Nursing, Saveetha College of Nursing, Saveetha Institute of Medical and Technical Sciences, Thandalam, Chennai, Tamil Nadu, India
| | - Anayat Ali
- Department of Child Health Nursing, Saveetha College of Nursing, Saveetha Institute of Medical and Technical Sciences, Thandalam, Chennai, Tamil Nadu, India
| | - M Ajith
- Department of Child Health Nursing, Saveetha College of Nursing, Saveetha Institute of Medical and Technical Sciences, Thandalam, Chennai, Tamil Nadu, India
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Wang G, Zhuo N, Liu Z. Anxiety and depression among patients with end-stage renal disease undergoing hemodialysis. Int Urol Nephrol 2024; 56:2449-2450. [PMID: 38386226 DOI: 10.1007/s11255-024-03979-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 02/04/2024] [Indexed: 02/23/2024]
Affiliation(s)
- Gang Wang
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China
| | - Ning Zhuo
- Department of Nephrology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, 215002, China
| | - Zhichun Liu
- Department of Rheumatology and Immunology, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China.
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Stanisławska M, Roman M, Nowicki M. The Plasma Neurofilament Light Chain, Brain-Derived Neurotrophic Factor, and Risk of Depression in Chronic Hemodialysis Patients. Biomedicines 2024; 12:103. [PMID: 38255209 PMCID: PMC10813685 DOI: 10.3390/biomedicines12010103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 12/27/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
INTRODUCTION Depression is highly prevalent among hemodialysis patients. Understanding the relationship between the plasma neurofilament light chain (NfL) and brain-derived neurotrophic factor (BDNF) may help us to better understand the mechanisms of depression. This study determined their impact, alongside that of other factors, on the risk of depression in hemodialysis patients. METHODS The study enrolled 82 patients undergoing chronic hemodialysis. Serum NfL, BDNF, uric acid, urea, potassium, calcium, phosphorus, intact parathyroid hormone, and C-reactive protein (CRP) levels were measured. The patients completed the Beck Depression Inventory (BDI). Blood pressure values, body mass before and after hemodialysis, and weekly duration of hemodialysis in hours were assessed. For 19-month survival analysis, the patients were stratified according to baseline BDI scores. RESULTS Based on the BDI score, 18.3% of the patients had an increased risk of depression. Lower scores were associated with significantly longer duration of hemodialysis treatment (37.5 (25-57) 24 (14-37) months, p = 0.01). Within the 19-month survival analysis, 31.7% of patients died. The patients with BDI scores above the median had significantly lower survival than those below the median (log-rank test p = 0.02). No significant differences in serum BDNF levels (192.7 [125.2-278.2]; 207.7 [142.8-265.8] pg/mL, p = 0.40), or NfL concentrations (1431.5 [1182.6-1625.7]; 1494.6 [1335.7-1667] kDa, p = 0.52) were found between patients with lower and higher risk of depression. Patients with BDI scores above the median had significantly higher levels of CRP (9.6 [4.4-14]) than those with scores below the median (3.6 [2.2-7.5], p = 0.01). A significant positive correlation was found between the BDI score and serum CRP level (r = 0.38, p = 0.01). A significant negative correlation was observed between the BDI score and URR% value (r = -0.36, p = 0.02). CONCLUSIONS Patients with lower BDI scores had a longer dialysis duration, indicating a potential negative association between depression risk and length of dialysis treatment. Neither serum NfL nor BDNF levels can serve as markers of depression risk in the dialysis population.
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Affiliation(s)
| | | | - Michał Nowicki
- Department of Nephrology, Hypertension and Kidney Transplantation, Central University Hospital, Medical University of Lodz, Pomorska 251, 92-213 Lodz, Poland; (M.S.); (M.R.)
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10
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Bahall M, Legall G, Lalla C. Depression among patients with chronic kidney disease, associated factors, and predictors: a cross-sectional study. BMC Psychiatry 2023; 23:733. [PMID: 37817099 PMCID: PMC10566121 DOI: 10.1186/s12888-023-05249-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 10/03/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Depression with diverse etiologies is exacerbated by chronic diseases, such as chronic kidney disease (CKD), coronary artery disease (CAD), cancer, diabetes mellitus, and hypertension. This study aimed to analyse depression, its associations, and predictors among patients attending the kidney clinic of a teaching hospital. METHODS Data were collected from 01 August 2017 to 30 September 2017 via face-to-face interviews and examination of the medical records of a convenience sample of 314 patients. The patients were categorised broadly as stages I and II with an estimated glomerular filtration rate (eGFR) > 60 mls/min/1.73 m2, and with stages III, IV, and V or GFR ≤ 60 mls/ min/1.73 m2 (or CKD). The Patient Health Questionnaire (PHQ)-9 was the data collection instrument for depression-related data. RESULTS Participants were predominantly male (n = 179; 57.0%), aged over 60 years (n = 211; 67.2%), Indo-Trinbagonian (n = 237; 75.5%), and with stages III, IV, and V CKD. The two leading comorbid conditions were hypertension (83.4%) and diabetes mellitus (56.1%). Of the 261 (83.1%) patients with recorded eGFR, 113 (43.3%) had Stage III CKD. The mean depression (PHQ-9) score was 13.0/27 (±9.15), with 306 (97.5%) patients diagnosed as having depression with the following severities: mild (n = 116; 37.9%), moderate (n = 138, 45.1%), moderately severe (n = 38; 12.4%), and severe (n = 14; 4.6%). Depression was independent of sex. Nine sociodemographic variables were associated with depression; however, 'level of education', was the only predictor of depression with greater severity associated with lower levels of education. eGFR was negatively correlated with the PHQ-9 scores (Pearson's correlation, r = -0.144, p = 0.022). At least 78.3% of the patients who self-reported no depression had clinical depression (moderate, moderately severe, or severe) PHQ-9 scores ≥ 10. CONCLUSION Depression was a significant comorbidity among patients with CKD, with the majority displaying clinical depression. "Level of education" was the only predictor of depression. Self-reported depression is an unreliable method for evaluating clinical depression.
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Affiliation(s)
- Mandreker Bahall
- University of the West Indies, Eric Williams Medical Sciences Complex, Mt. Hope, Trinidad and Tobago.
| | - George Legall
- University of the West Indies, Eric Williams Medical Sciences Complex, Mt. Hope, Trinidad and Tobago
| | - Carlyle Lalla
- San Fernando General Hospital, Chancery Lane, San Fernando, Trinidad and Tobago
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11
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Li Y, Zhu B, Shen J, Miao L. Depression in maintenance hemodialysis patients: What do we need to know? Heliyon 2023; 9:e19383. [PMID: 37662812 PMCID: PMC10472011 DOI: 10.1016/j.heliyon.2023.e19383] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 08/10/2023] [Accepted: 08/21/2023] [Indexed: 09/05/2023] Open
Abstract
Chronic kidney disease (CKD) is now recognized as a major public health problem in the world. The global prevalence of CKD is estimated at 13.4% (11.7-15.1%), with an estimated 490.2 to 7.083 million patients with End stage renal disease requiring renal replacement therapy. Hemodialysis is the main treatment for End stage renal disease patients because of its high safety and efficiency. The survival time of these patients was significantly prolonged, but many psychological problems followed. Depression is a type of mood disorder caused by a variety of causes, often manifested as disproportionate depression and loss of interest, sometimes accompanied by anxiety, agitation, even hallucinations, delusions and other psychotic symptoms. Depression has become the most common mental disorder in maintenance hemodialysis (MHD) patients according to the meta-analysis. In recent years, depression has seriously affected the quality of life and prognosis of MHD patients from dietary, sleep, treatment adherence, energy and other dimensions. This article reviews the epidemiology, etiology, diagnosis and treatment of depression in MHD patients.
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Affiliation(s)
- Yulu Li
- Department of Nephrology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Bin Zhu
- Department of Critical Care Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Jianqin Shen
- Blood Purification Centre, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Liying Miao
- Department of Nephrology, The Third Affiliated Hospital of Soochow University, Changzhou, China
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12
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Zhang R, Fu X, Song C, Shi H, Jiao Z. Characterizing Topological Properties of Brain Functional Networks Using Multi-Threshold Derivative for End-Stage Renal Disease with Mild Cognitive Impairment. Brain Sci 2023; 13:1187. [PMID: 37626543 PMCID: PMC10452699 DOI: 10.3390/brainsci13081187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/01/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
Patients with end-stage renal disease (ESRD) experience changes in both the structure and function of their brain networks. In the past, cognitive impairment was often classified based on connectivity features, which only reflected the characteristics of the binary brain network or weighted brain network. It exhibited limited interpretability and stability. This study aims to quantitatively characterize the topological properties of brain functional networks (BFNs) using multi-threshold derivative (MTD), and to establish a new classification framework for end-stage renal disease with mild cognitive impairment (ESRDaMCI). The dynamic BFNs (DBFNs) were constructed and binarized with multiple thresholds, and then their topological properties were extracted from each binary brain network. These properties were then quantified by calculating their derivative curves and expressing them as multi-threshold derivative (MTD) features. The classification results of MTD features were compared with several commonly used DBFN features, and the effectiveness of MTD features in the classification of ESRDaMCI was evaluated based on the classification performance test. The results indicated that the linear fusion of MTD features improved classification performance and outperformed individual MTD features. Its accuracy, sensitivity, and specificity were 85.98 ± 2.92%, 86.10 ± 4.11%, and 81.54 ± 4.27%, respectively. Finally, the feature weights of MTD were analyzed, and MTD-cc had the highest weight percentage of 28.32% in the fused features. The MTD features effectively supplemented traditional feature quantification by addressing the issue of indistinct classification differentiation. It improved the quantification of topological properties and provided more detailed features for diagnosing cognitive disorders.
