1
|
Akıncı N, Varışoğlu Y. Investigating Body Image and Self-Esteem in Kidney Transplant Patients: A Qualitative Study. Niger J Clin Pract 2024; 27:785-791. [PMID: 38943305 DOI: 10.4103/njcp.njcp_138_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 04/15/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND Kidney transplantation is one of the life-saving therapies for patients with end-stage renal disease, which affects a person's psychological, social, and physical well-being. How transplanted patients perceive their illness and their body can affect their physical and psychological recovery. AIM This qualitative study was designed to evaluate self-esteem and body image in kidney transplant patients. METHODS The study involved 16 female renal transplanted patients. Data were collected using a two-part interview form developed by the investigators in accordance with the literature. We used Lundman's method to transcribe the interviews and coded the data from the interviews. The results of the study were discussed using the themes. The first three interviews were entered into MAXQDA, and then, additional interviews were analyzed. RESULTS Six main themes and 15 subthemes were generated based on the thematic analysis of the interviews with participants about body image and self-esteem. Themes included body acceptance, changes in body image, deterioration of social relationships, changes in self-esteem, spousal concerns, and organ perceptions. This study collected detailed data on body image, self-esteem, social relationships, and spouse/partner relationships after kidney transplantation. CONCLUSION The change in participants' body image and self-esteem after kidney transplantation caused having negative feelings regarding sexual life, relationships, and social life and feeling unfamiliar with the transplanted organ.
Collapse
Affiliation(s)
- N Akıncı
- Nursing Department, Faculty of Health Sciences, Fenerbahçe University, Istanbul, Turkey
| | - Y Varışoğlu
- Midwifery Department, Faculty of Health Sciences, Atlas University, Istanbul, Turkey
| |
Collapse
|
2
|
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. [PMID: 38341770 DOI: 10.1111/jorc.12489] [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: 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.
Collapse
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
| |
Collapse
|
3
|
Ibrahim M, Saeed E, Hamarsheh I, Al Zabadi H, Ahmead M. Depression and death anxiety among patients undergoing hemodialysis during the COVID-19 pandemic in Palestine: a cross sectional study. Front Psychiatry 2023; 14:1247801. [PMID: 37720896 PMCID: PMC10501786 DOI: 10.3389/fpsyt.2023.1247801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/01/2023] [Indexed: 09/19/2023] Open
Abstract
Background Hemodialysis patients are vulnerable to serious complications such as prolonged hospital stay and psychosocial issues like depression and death anxiety. Studies on psychosocial factors on end-stage renal disease patients' outcomes during COVID-19 pandemic are limited. We aimed to determine the prevalence of depression and death anxiety among Palestinian hemodialysis patients and the evaluate the relationship between their sociodemographic and clinical characteristics during COVID-19 Pandemic. Methods A cross-sectional study was conducted using a convenience sampling technique. We recruited 308 hemodialysis patients from five hemodialysis units located in government hospitals in Palestine. Beck Depression Inventory and the Templers Death Anxiety Scale were used to collect data, which were then analyzed using SPSS version 20. Descriptive statistics (frequencies and means), t-test, ANOVA and multiple linear regression models were used for data analysis. Results Nearly 66.2% of the sample had depression symptoms, 61.4% met the diagnostic threshold for depression, and 69.8% had death anxiety. Furthermore, the multivariate analysis revealed that having a female identity, residing in a city or refugee camp, and patients who reported not experiencing depression had a significant relationship with death anxiety, while having a higher educational level than 12 years, having one or more chronic co-morbidities, and patients who reported experiencing death anxiety had a significant correlation with depression. Conclusion Patients receiving hemodialysis frequently experience depression and death anxiety. These patients should receive a psychiatric evaluation in the early stages of their illness so that timely and appropriate psychological interventions can be given in hemodialysis facilities in Palestine during and after future pandemics.