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Affiliation(s)
- Rupu Zhang
- School of Computer Science and Artificial Intelligence, Changzhou University, Changzhou 213164, China
| | - Xidong Fu
- School of Computer Science and Artificial Intelligence, Changzhou University, Changzhou 213164, China
| | - Chaofan Song
- School of Computer Science and Artificial Intelligence, Changzhou University, Changzhou 213164, China
| | - Haifeng Shi
- Department of Radiology, The Affiliated Changzhou No.2 People’s Hospital of Nanjing Medical University, Changzhou 213003, China
| | - Zhuqing Jiao
- School of Computer Science and Artificial Intelligence, Changzhou University, Changzhou 213164, China
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13
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Knowles SR, Apputhurai P, Jenkins Z, O'flaherty E, Ierino F, Langham R, Ski CF, Thompson DR, Castle DJ. Impact of chronic kidney disease on illness perceptions, coping, self-efficacy, psychological distress and quality of life. PSYCHOL HEALTH MED 2023; 28:1963-1976. [PMID: 36794381 DOI: 10.1080/13548506.2023.2179644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 02/07/2023] [Indexed: 02/17/2023]
Abstract
Chronic kidney disease (CKD) negatively impacts psychological well-being and quality of life (QoL). Underpinned by the Common Sense Model (CSM), this study evaluated the potential mediating role of self-efficacy, coping styles and psychological distress on the relationship between illness perceptions and QoL in patients living with CKD. Participants were 147 people with stage 3-5 kidney disease. Measures included eGFR, illness perceptions, coping styles, psychological distress, self-efficacy and QoL. Correlational analyses were performed, followed by regression modelling. Poorer QoL was associated with greater distress, engagement in maladaptive coping, poorer illness perceptions and lower self-efficacy. Regression analysis revealed that illness perceptions predicted QoL, with psychological distress acting as a mediator. The proportion of variance explained was 63.8%. These findings suggest that psychological interventions are likely to enhance QoL in CKD, if they target the mediating psychological processes associated with illness perceptions and psychological distress.
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Affiliation(s)
- Simon R Knowles
- School of Health Sciences, Swinburne University, Melbourne, Australia
| | | | - Zoe Jenkins
- Mental Health Services, St. Vincent's Hospital, Melbourne, Australia
| | - Emmet O'flaherty
- Nephrology Service, St. Vincent's Hospital, Melbourne, Australia
| | - Francesco Ierino
- Nephrology Service, St. Vincent's Hospital, Melbourne, Australia
| | - Robyn Langham
- St. Vincent's Hospital, University of Melbourne Department of Medicine, Melbourne, Australia
| | - Chantal F Ski
- Department of Psychiatry, The University of Melbourne, Melbourne, Australia
- Integrated Care Academy, University of Suffolk, Ipswich, UK
| | - David R Thompson
- Department of Psychiatry, The University of Melbourne, Melbourne, Australia
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - David J Castle
- Mental Health Services, St. Vincent's Hospital, Melbourne, Australia
- Centre for Complex Interventions, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
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14
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Bazazzadeh S, Sharbafchi MR, Naeini MK, Hosseini SM, Atapour A, Mortazavi M. Evaluation of factors related to depression in peritoneal dialysis patients: a multicenter cross-sectional study. RENAL REPLACEMENT THERAPY 2023. [DOI: 10.1186/s41100-023-00468-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
Abstract
Background
End-stage renal disease (ESRD) is serious global public health challenge in many developing countries. Treatment of ESRD is carried out through renal replacement therapy like peritoneal dialysis (PD). Depression is the most common mood disorder which has a strong impact on the quality of life in patients with ESRD. Little is known about the prevalence and risk factors of depression in peritoneal dialysis patients.
Method and materials
A multicenter cross-sectional study was conducted on 164 adult ESRD patients undergoing peritoneal dialysis for at least three months who referred to the peritoneal dialysis centers of Al-Zahra, Noor & Ali Asghar hospitals, Isfahan, Iran from May to August 2019. Beck Depression Inventory Second Edition questionnaire was used to measure the symptoms of depression and its severity.
Results
43.5% of patients had some levels of depression. Assessing the association of depression with demographic and PD-related factors showed that there was no significant difference regarding age, BMI, dialysis adequacy and residual kidney function, dialysis frequency, type of dialysis solution used, disease duration, and age at the start of dialysis. Ordinal logistics regression analysis showed significant association between depression severity categories and gender (OR = 0.397, CI: 0.160–0.985, p = 0.046), marital status (OR = 2.983, CI: 1.180–7.541, p = 0.021), having a separate room for dialysis (OR = 2.511, CI: 1.108–5.692, p = 0.027).
Conclusion
As our findings have revealed 43.5% of our participants suffered from mild-to-severe depression, we suggest careful attention and routine evaluation for depression in PD patients, especially women and single patients and those who have low socioeconomic status.
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15
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Ye W, Wang L, Wang Y, Wang C, Zeng J. Depression and anxiety symptoms among patients receiving maintenance hemodialysis: a single center cross-sectional study. BMC Nephrol 2022; 23:417. [PMID: 36585621 PMCID: PMC9804950 DOI: 10.1186/s12882-022-03051-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/21/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND To investigate depression and anxiety and related factors among patients receiving maintenance hemodialysis (MHD). METHODS This cross-sectional study included patients underwent MHD in 3/2022 at Jinshan Hospital affiliated to Fudan University. Depression and anxiety levels of patients were assessed using Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI), respectively. SF-36 was used to assess patients' quality of life. Multiple linear regression analysis was used to determine the variables associated with the scores of BDI/BAI. RESULTS A total of 103 patients were included, 71 cases (68.93%) and 38 cases (36.89%) with depression and anxiety, respectively. The scores of almost all domains of the SF-36 showed a declining trend with increasing depression or anxiety among patients on MHD. Higher Charlson Comorbidity Index (CCI) (β =0.066, 95%CI: 0.016-0.116, P = 0.010), lower educational status (β = - 0.139, 95%CI: - 0.243- -0.036, P = 0.009), and number of oral medications (β =0.177, 95%CI: 0.031-0.324, P = 0.018) were significantly associated with higher BDI scores. Longer dialysis duration (β =0.098, 95%CI: 0.003-0.193, P = 0.044) and number of oral medications (β =4.714, 95%CI: 1.837-7.590, P = 0.002) were significantly associated with higher BAI scores. CONCLUSIONS Depression and anxiety may be likely to occur among patients undergoing MHD and impact their quality of life. Higher CCI, lower educational status and usage of multiple oral medications may be associated with depression, whereas longer dialysis duration and multiple oral medications may be associated with anxiety in MHD patients.
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Affiliation(s)
- Wei Ye
- grid.8547.e0000 0001 0125 2443Department of Nephrology, Jinshan Hospital, Fudan University, Shanghai, 201508 China
| | - Lizhen Wang
- grid.8547.e0000 0001 0125 2443Department of Nephrology, Jinshan Hospital, Fudan University, Shanghai, 201508 China
| | - Yu Wang
- grid.8547.e0000 0001 0125 2443Department of Nephrology, Jinshan Hospital, Fudan University, Shanghai, 201508 China
| | - Chengjun Wang
- grid.8547.e0000 0001 0125 2443Department of Nephrology, Jinshan Hospital, Fudan University, Shanghai, 201508 China
| | - Jingyi Zeng
- grid.415108.90000 0004 1757 9178Department of Nephrology, Fujian Provincial Hospital, Fuzhou, 350001 China
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16
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Shanmukham B, Varman M, Subbarayan S, Sakthivadivel V, Kaliappan A, Gaur A, Jyothi L. Depression in Patients on Hemodialysis: A Dilapidated Facet. Cureus 2022; 14:e29077. [PMID: 36249649 PMCID: PMC9557239 DOI: 10.7759/cureus.29077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction End-stage renal disease (ESRD) has increased in India due to the growing load of non-communicable diseases. The most prevalent psychological issue among these patients has been identified as depression, which may have an impact on treatment success. Around 20% to 90% of hemodialysis patients experience depression. The current study aimed to determine the prevalence of depression among patients undergoing hemodialysis as well as the relationship between this condition and the sociodemographic and clinical parameters of the patients. Methods Basic demographic information and particulars of chronic morbidity, duration, and the number of cycles of hemodialysis per week were noted. The Beck Depression Inventory (BDI) score was administered to screen for depression. Results A total of 92 participants were enrolled in the study; 69 (75%) were males. The mean age of participants was 52 years. Hypertension (100%) was the most common co-morbidity followed by diabetes mellitus (38%). The mean duration of chronic kidney disease was 3.9 years. The majority (68.5%) had hemodialysis twice per week. Forty-one percent (41%) screened positive for borderline clinical depression or more. The mean BDI score was 17.07. The number of hemodialyses per week had a significant relation with depression with an odds ratio of 4.16 and 95% CI of 1.4-12.38. Conclusion Depression is prevalent among patients with chronic kidney disease who are on dialysis. The management of this preventable illness demands a repertoire of measures such as launching a program for the detection and treatment of depression combining psychiatric professionals and social volunteer organizations.
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Affiliation(s)
- Bhaskaran Shanmukham
- General Medicine, Melamruvathur Adhiparasakthi Institute of Medical Sciences and Research, Melmaruvathur, IND
| | - Mahendra Varman
- General Medicine, Melamruvathur Adhiparasakthi Institute of Medical Sciences and Research, Melmaruvathur, IND
| | - Sarojini Subbarayan
- Pediatrics, Sri Muthukumaran Medical College Hospital and Research Institute, Chennai, IND
| | | | | | - Archana Gaur
- Physiology, All India Institute of Medical Sciences - Bibinagar, Hyderabad, IND
| | - Lakshmi Jyothi
- Microbiology, All India Institute of Medical Sciences - Bibinagar, Hyderabad, IND
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17
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Cao C, Zhang D, Liu W. Abnormal topological parameters in the default mode network in patients with impaired cognition undergoing maintenance hemodialysis. Front Neurol 2022; 13:951302. [PMID: 36062001 PMCID: PMC9433780 DOI: 10.3389/fneur.2022.951302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/22/2022] [Indexed: 12/05/2022] Open
Abstract
Objective The role of the default mode network (DMN) in the cognitive impairment experienced by patients with end-stage renal disease (ESRD) undergoing maintenance hemodialysis (MHD) remains unknown. This study tested the hypothesis that the topological architecture of the DMN plays a key role in ESRD-related cognitive impairment. Methods For this study, 43 ERSD patients receiving MHD and 41 healthy control (HC) volunteers matched for gender, age and education underwent resting-state functional magnetic resonance imaging examinations. DMN architecture was depicted by 20 selected DMN subregions. Graph theory approaches were applied to investigate multiple topological parameters within the DMN in resting state at the global, local and edge levels. Results Globally, the MHD group exhibited topological irregularities as indicated by reduced values for the clustering coeffcient (Cp), normalized Cp (γ), world-index (σ), and local effciency (Eloc) compared with the HC group. Locally, the MHD group showed greater nodal betweenness in the left retrosplenial cortex (RC) compared with the HC group. At the edge level, the MHD group exhibited disconnected resting-state functional connections (RSFCs) in the medial temporal lobe (MTL) subsystem including the ventral medial prefrontal cortex (VMPC)–left posterior inferior parietal lobule, VMPC–right parahippocampal cortex (PC), and right RC–left PC RSFCs. Additionally, the VMPC–right PC RSFC was positively correlated with the Digit Span Test score and Eloc, and the right RC–left PC RSFC was positively correlated with the Montreal Cognitive Assessment score and Eloc in the MHD group. Conclusions ESRD patients undergoing MHD showed local inefficiency, abnormal nodal centralities, and hypoconnectivity within the DMN, implying that the functional differentiation and local information transmission efficiency of the DMN are disturbed in ESRD. The disconnected RSFCs in the MTL subsystem likely facilitated topological reconfiguration in the DMN of ESRD patients, leading to impairments of multidomain neurocognition including memory and emotion regulation.