Collapse
Affiliation(s)
| | - Elias Saeed
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Islam Hamarsheh
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Hamzeh Al Zabadi
- Department of Public Health, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Muna Ahmead
- Faculty of Public Health, Al-Quds University, Jerusalem, Palestine
| |
Collapse
|
4
|
Natale P, Ju A, Strippoli GF, Craig JC, Saglimbene VM, Unruh ML, Stallone G, Jaure A. Interventions for fatigue in people with kidney failure requiring dialysis. Cochrane Database Syst Rev 2023; 8:CD013074. [PMID: 37651553 PMCID: PMC10468823 DOI: 10.1002/14651858.cd013074.pub2] [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] [Indexed: 09/02/2023]
Abstract
BACKGROUND Fatigue is a common and debilitating symptom in people receiving dialysis that is associated with an increased risk of death, cardiovascular disease and depression. Fatigue can also impair quality of life (QoL) and the ability to participate in daily activities. Fatigue has been established by patients, caregivers and health professionals as a core outcome for haemodialysis (HD). OBJECTIVES We aimed to evaluate the effects of pharmacological and non-pharmacological interventions on fatigue in people with kidney failure receiving dialysis, including HD and peritoneal dialysis (PD), including any setting and frequency of the dialysis treatment. SEARCH METHODS We searched the Cochrane Kidney and Transplant Register of Studies up to 18 October 2022 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Registry Platform (ICTRP) Search Portal and ClinicalTrials.gov. SELECTION CRITERIA Studies evaluating pharmacological and non-pharmacological interventions affecting levels of fatigue or fatigue-related outcomes in people receiving dialysis were included. Studies were eligible if fatigue or fatigue-related outcomes were reported as a primary or secondary outcome. Any mode, frequency, prescription, and duration of therapy were considered. DATA COLLECTION AND ANALYSIS Three authors independently extracted data and assessed the risk of bias. Treatment estimates were summarised using random effects meta-analysis and expressed as a risk ratio (RR) or mean difference (MD), with a corresponding 95% confidence interval (CI) or standardised MD (SMD) if different scales were used. Confidence in the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. MAIN RESULTS Ninety-four studies involving 8191 randomised participants were eligible. Pharmacological and non-pharmacological interventions were compared either to placebo or control, or to another pharmacological or non-pharmacological intervention. In the majority of domains, risks of bias in the included studies were unclear or high. In low certainty evidence, when compared to control, exercise may improve fatigue (4 studies, 217 participants (Iowa Fatigue Scale, Modified Fatigue Impact Scale, Piper Fatigue Scale (PFS), or Haemodialysis-Related Fatigue scale score): SMD -1.18, 95% CI -2.04 to -0.31; I2 = 87%) in HD. In low certainty evidence, when compared to placebo or standard care, aromatherapy may improve fatigue (7 studies, 542 participants (Fatigue Severity Scale (FSS), Rhoten Fatigue Scale (RFS), PFS or Brief Fatigue Inventory score): SMD -1.23, 95% CI -1.96 to -0.50; I2 = 93%) in HD. In low certainty evidence, when compared to no intervention, massage may improve fatigue (7 studies, 657 participants (FSS, RFS, PFS or Visual Analogue Scale (VAS) score): SMD -1.06, 95% CI -1.47, -0.65; I2 = 81%) and increase energy (2 studies, 152 participants (VAS score): MD 4.87, 95% CI 1.69 to 8.06, I2 = 59%) in HD. In low certainty evidence, when compared to placebo or control, acupressure may reduce fatigue (6 studies, 459 participants (PFS score, revised PFS, or Fatigue Index): SMD -0.64, 95% CI -1.03 to -0.25; I2 = 75%) in HD. A wide range of heterogenous interventions and fatigue-related outcomes were reported for exercise, aromatherapy, massage and acupressure, preventing our capability to pool and analyse the data. Due to the paucity of studies, the effects of pharmacological and other non-pharmacological interventions on fatigue or fatigue-related outcomes, including non-physiological neutral amino acid, relaxation with or without music therapy, meditation, exercise with nandrolone, nutritional supplementation, cognitive-behavioural therapy, ESAs, frequent HD sections, home blood pressure monitoring, blood flow rate reduction, serotonin reuptake inhibitor, beta-blockers, anabolic steroids, glucose-enriched dialysate, or light therapy, were very uncertain. The effects of pharmacological and non-pharmacological treatments on death, cardiovascular diseases, vascular access, QoL, depression, anxiety, hypertension or diabetes were sparse. No studies assessed tiredness, exhaustion or asthenia. Adverse events were rarely and inconsistently reported. AUTHORS' CONCLUSIONS Exercise, aromatherapy, massage and acupressure may improve fatigue compared to placebo, standard care or no intervention. Pharmacological and other non-pharmacological interventions had uncertain effects on fatigue or fatigue-related outcomes in people receiving dialysis. Future adequately powered, high-quality studies are likely to change the estimated effects of interventions for fatigue and fatigue-related outcomes in people receiving dialysis.