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Affiliation(s)
- Chuanlong Cao
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, China
- Department of Radiology, Affiliated Xinhua Hospital of Dalian University, Dalian, China
| | - Die Zhang
- Department of Radiology, National Clinical Research Center for Infectious Disease, Shenzhen Third People's Hospital, The Second Affiliated Hospital, School of Medicine Southern University of Science and Technology, Shenzhen, China
| | - Wanqing Liu
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
- *Correspondence: Wanqing Liu
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18
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KEMEÇ Z, ASLAN S. The effect of COVID-19 fear on hygiene behaviors in hemodialysis patients during the COVID-19 pandemic. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1130930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aim: Current study aims to specify the fear levels and hygiene habits of hemodialysis (HD) patients infected or not infected with coronavirus disease 2019 (COVID-19) in the course of the COVID-19 pandemic.
Material and Method: This study was performed between 15-30 April 2021 as a case-control study whose population consisted of 124 dialysis patients treated in the dialysis unit of Batman Education and Research Hospital. In the dialysis unit, while 25 HD patients who were not present with COVID-19 were included in the control group, 25 dialysis patients were diagnosed with COVID-19 and agreed to participate in the study were included in the case group. “Patient Descriptive Form”, “COVID-19 Hygiene Scale (CHS)” and “COVID-19 Fear Scale (CFS)” were used to collect the study data.
Results: While the mean score of the Changing Hygiene Behaviors sub-dimension of the HD patients in the case group was 23.72±4.90; the mean score of the same sub-dimension belonging to the HD patients in the control group was determined as 22.40±5.25, and there was no statistically meaningful difference between the two groups. The mean CFS score of the HD patients in the case group was 13.60±7.92; while the mean CFS score of the HD patients in the control group was found to be 17.72±7.43. No statistically meaningful difference was observed between the two groups.
Conclusion: The mean CFS and CHS scores of the HD patients in the control group were higher, but no statistically meaningful difference was observed between the two groups.
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Affiliation(s)
- Zeki KEMEÇ
- Batman Education and Research Hospital Nephrology Clinic
| | - Sinan ASLAN
- Batman University Faculty of Health Science Nursing Department
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19
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YAVUZ D, DOĞRU BALAKBABALAR AP, DEMİRAG MD, SEZER S. COVID-19 pandemic: depression and sleep quality in hemodialysis patients. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1054899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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20
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Walker RC, Hay S, Walker C, Tipene-Leach D, Palmer SC. Exploring rural and remote patients' experiences of health services for kidney disease in Aotearoa New Zealand: An in-depth interview study. Nephrology (Carlton) 2022; 27:421-429. [PMID: 34985814 DOI: 10.1111/nep.14018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 12/16/2021] [Accepted: 12/28/2021] [Indexed: 11/30/2022]
Abstract
AIMS People with chronic kidney disease (CKD) living in rural communities have increased risks of death, morbidity, hospitalization and poorer quality of life compared with people with CKD living in urban areas. This study explores the experiences and perceptions of rural and remote patients and families in relation to accessing health services for kidney disease in Aotearoa New Zealand. METHODS We conducted an In-depth interview study. We purposively sampled adult patients with CKD and their caregivers who lived further than 100 km (62 miles) or more than 1 h drive from their nearest dialysis or transplant centre. Qualitative data were analyzed inductively to generate themes, subthemes and a conceptual framework. RESULTS Of 35 participants, including 26 patients and nine caregivers, 51% were female, 71% travelled between 1 and 3 h to their nearest renal unit, and the remainder, between 3 and 6 h. We identified five themes and related subthemes: intense psychological impact of rurality; pressure of extended periods away from home; services not designed for rural and remote living; suffering from financial losses; and poor communication. CONCLUSION Rural and remote patients with CKD and their caregivers face the added challenges of separation from family, social and community support and financial burden, which can have profound consequences on their psychological and physical well-being and that of their families.
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Affiliation(s)
- Rachael C Walker
- Research Innovation Centre, Eastern Institute of Technology, Hawke's Bay, New Zealand
| | - Sandra Hay
- Department of Nephrology, Canterbury District Health Board, Christchurch, New Zealand
| | - Curtis Walker
- Department of Medicine, Midcentral District Health Board, Palmerston North, New Zealand
| | - David Tipene-Leach
- Research Innovation Centre, Eastern Institute of Technology, Hawke's Bay, New Zealand
| | - Suetonia C Palmer
- Department of Nephrology, Canterbury District Health Board, Christchurch, New Zealand.,Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
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21
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Elander J, Kapadi R, Coyne E, Taal MW, Selby NM, Stalker C, Mitchell K. Using patient feedback to adapt intervention materials based on acceptance and commitment therapy for people receiving renal dialysis. BMC Urol 2021; 21:157. [PMID: 34775953 PMCID: PMC8591942 DOI: 10.1186/s12894-021-00921-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 11/01/2021] [Indexed: 11/21/2022] Open
Abstract
Background Theory-based intervention materials must be carefully adapted to meet the needs of users with specific physical conditions. Acceptance and Commitment Therapy (ACT) has been adapted successfully for cancer, chronic pain, diabetes, irritable bowel syndrome, multiple sclerosis, and a range of other conditions, but not so far for people receiving renal haemodialysis. This paper presents findings from a study to adapt ACT-based intervention materials specifically for renal dialysis. Methods Draft written materials consisting of four stories depicting fictitious individuals who used ACT-related techniques to help overcome different challenges and difficulties related to dialysis were adapted using a systematic patient consultation process. The participants were 18 people aged 19–80 years, with chronic kidney disease and receiving renal dialysis. Individual, semi-structured interviews were conducted to elicit participants’ views about how the content of the draft materials should be adapted to make them more realistic and relevant for people receiving renal dialysis and about how the materials should be presented and delivered to people receiving renal dialysis. The interview transcripts were analysed using a qualitative adaptation of the Delphi method in which themes are used as a framework for translating feedback into proposals for modifications. Results The analysis of patient feedback supported the use of patient stories but suggested they should be presented by video and narrated by real dialysis patients. They also indicated specific adaptations to make the stories more credible and realistic. Participant feedback was translated into proposals for change that were considered along with clinical, ethical and theoretical factors. The outcome was a design for a video-based intervention that separated the stories about individuals from the explanations of the specific ACT techniques and provided greater structure, with material organised into smaller chunks. This intervention is adapted specifically for people receiving renal dialysis while retaining the distinctive theoretical principles of ACT. Conclusions The study shows the value of consulting patients in the development of intervention materials and illustrates a process for integrating patient feedback with theoretical, clinical and practical considerations in intervention design. Supplementary Information The online version contains supplementary material available at 10.1186/s12894-021-00921-5.
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Affiliation(s)
- James Elander
- School of Psychology, University of Derby, Derby, UK.
| | | | - Emma Coyne
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Maarten W Taal
- Centre for Kidney Research and Innovation, University of Nottingham, Derby, UK
| | - Nicholas M Selby
- Centre for Kidney Research and Innovation, University of Nottingham, Derby, UK
| | - Carol Stalker
- School of Psychology, University of Derby, Derby, UK
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22
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Aghakhani N, Baghaei R. Reducing suicidal ideation in hemodialysis patients treated in Urmia, Iran. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2021; 31:296-297. [PMID: 32129230 DOI: 10.4103/1319-2442.279958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Nader Aghakhani
- Patient Safety Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Rahim Baghaei
- Patient Safety Research Center, Urmia University of Medical Sciences, Urmia, Iran
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23
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Ameri N, Nobahar M, Ghorbani R, Bazghalee M, Sotodeh-Asl N, Babamohamadi H. Effect of reminiscence on cognitive impairment and depression in haemodialysis patients. J Ren Care 2021; 47:208-216. [PMID: 33423401 DOI: 10.1111/jorc.12359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 12/02/2020] [Accepted: 12/17/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Cognitive impairment and depression are common problems in haemodialysis patients. AIM The present study was carried out to determine the impact of reminiscence on cognitive impairment and depression in haemodialysis patients. DESIGN This clinical trial (2016) was conducted with a pretest-posttest design on the haemodialysis patients of hospitals in Shahrud, Iran. PARTICIPANTS AND MEASUREMENTS Block random sampling was used to investigate the patients' cognitive status and Beck's Depression Scale were administered among 75 patients divided into intervention (given 12 sessions of Stinson's group reminiscence), control (group discussions), and sham (without any intervention) groups before, immediately and 30 days after the intervention. RESULTS Immediately and 30 days after the intervention, the cognitive score was significantly higher in the reminiscence group than the control (p < 0.001) and sham (p < 0.001) groups. Immediately after the intervention, the depression score was significantly lower in the reminiscence group than the control (p = 0.011) and sham (p < 0.001) groups. Also, immediately and 30 days after the intervention, the depression score was significantly lower in the reminiscence group than the control (p = 0.031) and sham (p < 0.001) groups. CONCLUSIONS The findings showed that reminiscence increased the cognitive health score and improved depression in haemodialysis patients. Therefore, reminiscence protocols can be utilized as an independent routine nursing care measure for improving cognitive status and depression in haemodialysis patients.
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Affiliation(s)
- Neda Ameri
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Monir Nobahar
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
- Department of Nursing, Faculty of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan, Iran
| | - Raheb Ghorbani
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
- Department of Epidemiology and Biostatistics, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Milad Bazghalee
- Department of Nursing, Faculty of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Nemath Sotodeh-Asl
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran
- Department of Nursing, Faculty of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan, Iran
| | - Hassan Babamohamadi
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran
- Department of Nursing, Faculty of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan, Iran
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24
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Virani A, Shah RP, Haneef G, Khan AT, Dias CC, Pereira KN, Gupta S, Sharma P. Depression Impairs Level of Functioning in Chronic Kidney Disease Inpatients: A Case-Control Study. Cureus 2021; 13:e16017. [PMID: 34336507 PMCID: PMC8320405 DOI: 10.7759/cureus.16017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 01/23/2023] Open
Abstract
Objectives To evaluate the difference in demographics and clinical correlates during hospitalization for chronic kidney disease (CKD) between patients with depression and those without depression, and its impact on the severity of illness and in-hospital mortality. Methods We conducted a case-control study and included 2,296 adult inpatients (age ≥18 years) with a primary discharge diagnosis of CKD using the nationwide inpatient sample (NIS). We used propensity score matching to extract the cases i.e., CKD inpatients with depression (N = 1,264) and the controls i.e. CKD inpatients without depression (N = 1,032). The matching was done based on demographic characteristics of age at admission, sex, race, and median household income. Our outcomes of interest are the severity of illness and all-cause in-hospital mortality. All patient refined drg (APR-DRG) are allocated using health information systems software by the NIS and the severity of illness within each base APR-DRG was classified into minor, moderate, or major loss of body functions. Binomial logistic regression analysis was conducted to find the odds ratio (OR) of association for major loss of function in CKD inpatients with depression, and this model was adjusted for potential confounders of congestive heart failure (CHF), coronary artery disease (CAD), diabetes, hypertension, obesity, and tobacco abuse, and utilization of hemodialysis. Results A higher proportion of CKD inpatients with depression had a statistically significant higher prevalence of major loss of function (49.8% vs. 40.3% in non-depressed). There was a statistically significant difference with higher utilization of hemodialysis in CKD inpatients with depression (76.2% vs. 70.7% in non-depressed). The all-cause in-hospital mortality rate was lower in CKD inpatients with depression (2.1% vs. 3.5% in non-depressed). After controlling the logistic regression model for potential comorbidities and utilization of hemodialysis, depression was associated with increased odds (OR 1.46; 95% CI 1.227 - 1.734) for major loss of function versus in non-depressed CKD inpatients Conclusion Comorbid depression increases the likelihood of major loss of functioning in CKD inpatients by 46%. Treating depression can allow patients to better cope emotionally and physically with CKD and other comorbidities and significantly improve the patient's quality of life (QoL) and health outcome.
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Affiliation(s)
- Anuj Virani
- Family Medicine, Windsor University School of Medicine, Cayon, KNA
| | - Rushi P Shah
- Medicine, Byramjee Jeejeebhoy Medical College, Ahmedabad, Rajkot, IND
| | - Goher Haneef
- Internal Medicine, University of Health Sciences, Lahore, PAK
- Emergency Medicine, University of Cincinnati Medical Center, Cincinnati, USA
| | - Asma T Khan
- Internal Medicine, Larkin Community Hospital, South Miami, USA
| | - Caroline C Dias
- Psychiatry, Yenepoya Medical College and Hospital, Toronto, CAN
| | | | - Siddharth Gupta
- Internal Medicine, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, IND
| | - Prerna Sharma
- Psychiatry, Government Medical College, Amritsar, IND
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Salazar-Robles E, Lerma A, Calderón-Juárez M, Ibarra A, Pérez-Grovas H, Bermúdez-Aceves LA, Bosques-Brugada LE, Lerma C. Assessment of Factors Related to Diminished Appetite in Hemodialysis Patients with a New Adapted and Validated Questionnaire. Nutrients 2021; 13:nu13041371. [PMID: 33921875 PMCID: PMC8073866 DOI: 10.3390/nu13041371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/13/2021] [Accepted: 04/16/2021] [Indexed: 11/28/2022] Open
Abstract
Appetite loss is a common phenomenon in end-stage renal disease (ESRD) patients undergoing maintenance hemodialysis (HD). We aimed to (i) adapt and validate a Spanish language version of the Council on Nutrition Appetite Questionnaire (CNAQ) and (ii) to identify psychological and biological factors associated with diminished appetite. We recruited 242 patients undergoing HD from four hemodialysis centers to validate the Spanish-translated version of the CNAQ. In another set of 182 patients from three HD centers, the Appetite and Diet Assessment Tool (ADAT) was used as the gold standard to identify a cut-off value for diminished appetite in our adapted questionnaire. The Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Distorted Thoughts Scale (DTS), Dialysis Malnutrition Score (DMS), anthropometric, values and laboratory values were also measured. Seven items were preserved in the adapted appetite questionnaire, with two factors associated with flavor and gastric fullness (Cronbach’s alpha = 0.758). Diminished appetite was identified with a cut-off value ≤25 points (sensitivity 73%, specificity 77%). Patients with diminished appetite had a higher proportion of females and DMS punctuation, lower plasmatic level of creatinine, blood urea nitrogen, and phosphorus. Appetite score correlated with BDI score, BAI score and DTS. Conclusions: This simple but robust appetite score adequately discriminates against patients with diminished appetite. Screening and treatment of psychological conditions may be useful to increase appetite and the nutritional status of these patients.
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Affiliation(s)
- Elihud Salazar-Robles
- Centro Universitario de la Costa, Universidad de Guadalajara, Puerto Vallarta 66376, Mexico;
| | - Abel Lerma
- Instituto de Ciencias de la Salud, Universidad Autónoma del Estado de Hidalgo, Pachuca 42160, Mexico; (A.L.); (L.E.B.-B.)
| | - Martín Calderón-Juárez
- Plan de Estudios Combinados en Medicina (PECEM), Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico;
| | | | - Héctor Pérez-Grovas
- Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico;
| | | | - Lilian E. Bosques-Brugada
- Instituto de Ciencias de la Salud, Universidad Autónoma del Estado de Hidalgo, Pachuca 42160, Mexico; (A.L.); (L.E.B.-B.)
| | - Claudia Lerma
- Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico;
- Correspondence: ; Tel.: +52-(55)-5573-2911 (ext. 26202)
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Effect of Cool Dialysate on Depression in Patients with Chronic Renal Failure Treated with Hemodialysis: A Randomized Clinical Trial. Nephrourol Mon 2021. [DOI: 10.5812/numonthly.112174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Depression is one of the most common psychiatric problems in hemodialysis patients. Objectives: This study aimed to evaluate the effect of cool dialysate on depression in patients with chronic renal failure treated with hemodialysis. Methods: This randomized clinical trial was performed on 66 hemodialysis patients suffering from depression. Patients were selected by a convenience sampling method and divided equally into intervention and control groups randomly by permuted block allocation, each group containing 33 patients. Data were acquired with the Beck Depression inventory-I. The intervention and control groups underwent one month of treatment with cool dialysate at 35.5 and 37°C, respectively. The severity of depression for each group was measured at the end of each treatment stage and two weeks after the intervention. Data were analyzed using R version 25 software with a confidence level of 95%. Results: There was no statistically significant difference between the control and intervention groups before and after the intervention (P-values more than 0.05). While the mean of depression severity for the control group decreased from 26.15 ± 1.46 to 22.24 ± 2.00 (P-values < 0.01), the mean of depression severity for the intervention group decreased from 25.56 ± 1.28 to 22.41 ± 1.65 by the intervention (P-value > 0.05). Conclusions: The application of cool dialysate as a non-pharmacological method did not significantly reduce the severity of depression in patients undergoing hemodialysis. Therefore, it is advised to perform further studies that include more research units from different geographical locations, considering a longer intervening duration.
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El Hechi M, Kongkaewpaisan N, Naar L, Aicher B, Diaz J, O'Meara L, Decker C, Rodriquez J, Schroeppel T, Rattan R, Vasileiou G, Yeh DD, Simonoski U, Turay D, Cullinane D, Emmert C, McCrum M, Wall N, Badach J, Goldenberg-Sandau A, Carmichael H, Velopulos C, Choron R, Sakran J, Bekdache K, Black G, Shoultz T, Chadnick Z, Sim V, Madbak F, Steadman D, Camazine M, Zielinski M, Hardman C, Walusimbi M, Kim M, Rodier S, Papadopoulos V, Tsoulfas G, Perez J, Kaafarani HMA. The Emergency Surgery Score accurately predicts the need for postdischarge respiratory and renal support after emergent laparotomies: A prospective EAST multicenter study. J Trauma Acute Care Surg 2021; 90:557-564. [PMID: 33507026 DOI: 10.1097/ta.0000000000003016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The Emergency Surgery Score (ESS) was recently validated as an accurate mortality risk calculator for emergency general surgery. We sought to prospectively evaluate whether ESS can predict the need for respiratory and/or renal support (RRS) at discharge after emergent laparotomies (EL). METHODS This is a post hoc analysis of a 19-center prospective observational study. Between April 2018 and June 2019, all adult patients undergoing EL were enrolled. Preoperative, intraoperative, and postoperative variables were systematically collected. In this analysis, patients were excluded if they died during the index hospitalization, were discharged to hospice, or transferred to other hospitals. A composite variable, the need for RRS, was defined as the need for one or more of the following at hospital discharge: tracheostomy, ventilator dependence, or dialysis. Emergency Surgery Score was calculated for all patients, and the correlation between ESS and RRS was examined using the c-statistics method. RESULTS From a total of 1,649 patients, 1,347 were included. Median age was 60 years, 49.4% were men, and 70.9% were White. The most common diagnoses were hollow viscus organ perforation (28.1%) and small bowel obstruction (24.5%); 87 patients (6.5%) had a need for RRS (4.7% tracheostomy, 2.7% dialysis, and 1.3% ventilator dependence). Emergency Surgery Score predicted the need for RRS in a stepwise fashion; for example, 0.7%, 26.2%, and 85.7% of patients required RRS at an ESS of 2, 12, and 16, respectively. The c-statistics for the need for RRS, the need for tracheostomy, ventilator dependence, or dialysis at discharge were 0.84, 0.82, 0.79, and 0.88, respectively. CONCLUSION Emergency Surgery Score accurately predicts the need for RRS at discharge in EL patients and could be used for preoperative patient counseling and for quality of care benchmarking. LEVEL OF EVIDENCE Prognostic and epidemiological, level III.
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Affiliation(s)
- Majed El Hechi
- From the Division of Trauma, Emergency Surgery & Surgical Critical Care (M.E.H., N.K., L.N., H.M.A.K.), Massachusetts General Hospital, Boston, Massachusetts; Division of Acute Care and Ambulatory Surgery (N.K.), Siriraj Hospital, Mahidol University, Bangkok, Thailand; R Adams Cowley Shock Trauma Center (B.A., J.D., L.O.), University of Maryland Medical Center, Baltimore, Maryland; Department of Surgery, UCHealth Memorial Hospital Central Trauma Center (C.D., J.R., T.S.), Colorado Springs, Colorado; The Dewitt Daughtry Family Department of Surgery Ryder Trauma Center/Jackson Memorial Hospital (R.R., G.V., D.D.Y.), Miami, Florida; Department of Surgery, Loma Linda University Medical Center (U.S., D.T.), Department of Surgery, Loma Linda, California; Marshfield Clinic (D.C., C.E.), Marshfield, Wisconsin; University of Utah (M.C., N.W.), Salt Lake City, Utah; Department of Surgery, Cooper University Hospital (J.B., A.G.-S.), Camden, New Jersey; Department of Surgery, University of Colorado Anschutz Medical Campus (H.C., C.V.), Aurora, Colorado; Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine (R.C., J.S.), Baltimore, Maryland; Department of Surgery, Eastern Maine Medical Center (K.B.), Bangor, Maine; Department of Surgery, University of Texas Southwestern Medical Center and Parkland Hospital (G.B., T.S.), Dallas, Texas; Department of Surgery, Staten Island University Hospital, Northwell Health (Z.C., V.S.), Staten Island, New York; Department of Surgery, University of Florida College of Medicine-Jacksonville (F.M., D.S.), Jacksonville, Florida; Mayo Clinic (M.C., M.Z.), Rochester, Minnesota; Miami Valley Hospital (C.H., M.W.), Dayton, Ohio; New York University School of Medicine (M.K., S.R.), New York, New York; Department of Surgery, Papageorgiou General Hospital/Aristotle University School of Medicine (V.P., G.T.), Greece; and Department of Surgery, Hackensack University Medical Center (J.P.), Hackensack, New Jersey
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The Role of Psychosocial Factors in Depression and Mortality Among Urban Hemodialysis Patients. Kidney Int Rep 2021; 6:1437-1443. [PMID: 34013122 PMCID: PMC8116760 DOI: 10.1016/j.ekir.2021.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/31/2021] [Accepted: 02/01/2021] [Indexed: 11/22/2022] Open
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Endreddy A, Chennareddy L, Shaik S. Assessment of quality of life and psychiatric morbidity in patients undergoing hemodialysis at a tertiary care center. ARCHIVES OF MENTAL HEALTH 2021. [DOI: 10.4103/amh.amh_60_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Influence of unstable psychological condition on the quality of life of hemodialysis patients. RENAL REPLACEMENT THERAPY 2020. [DOI: 10.1186/s41100-020-00271-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Purpose
Hemodialysis patients tend to be in “unstable psychological conditions” because of complications and physical activity restriction. This study aimed to investigate unusual psychological factors and their influence on the quality of life (QOL) of hemodialysis patients.
Methods
This study targeted 55 patients who had experienced > 1 year of stable maintenance outpatient hemodialysis. The Hospital Anxiety and Depression Scale (HADS) was used to evaluate unusual psychological conditions. The Kidney Disease Quality of Life Short Form (KDQOL-SF) was used to evaluate QOL. Participants were grouped into “unstable psychological conditions” if HADS indicated that “depression is suspected” or “suspected depression, anxiety stated” (“Anxiety/Depression group”); this group was then compared to the “Stable group”.
Results
A total of 18 participants (32.7%) were included in the “Anxiety/Depression group”, and all QOL scores in this group were lower than those in the “Stable group”. In particular, a significantly low value was shown in the respective criteria such as “effects of kidney disease,” “social support,” and “general health perceptions”.
Conclusions
A possibility was suggested that the major causes were the restrictions of social activity by hospital visits and treatment and unique psychological conditions.
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Ma S, Zhang M, Liu Y, Ding D, Li P, Ma X, Liu H, Mu J. Abnormal rich club organization in end-stage renal disease patients before dialysis initiation and undergoing maintenance hemodialysis. BMC Nephrol 2020; 21:515. [PMID: 33243163 PMCID: PMC7689979 DOI: 10.1186/s12882-020-02176-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 11/18/2020] [Indexed: 11/25/2022] Open
Abstract
Background End-stage renal disease (ESRD) patients are at a substantially higher risk for developing cognitive impairment compared with the healthy population. Dialysis is an essential way to maintain the life of ESRD patients. Based on previous research, there isn’t an uncontested result whether cognition was improved or worsened during dialysis. Methods To explore the impact of dialysis treatment on cognitive performance, we recruited healthy controls (HCs), predialysis ESRD patients (predialysis group), and maintenance hemodialysis ESRD patients (HD group). All ESRD patients performed six blood biochemistry tests (hemoglobin, urea, cystatin C, Na+, K+, and parathyroid hormone). Neuropsychological tests were used to measure cognitive function. By using diffusion tensor imaging and graph-theory approaches, the topological organization of the whole-brain structural network was investigated. Generalized linear models (GLMs) were performed to investigate blood biochemistry predictors of the neuropsychological tests and the results of graph analyses in the HD group and predialysis group. Results Neuropsychological analysis showed the HD group exhibited better cognitive function than the predialysis group, but both were worse than HCs. Whole-brain graph analyses revealed that increased global efficiency and normalized shortest path length remained in the predialysis group and HD group than the HCs. Besides, a lower normalized clustering coefficient was found in the predialysis group relative to the HCs and HD group. For the GLM analysis, only the Cystatin C level was significantly associated with the average fiber length of rich club connections in the predialysis group. Conclusions Our study revealed that dialysis had a limited effect on cognitive improvement.
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Affiliation(s)
- Shaohui Ma
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, No. 277, West Yanta Road, Xi'an, 710061, Shaanxi-Province, People's Republic of China
| | - Ming Zhang
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, No. 277, West Yanta Road, Xi'an, 710061, Shaanxi-Province, People's Republic of China
| | - Yang Liu
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, 710126, People's Republic of China.,Engineering Research Center of Molecular & Neuroimaging, Ministry of Education, Xi'an, 710126, People's Republic of China
| | - Dun Ding
- Department of Medical Imaging, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, People's Republic of China
| | - Peng Li
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, No. 277, West Yanta Road, Xi'an, 710061, Shaanxi-Province, People's Republic of China.,Department of Medical Imaging, Shaanxi Nuclear Geology 215 Hospital, Xianyang, People's Republic of China
| | - Xueying Ma
- The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010000, People's Republic of China
| | - Hongjuan Liu
- Department of Medical Imaging, First Affiliated Hospital of Xi'an Jiaotong University, No. 277, West Yanta Road, Xi'an, 710061, Shaanxi-Province, People's Republic of China.
| | - Junya Mu
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, 710126, People's Republic of China. .,Engineering Research Center of Molecular & Neuroimaging, Ministry of Education, Xi'an, 710126, People's Republic of China. .,School of Life Science and Technology, Xidian University, Xi'an, 710071, People's Republic of China.
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Othayq A, Aqeeli A. Prevalence of depression and associated factors among hemodialyzed patients in Jazan area, Saudi Arabia: a cross-sectional study. Ment Illn 2020; 12:1-5. [PMID: 32742625 PMCID: PMC7370954 DOI: 10.1108/mij-02-2020-0004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 02/19/2020] [Accepted: 02/19/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose This study aims to evaluate the prevalence of depression and associated risk factors among patients on hemodialysis in Jazan area, Saudi Arabia. Design/methodology/approach The study was conducted on 211 randomly selected hemodialysis patients in Jazan area, Saudi Arabia, using an observational cross-sectional design. Patients were screened for depressive symptoms using the depression, anxiety and stress scale 42 (DASS-42). Descriptive statistics were used to present sociodemographic data. Multiple logistic regression was implemented to identify the predictors of depression. Data were entered and analyzed using SPSS 22.0 software. Findings The study found the overall prevalence of depression among patients on hemodialysis to be 43.6 per cent. Of them, 12.8 per cent were mildly depressed, 15.6 per cent were moderately depressed and 15.1 per cent fell in the severe or extremely severe category. Depression was significantly associated with marital status, education level and the presence of sleep disturbances. The study indicates a high prevalence of depressive symptoms among patients on hemodialysis in Jazan. A higher rate of depressive symptoms was observed in currently unmarried, lower-educated patients and those with sleep disturbance. Originality/value Periodic evaluation of patients on hemodialysis for depression is needed to allow for early intervention.
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Affiliation(s)
- Asim Othayq
- Department of Health Affairs, Saudi Arabia Ministry of Health, Riyadh, Saudi Arabia
| | - Abdulwahab Aqeeli
- Department of Family and Community Medicine, Jazan University, Jazan, Saudi Arabia
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Patel MP, Kute VB, Prasad N, Agarwal SK, On behalf of COVID-19 Working Group of Indian Society of Nephrology. COVID 19 and Hemodialysis Anxiety. Indian J Nephrol 2020; 30:174-175. [PMID: 33013065 PMCID: PMC7470204 DOI: 10.4103/ijn.ijn_203_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/08/2020] [Indexed: 12/28/2022] Open
Affiliation(s)
- Mohan P. Patel
- Department of Nephrology, Apollo Hospitals, Nashik, Maharashtra, India
| | - Vivek B. Kute
- Department of Nephrology, Institute of Kidney Diseases and Research Centre, Dr. HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, Gujarat, India
| | - Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGI), Lucknow, Uttar Pradesh, India
| | - Sanjay K. Agarwal
- Department of Nephrology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Zhou H, Al-Ali F, Kang GE, Hamad AI, Ibrahim RA, Talal TK, Najafi B. Application of Wearables to Facilitate Virtually Supervised Intradialytic Exercise for Reducing Depression Symptoms. SENSORS 2020; 20:s20061571. [PMID: 32178231 PMCID: PMC7146558 DOI: 10.3390/s20061571] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 11/16/2022]
Abstract
Regular exercise can reduce depression. However, the uptake of exercise is limited in patients with end-stage renal disease undergoing hemodialysis. To address the gap, we designed a gamified non-weight-bearing intradialytic exercise program (exergame). The intradialytic exergame is virtually supervised based on its interactive feedback via wearable sensors attached on lower extremities. We examined the effectiveness of this program to reduce depression symptoms compared to nurse-supervised intradialytic exercise in 73 hemodialysis patients (age = 64.5 ± 8.7years, BMI = 31.6 ± 7.6kg/m2). Participants were randomized into an exergame group (EG) or a supervised exercise group (SG). Both groups received similar exercise tasks for 4 weeks, with three 30 min sessions per week, during hemodialysis treatment. Depression symptoms were assessed at baseline and the fourth week using the Center for Epidemiologic Studies Depression Scale. Both groups showed a significant reduction in depression score (37%, p < 0.001, Cohen's effect size d = 0.69 in EG vs. 41%, p < 0.001, d = 0.65 in SG) with no between-group difference for the observed effect (p > 0.050). The EG expressed a positive intradialytic exercise experience including fun, safety, and helpfulness of sensor feedback. Together, results suggested that the virtually supervised low-intensity intradialytic exergame is feasible during routine hemodialysis treatment. It also appears to be as effective as nurse-supervised intradialytic exercise to reduce depression symptoms, while reducing the burden of administrating exercise on dialysis clinics.
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Affiliation(s)
- He Zhou
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA; (H.Z.); (G.E.K.)
| | - Fadwa Al-Ali
- Fahad Bin Jassim Kidney Center, Department of Nephrology, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050 Doha, Qatar; (F.A.-A.)
| | - Gu Eon Kang
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA; (H.Z.); (G.E.K.)
| | - Abdullah I. Hamad
- Fahad Bin Jassim Kidney Center, Department of Nephrology, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050 Doha, Qatar; (F.A.-A.)
| | - Rania A. Ibrahim
- Fahad Bin Jassim Kidney Center, Department of Nephrology, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050 Doha, Qatar; (F.A.-A.)
| | - Talal K. Talal
- Diabetic Foot and Wound Clinic, Hamad Medical Corporation, PO Box 3050, Doha, Qatar;
| | - Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA; (H.Z.); (G.E.K.)
- Correspondence: or ; Tel.: +1-713-798-7536
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Guirguis A, Chilcot J, Almond M, Davenport A, Wellsted D, Farrington K. Antidepressant Usage in Haemodialysis Patients: Evidence of Sub-Optimal Practice Patterns. J Ren Care 2020; 46:124-132. [PMID: 32052572 DOI: 10.1111/jorc.12320] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Depression is common in patients on haemodialysis and associated with adverse outcomes. Antidepressant use is widespread though evidence of efficacy is limited. OBJECTIVES To study antidepressant management practices in patients on haemodialysis with reference to NICE guidelines on management of depression in adults with chronic physical health problems. DESIGN Prospective, multicentre, longitudinal cohort study with 6-15 month follow-up. PARTICIPANTS Patients on haemodialysis established on antidepressant medication. MEASUREMENTS Baseline assessment of mood was undertaken using Beck Depression Inventory (BDI-II). Demographic, clinical and medication data were also collected. Changes in clinical and life circumstances and medication during follow-up were recorded. At follow-up, BDI-II was reassessed and diagnostic psychiatric assessment undertaken. RESULTS Forty-one patients were studied. General practitioners were the main prescribers (68%). Ten agents were in use, the commonest being Citalopram (39%). Doses were often suboptimal. At baseline, 30 patients had high BDI-II scores (≥16) and 22 remained high at follow-up. Eleven had BDI-II < 16 at baseline. In five, this increased on follow-up to ≥16. Sixteen patients (39%) had no medication review during follow-up, 14 (34%) had a dose review, and 11 (27%) a medication change. On psychiatric assessment at follow-up, eight patients had current major depressive disorder (MDD), seven recurrent and 20 evidence of past MDD. Six displayed no evidence of ever having MDD. CONCLUSIONS Antidepressant management in patients on haemodialysis reflected poor drug selection, overprescription, under-dosing and inadequate follow-up suggesting sub-optimal adherence to NICE guidelines. Most patients had high depression scores at follow-up. Antidepressant use in haemodialysis requires reappraisal.
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Affiliation(s)
- Ayman Guirguis
- Centre for Health Services and Clinical Research, University of Hertfordshire, Hatfield, UK.,John Hampden Unit, Oxford Health NHS Foundation Trust, Psychiatric Liaison Service, Stoke Mandeville Hospital, Aylesbury, UK
| | - Joseph Chilcot
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Michael Almond
- School of Education and Social Care, Anglia Ruskin University, Chelmsford, UK
| | - Andrew Davenport
- UCL Centre for Nephrology, Royal Free Hospital NHS Foundation Trust, London, UK
| | - David Wellsted
- Centre for Health Services and Clinical Research, University of Hertfordshire, Hatfield, UK
| | - Ken Farrington
- Centre for Health Services and Clinical Research, University of Hertfordshire, Hatfield, UK.,Renal Unit, Lister Hospital, East & North Hertfordshire NHS Trust, Stevenage, UK
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Zegarow P, Manczak M, Rysz J, Olszewski R. The influence of cognitive-behavioral therapy on depression in dialysis patients - meta-analysis. Arch Med Sci 2020; 16:1271-1278. [PMID: 33224325 PMCID: PMC7667424 DOI: 10.5114/aoms.2019.88019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 12/31/2018] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Depressive disorders are the most common mental health problem among patients undergoing dialysis. Furthermore, depression is an independent factor increasing the mortality and frequency of hospitalization in this group of patients, yet psychological intervention programs aimed at improving the mental health of dialysis patients have still not been developed. This meta-analysis aimed to assess the effects of cognitive-behavioral therapy on depressive symptoms in dialysis patients. The main hypothesis of this study is that cognitive-behavioral therapy is an effective psychological method of reducing the severity of depression symptoms among patients undergoing dialysis. MATERIAL AND METHODS A systematic search was conducted using Medline, PubMed, Web of Science, Scopus and Google Scholar. Data extraction was carried out by two independent researchers. The severity of depression symptoms in the included studies was measured by the Beck Depression Inventory. A random-effects model was used to estimate the pooled mean difference of these values between patients undergoing CBT and the controls. RESULTS Four of the 1841 search results met the inclusion criteria with data from 226 patients who had undergone dialysis therapy due to renal disorders and psychological intervention based on cognitive-behavioral therapy. This therapy significantly reduced the level of depression symptoms in all studies included in the meta-analysis (mean difference = -5.3, p = 0.001; 95% CI: -7.95 to -2.66). CONCLUSIONS The study showed that the use of psychological intervention based on cognitive- behavioral therapy was an effective method of decreasing the severity of depressive symptoms in hemodialyzed patients. For the sake of patient well-being, it seems reasonable to extend renal replacement therapy with psychological intervention such as cognitive-behavioral therapy.
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Affiliation(s)
- Pawel Zegarow
- Department of Gerontology, Public Health and Didactics, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Malgorzata Manczak
- Department of Gerontology, Public Health and Didactics, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Jacek Rysz
- Department of Nephrology, Hypertension and Family Medicine, University Clinical Hospital Military Memorial Medical Academy – Central Veterans’ Hospital, Lodz, Poland
| | - Robert Olszewski
- Department of Gerontology, Public Health and Didactics, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
- Department of Ultrasound, Institute of Fundamental Technological Research, Polish Academy of Sciences, Warsaw, Poland
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Post A, Huberts M, Poppe E, van Faassen M, P. Kema I, Vogels S, M. Geleijnse J, Westerhuis R, J. R. Ipema K, J. L. Bakker S, F. M. Franssen C. Tryptophan Intake and Tryptophan Losses in Hemodialysis Patients: A Balance Study. Nutrients 2019; 11:nu11122851. [PMID: 31766383 PMCID: PMC6950375 DOI: 10.3390/nu11122851] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 11/12/2019] [Accepted: 11/18/2019] [Indexed: 01/28/2023] Open
Abstract
Tryptophan depletion is common in hemodialysis patients. The cause of this depletion remains largely unknown, but reduced nutritional tryptophan intake, losses during dialysis or an increased catabolism due to an inflammatory state are likely contributors. Currently, little is known about tryptophan homeostasis in hemodialysis patients. We assessed dietary tryptophan intake, measured plasma tryptophan during dialysis, and measured the combined urinary and dialysate excretion of tryptophan in 40 hemodialysis patients (66 ± 15 years and 68% male). Patients had low tryptophan concentrations (27 ± 9 µmol/L) before dialysis. Mean dietary tryptophan intake was 4454 ± 1149 µmol/24 h. Mean urinary tryptophan excretion was 15.0 ± 12.3 μmol/24 h, dialysate excretion was 209 ± 67 μmol/24 h and combined excretion was 219 ± 66 µmol/24 h, indicating only 5% of dietary tryptophan intake was excreted. No associations were found between plasma tryptophan concentration and tryptophan intake, plasma kynurenine/tryptophan ratio or inflammatory markers. During dialysis, mean plasma tryptophan concentration increased 16% to 31 ± 8 µmol/L. Intradialytic increase in plasma tryptophan was associated with a lower risk of mortality, independent of age, sex and dialysis vintage (HR: 0.87 [0.76–0.99]; P = 0.04). Tryptophan intake was well above the dietary recommendations and, although tryptophan was removed during dialysis, mean plasma tryptophan increased during dialysis. The cause of this phenomenon is unknown, but it appears to be protective.
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Affiliation(s)
- Adrian Post
- Department of Nephrology, University Medical Center Groningen; University of Groningen, 9713 GZ Groningen, The Netherlands; (M.H.); (E.P.); (K.J.R.I.); (S.J.L.B.); (C.F.M.F.)
- Correspondence: ; Tel.: +31-649-653-442
| | - Marleen Huberts
- Department of Nephrology, University Medical Center Groningen; University of Groningen, 9713 GZ Groningen, The Netherlands; (M.H.); (E.P.); (K.J.R.I.); (S.J.L.B.); (C.F.M.F.)
| | - Enya Poppe
- Department of Nephrology, University Medical Center Groningen; University of Groningen, 9713 GZ Groningen, The Netherlands; (M.H.); (E.P.); (K.J.R.I.); (S.J.L.B.); (C.F.M.F.)
| | - Martijn van Faassen
- Department of Laboratory Medicine, University Medical Center Groningen; University of Groningen, 9713 GZ Groningen, The Netherlands; (M.v.F.); (I.P.K.)
| | - Ido P. Kema
- Department of Laboratory Medicine, University Medical Center Groningen; University of Groningen, 9713 GZ Groningen, The Netherlands; (M.v.F.); (I.P.K.)
| | - Steffie Vogels
- Dialysis Center Groningen, 9713 GZ Groningen, The Netherlands; (S.V.); (R.W.)
| | - Johanna M. Geleijnse
- Department of Human Nutrition and Health, Wageningen University, 6708 PB Wageningen, The Netherlands;
| | - Ralf Westerhuis
- Dialysis Center Groningen, 9713 GZ Groningen, The Netherlands; (S.V.); (R.W.)
| | - Karin J. R. Ipema
- Department of Nephrology, University Medical Center Groningen; University of Groningen, 9713 GZ Groningen, The Netherlands; (M.H.); (E.P.); (K.J.R.I.); (S.J.L.B.); (C.F.M.F.)
| | - Stephan J. L. Bakker
- Department of Nephrology, University Medical Center Groningen; University of Groningen, 9713 GZ Groningen, The Netherlands; (M.H.); (E.P.); (K.J.R.I.); (S.J.L.B.); (C.F.M.F.)
| | - Casper F. M. Franssen
- Department of Nephrology, University Medical Center Groningen; University of Groningen, 9713 GZ Groningen, The Netherlands; (M.H.); (E.P.); (K.J.R.I.); (S.J.L.B.); (C.F.M.F.)
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Combes G, Damery S, Sein K, Allen K, Nicholas J, Baharani J. Distress in patients with end-stage renal disease: Staff perceptions of barriers to the identification of mild-moderate distress and the provision of emotional support. PLoS One 2019; 14:e0225269. [PMID: 31751382 PMCID: PMC6871782 DOI: 10.1371/journal.pone.0225269] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 10/31/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To explore staff perceptions of barriers to the identification of mild to moderate distress and the provision of emotional support in patients with end-stage renal disease. METHODS Qualitative semi-structured interviews with staff in two hospitals (n = 31), with data analysed using a hybrid approach combining thematic analysis with aspects of grounded theory. RESULTS Staff appeared very aware that many patients with end-stage renal disease experience distress, and most thought distressed patients should be helped as part of routine care. However, practice was variable and looking for and addressing distress was not embedded in care pathways. Interviews identified six themes: i) staff perceptions about how distress is manifested and what causes distress were variable; ii) staff perceptions of patients could lead to distress being overlooked because patients were thought to hide their distress whilst some groups were assumed to be more prone to distress than others; iii) role perceptions varied, with many staff believing it to be their role but not feeling comfortable with it, with doctors being particularly ambivalent; iv) fears held back some staff, who were concerned about what might happen when talking about distress, or who found the emotional load for themselves to be too high; v) staff felt they lacked skills, confidence and training, vi) capacity to respond may be limited, as staff perceive there to be insufficient time, with little or no specialist support services to refer patients to. CONCLUSIONS Staff perceived significant barriers in identifying and responding to patient distress. Barriers related to skills and knowledge could be addressed through training, with training ideally targeted at staff with positive attitudes, but who currently lack skills and confidence. Barriers related to role perceptions would be harder to address. The study is relevant internationally as part of improving long-term condition pathways.
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Affiliation(s)
- Gill Combes
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Sarah Damery
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Kim Sein
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Kerry Allen
- Health Services Management Centre, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Johann Nicholas
- New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - Jyoti Baharani
- Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Trust, Birmingham, United Kingdom
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Kimmel PL, Fwu CW, Abbott KC, Moxey-Mims MM, Mendley S, Norton JM, Eggers PW. Psychiatric Illness and Mortality in Hospitalized ESKD Dialysis Patients. Clin J Am Soc Nephrol 2019; 14:1363-1371. [PMID: 31439538 PMCID: PMC6730507 DOI: 10.2215/cjn.14191218] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 06/24/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Limited existing data on psychiatric illness in ESKD patients suggest these diseases are common and burdensome, but under-recognized in clinical practice. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We examined hospitalizations with psychiatric diagnoses using inpatient claims from the first year of ESKD in adult and pediatric Medicare recipients who initiated treatment from 1996 to 2013. We assessed associations between hospitalizations with psychiatric diagnoses and all-cause death after discharge in adult dialysis patients using multivariable-adjusted Cox proportional hazards regression models. RESULTS In the first ESKD year, 72% of elderly adults, 66% of adults and 64% of children had at least one hospitalization. Approximately 2% of adults and 1% of children were hospitalized with a primary psychiatric diagnosis. The most common primary psychiatric diagnoses were depression/affective disorder in adults and children, and organic disorders/dementias in elderly adults. Prevalence of hospitalizations with psychiatric diagnoses increased over time across groups, primarily from secondary diagnoses. 19% of elderly adults, 25% of adults and 15% of children were hospitalized with a secondary psychiatric diagnosis. Hazards ratios of all-cause death were higher in all dialysis adults hospitalized with either primary (1.29; 1.26 to 1.32) or secondary (1.11; 1.10 to 1.12) psychiatric diagnoses than in those hospitalized without psychiatric diagnoses. CONCLUSIONS Hospitalizations with psychiatric diagnoses are common in pediatric and adult ESKD patients, and are associated with subsequent higher mortality, compared with hospitalizations without psychiatric diagnoses. The prevalence of hospitalizations with psychiatric diagnoses likely underestimates the burden of mental illness in the population.
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Affiliation(s)
- Paul L. Kimmel
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Chyng-Wen Fwu
- Department of Public Health Sciences, Social & Scientific Systems, Inc., Silver Spring, Maryland; and
| | - Kevin C. Abbott
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | | | - Susan Mendley
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Jenna M. Norton
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Paul W. Eggers
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
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Dimensions of Depressive Symptoms and Their Association With Mortality, Hospitalization, and Quality of Life in Dialysis Patients: A Cohort Study. Psychosom Med 2019; 81:649-658. [PMID: 31232914 PMCID: PMC6727937 DOI: 10.1097/psy.0000000000000723] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE Unraveling specific dimensions of depressive symptoms may help to improve screening and treatment in dialysis patients. We aimed to identify the best-fitting factorial structure for the Beck Depression Inventory-II (BDI) in dialysis patients and to assess the relation of these structure dimensions with quality of life (QoL), hospitalization, and mortality. METHODS This prospective study included chronic dialysis patients from 10 dialysis centers in five hospitals between 2012 and 2017. Dimensions of depressive symptoms within the BDI were analyzed using confirmatory factor analysis. To investigate the clinical impact of these dimensions, the associations between symptom dimensions and QoL, hospitalization rate, and mortality were investigated using logistic, Poisson, and Cox proportional hazard regression models. Multivariable regression models included demographic, social, and clinical variables. RESULTS In total, 687 dialysis patients were included. The factor model that included a general and a somatic factor provided the best-fitting structure of the BDI-II. Only the somatic dimension scores were associated with all-cause mortality (hazard ratio of 1.7 [1.2-2.5], p < .007) in the multivariable model. All dimensions were associated with increased hospitalization rate and reduced QoL. CONCLUSIONS The somatic dimension of the BDI-II in dialysis patients was associated with all-cause mortality, increased hospitalization rate, and reduced QoL. Other dimensions were associated with hospitalization rate and decreased QoL. These findings show that symptom dimensions of depression have differential association with adverse clinical outcomes. Future studies should take symptom dimensions into account when investigating depression-related pathways, screening, and treatment effects in dialysis patients.
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The Effects of Peer Support on Depression, Anxiety, and Stress Among Patients Receiving Hemodialysis. IRANIAN RED CRESCENT MEDICAL JOURNAL 2019. [DOI: 10.5812/ircmj.66321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Anxiety-Depression of Dialysis Patients and Their Caregivers. ACTA ACUST UNITED AC 2019; 55:medicina55050168. [PMID: 31137563 PMCID: PMC6572629 DOI: 10.3390/medicina55050168] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 04/03/2019] [Accepted: 05/13/2019] [Indexed: 01/11/2023]
Abstract
Background and Objectives: Anxiety–depression of patients undergoing hemodialysis has a strong relation with the levels of anxiety–depression of their caregivers. The aim of this study was to evaluate anxiety–depression of dialysis patients and their caregivers. Materials and Methods: In this cross-sectional study, 414 pairs of patients and caregivers from 24 hemodialysis centers of Greece completed the Hospital Anxiety and Depression Scale (HADS). The statistical analysis of the data was performed through the Statistical Program SPSS version 20.0. The statistical significance level was set up at 5%. Results: The mean age of patients was 64 (54.06–72.41) years old and the mean duration of hemodialysis was 36 (16–72) months. The mean age of caregivers was 54 (44–66) years old. Of the total sample, 17.1% (n = 71) of patients had high levels of anxiety and 12.3% (n = 51) had high levels of depression. Additionally, 27.8% (n = 115) of caregivers had high levels of anxiety and 11.4% (n = 47) had high levels of depression. Caregivers had higher levels of anxiety when their patients had high levels of anxiety as well (42.3%). Additionally, they had higher levels of depression when their patients had high levels of depression as well (17.6%). Conclusions: The results of this study showed a significant association between the levels of anxiety and depression among patients and caregivers. There is a necessity for individualized assessment of dialysis patients and their caregivers and the implementation of specific interventions for reducing the levels of anxiety and depression among them.
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Damery S, Brown C, Sein K, Nicholas J, Baharani J, Combes G. The prevalence of mild-to-moderate distress in patients with end-stage renal disease: results from a patient survey using the emotion thermometers in four hospital Trusts in the West Midlands, UK. BMJ Open 2019; 9:e027982. [PMID: 31097489 PMCID: PMC6530384 DOI: 10.1136/bmjopen-2018-027982] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To assess the prevalence of mild-to-moderate distress in patients with end-stage renal disease (ESRD) and determine the association between distress and patient characteristics. DESIGN Cross-sectional survey using emotion thermometer and distress thermometer problem list. SETTING Renal units in four hospital Trusts in the West Midlands, UK. PARTICIPANTS Adult patients with stage 5 chronic kidney disease who were: (1) On prerenal replacement therapy. (2) On dialysis for less than 2 years. (3) On dialysis for 2 years or more (4) With a functioning transplant. OUTCOMES The prevalence of mild-to-moderate distress, and the incidence of distress thermometer problems and patient support needs. RESULTS In total, 1040/3730 surveys were returned (27.9%). A third of survey respondents met the criteria for mild-to-moderate distress (n=346; 33.3%). Prevalence was highest in patients on dialysis for 2 years or more (n=109/300; 36.3%) and lowest in transplant patients (n=118/404; 29.2%). Prevalence was significantly higher in younger versus older patients (χ2=14.33; p=0.0008), in women versus men (χ2=6.63; p=0.01) and in black and minority ethnic patients versus patients of white ethnicity (χ2=10.36; p=0.013). Over 40% of patients (n=141) reported needing support. More than 95% of patients reported physical problems and 91.9% reported at least one emotional problem. CONCLUSIONS Mild-to-moderate distress is common in patients with ESRD, and there may be substantial unmet support needs. Regular screening could help identify patients whose distress may otherwise remain undetected. Further research into differences in distress prevalence over time and at specific transitional points across the renal disease pathway is needed, as is work to determine how best to support patients requiring help.
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Affiliation(s)
- Sarah Damery
- Institute of Applied Health Research, University of Birmingham, Edgbaston, UK
| | - Celia Brown
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Kim Sein
- Institute of Applied Health Research, University of Birmingham, Edgbaston, UK
| | - Johann Nicholas
- Renal Unit, Shrewsbury and Telford NHS Trust, Shrewsbury, UK
| | - Jyoti Baharani
- Renal Unit, Birmingham Heartlands Hospital, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Gill Combes
- Institute of Applied Health Research, University of Birmingham, Edgbaston, UK
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Khan A, Khan AH, Adnan AS, Sulaiman SAS, Mushtaq S. Prevalence and predictors of depression among hemodialysis patients: a prospective follow-up study. BMC Public Health 2019; 19:531. [PMID: 31072378 PMCID: PMC6507067 DOI: 10.1186/s12889-019-6796-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 04/10/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Even though depression is one of the most common psychiatric disorders, it is under-recognized in hemodialysis (HD) patients. Existing literature does not provide enough information on evaluation of predictors of depression among HD patients. The objective of the current study was to determine the prevalence and predictors of depression among HD patients. METHODS A multicenter prospective follow-up study. All eligible confirmed hypertensive HD patients who were consecutively enrolled for treatment at the study sites were included in the current study. HADS questionnaire was used to assess the depression level among study participants. Patients with physical and/or cognitive limitations that prevent them from being able to answer questions were excluded. RESULTS Two hundred twenty patients were judged eligible and completed questionnaire at the baseline visit. Subsequently, 216 and 213 patients completed questionnaire on second and final follow up respectively. The prevalence of depression among patients at baseline, 2nd visit and final visit was 71.3, 78.2 and 84.9% respectively. The results of regression analysis showed that treatment given to patients at non-governmental organizations (NGO's) running HD centers (OR = 0.347, p-value = 0.039) had statistically significant association with prevalence of depression at final visit. CONCLUSIONS Depression was prevalent in the current study participants. Negative association observed between depression and hemodialysis therapy at NGO's running centers signifies patients' satisfaction and better depression management practices at these centers.
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Affiliation(s)
- Amjad Khan
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Penang, Malaysia
- Chronic Kidney Disease Resource Centre, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan Malaysia
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, 45320 Pakistan
| | - Amer Hayat Khan
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Penang, Malaysia
- Chronic Kidney Disease Resource Centre, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan Malaysia
| | - Azreen Syazril Adnan
- Chronic Kidney Disease Resource Centre, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan Malaysia
- Management Science University, University Drive, Off Persiaran Olahraga, Section 13, 40100 Shah Alam, Selangor Malaysia
| | - Syed Azhar Syed Sulaiman
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Penang, Malaysia
| | - Saima Mushtaq
- Health Care Biotechnology Department, Atta ur Rahman School of Applied Biosciences, National University of Science & Technology, Islamabad, 44000 Pakistan
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Fiuk JV, Tadros NN. Erectile dysfunction in renal failure and transplant patients. Transl Androl Urol 2019; 8:155-163. [PMID: 31080776 PMCID: PMC6503231 DOI: 10.21037/tau.2018.09.04] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 09/10/2018] [Indexed: 12/21/2022] Open
Abstract
Erectile dysfunction (ED) is a prevalent and pertinent condition in the chronic kidney disease (CKD) population. It has a multifactorial etiology, including disruptions of the hypothalamic-pituitary-gonadal axis, the endothelial paracrine signaling system, calcium and vitamin D homeostasis, along with several other factors. Efficacy of treatment of ED in the CKD population is comparable to non-CKD patients across multiple modalities, including PDE5 inhibitors, vacuum erectile devices, intracavernosal injections and penile prostheses. Renal transplant improves the contributing comorbid conditions that lead to ED in CKD patients; thus rates of ED are improved post-transplant. It is important to note that there is a small percentage of patients with persistent ED after renal transplantation.
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Affiliation(s)
- Julia V Fiuk
- Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Nicholas N Tadros
- Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA
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Management of anxiety and depression in haemodialysis patients: the role of non-pharmacological methods. Int Urol Nephrol 2018; 51:113-118. [DOI: 10.1007/s11255-018-2022-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 10/29/2018] [Indexed: 01/13/2023]
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Microbiota issue in CKD: how promising are gut-targeted approaches? J Nephrol 2018; 32:27-37. [PMID: 30069677 DOI: 10.1007/s40620-018-0516-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 07/15/2018] [Indexed: 12/12/2022]
Abstract
In chronic kidney disease (CKD), the progressive decline in the renal excretory function leads to accumulation of urea and toxins in the blood. The CKD-associated dysbiosis of gut microbiota further contributes to uremia by increasing intestinal toxins production. Gut microbiota is involved in a complex network of human organs, mediated by microbial metabolites: in CKD, gut-heart and gut-brain axes may have a role in increased cardiovascular risk and neuropsychiatric disorders. While the cardiovascular toxicity of some microbial molecules is well known, their presumptive neurotoxicity needs to be confirmed by specific studies. In this review, we describe gut-heart and gut-brain axes in CKD, with an overview of the experimental and human studies characterizing CKD-associated gut microbiota, and we discuss the benefits coming from new approaches aimed at gut manipulation. Microbiota metabolism is emerging as a modifiable non-traditional risk factor in nephrology. In order to take advantage of this issue, it is necessary to consider the microbiota manipulation as part of the nutritional management of CKD. Integrating the low-protein nutritional approach with prebiotic, probiotic and synbiotic supplementation is a promising tool to control disease progression and comorbidities, though an extensive validation in large-scale clinical trials is still required.
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Semaan V, Noureddine S, Farhood L. Prevalence of depression and anxiety in end-stage renal disease: A survey of patients undergoing hemodialysis. Appl Nurs Res 2018; 43:80-85. [PMID: 30220369 DOI: 10.1016/j.apnr.2018.07.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 07/25/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Dialysis is a lifelong treatment required by end stage renal disease patients who are not able to undergo renal transplantation. Dialysis impacts the patients' quality of life drastically, increasing the risk of mortality. Depression and anxiety are commonly reported among dialysis patients, but their prevalence and correlates vary by sociocultural context. OBJECTIVE The aim of this study is to examine the prevalence of anxiety and depression and associated factors among patients receiving hemodialysis at a major tertiary referral medical center in Lebanon that receives patients from all over the country. DESIGN A cross-sectional, descriptive design was used. METHODS Ninety patients receiving hemodialysis were targeted using convenience sampling, with a final sample size of 83 patients. The patients were interviewed while undergoing their dialysis session using the Hospital Anxiety and Depression Scale, and asked demographic and clinical questions. RESULTS The majority of participants were married men over 60 years of age; 48% achieved high school education. Depression was prevalent in 40.8% and anxiety in 39.6%, with 20 patients (24.1%) having both conditions. Although 24.1% self-reported anxiety symptoms, only 2.4% were taking anxiolytics. Illiterate patients had significantly higher depression scores than those with higher levels of education (p = 0.021). Patients who were living with their family had higher anxiety scores than those living alone (p = 0.014). CONCLUSION Anxiety and depression are underdiagnosed and undertreated in Lebanese dialysis patients. Screening and appropriate referral to mental health specialists are needed.
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Affiliation(s)
- Victoria Semaan
- American University of Beirut Medical Center, Cairo Street, Beirut 1107 2020, Lebanon.
| | - Samar Noureddine
- American University of Beirut, Hariri School of Nursing, Beirut 1107 2020, Lebanon
| | - Laila Farhood
- American University of Beirut, Hariri School of Nursing, Beirut 1107 2020, Lebanon
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Picariello F, Norton S, Moss-Morris R, Macdougall IC, Chilcot J. Fatigue in Prevalent Haemodialysis Patients Predicts All-cause Mortality and Kidney Transplantation. Ann Behav Med 2018; 53:501-514. [DOI: 10.1093/abm/kay061] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Federica Picariello
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 5th floor Bermondsey Wing, Guy’s Campus, London Bridge, London, UK
| | - Sam Norton
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 5th floor Bermondsey Wing, Guy’s Campus, London Bridge, London, UK
| | - Rona Moss-Morris
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 5th floor Bermondsey Wing, Guy’s Campus, London Bridge, London, UK
| | | | - Joseph Chilcot
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 5th floor Bermondsey Wing, Guy’s Campus, London Bridge, London, UK
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A holistic approach to factors affecting depression in haemodialysis patients. Int Urol Nephrol 2018; 50:1467-1476. [PMID: 29779116 DOI: 10.1007/s11255-018-1891-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 05/10/2018] [Indexed: 12/26/2022]
Abstract
Depression in dialysis populations is affected by co-morbid diseases, such as cardiovascular disease, diabetes, and immune dysfunction, and it also includes high suicide risk and frequent hospitalizations. Depressive disorders have a close association with malnutrition and chronic inflammation, as well as with cognitive impairment. Impaired cognitive function may be manifested as low adherence to dialysis treatment, leading to malnutrition. Additionally, chronic pain and low quality of sleep lead to high rates of depressive symptoms in haemodialysis patients, while an untreated depression can cause sleep disturbances and increased mortality risk. Depression can also lead to sexual dysfunction and non-adherence, while unemployment can cause depressive disorders, due to patients' feelings of being a financial burden on their family. The present review provides a holistic approach to the factors affecting depression in haemodialysis, offering significant knowledge to renal professionals.
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