Collapse
Affiliation(s)
- Patrizia Natale
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J) Nephrology, Dialysis and Transplantation Unit, University of Bari Aldo Moro, Bari, Italy
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Nephrology, Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Angela Ju
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Giovanni Fm Strippoli
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePre-J) Nephrology, Dialysis and Transplantation Unit, University of Bari Aldo Moro, Bari, Italy
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Cochrane Kidney and Transplant, Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Jonathan C Craig
- Cochrane Kidney and Transplant, Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Valeria M Saglimbene
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Mark L Unruh
- University of New Mexico, Department of Internal Medicine, Albuquerque, New Mexico, USA
| | - Giovanni Stallone
- Nephrology, Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Allison Jaure
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| |
Collapse
|
5
|
Anderson BM, Qasim M, Correa G, Evison F, Gallier S, Ferro CJ, Jackson TA, Sharif A. Somatic Symptoms of Depression Lose Association with Mortality upon Adjustment for Frailty: Analysis from the Fitness Haemodialysis Cohort. Int J Nephrol 2023; 2023:4518843. [PMID: 37388527 PMCID: PMC10307017 DOI: 10.1155/2023/4518843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/25/2023] [Accepted: 06/14/2023] [Indexed: 07/01/2023] Open
Abstract
Introduction The somatic symptom component of depression is associated with increased hospitalisation and mortality and poorer health-related quality of life (HRQOL). However, the relationship of subsets of depression symptoms with frailty and outcomes is not known. This study aimed to (1) explore the relationship between the Clinical Frailty Scale (CFS) and components of depression and (2) their association with mortality, hospitalisation, and HRQOL in haemodialysis recipients. Methods We conducted a prospective cohort study of prevalent haemodialysis recipients, with deep bio-clinical phenotyping including CFS and PHQ-9 somatic (fatigue, poor appetite, and poor sleep) and cognitive component scores. EuroQol EQ-5D summary index assessed HRQOL at the baseline. Electronic linkage to English national administration datasets ensured robust follow-up data for hospitalisation and mortality events. Findings. Somatic (β = 0.067; 95% C.I. 0.029 to 0.104; P < 0.001) and cognitive (β = 0.062; 95% C.I. 0.034 to 0.089; P<0.001) components were associated with increased CFS scores. Both somatic (β = -0.062; 95% C.I. -0.104 to -0.021; P<0.001) and cognitive (β = 0.052; 95% C.I. -0.081 to -0.024; P < 0.001) scores were associated with lower HRQOL. Somatic scores lost mortality association on addition of CFS to the multivariable model (HR1.06; 95% C.I. 0.977 to 1.14; P=0.173). Cognitive symptoms were not associated with mortality. Neither the component score was associated with hospitalisation on multivariable analyses. Conclusions Both somatic and cognitive depression symptoms are associated with frailty and poorer HRQOL in haemodialysis recipients but were not associated with mortality or hospitalisation when adjusted for frailty. The risk profile of depression somatic scores may be related to overlap with symptoms of frailty.
Collapse
Affiliation(s)
- Benjamin M. Anderson
- Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Muhammad Qasim
- Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Gonzalo Correa
- Department of Nephrology, Hospital del Salvador, Santiago, Chile
| | - Felicity Evison
- Department of Health Informatics, Queen Elizabeth Hospital, Birmingham, UK
| | - Suzy Gallier
- Department of Health Informatics, Queen Elizabeth Hospital, Birmingham, UK
- PIONEER HDR-UK Hub in Acute Care, Edgbaston, Birmingham, UK
| | - Charles J. Ferro
- Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, UK
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Thomas A. Jackson
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Department of Healthcare for Older People, Queen Elizabeth Hospital, Birmingham, UK
| | - Adnan Sharif
- Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| |
Collapse
|
6
|
Depression and health-related quality of life in adolescents and young adults with childhood-onset end-stage kidney disease: a multicenter study in Japan. Clin Exp Nephrol 2023; 27:473-479. [PMID: 36840901 DOI: 10.1007/s10157-023-02330-4] [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: 11/21/2022] [Accepted: 02/13/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND Patient survival and physical outcomes among children with end-stage kidney disease (ESKD) have significantly improved, and recent research has focused on long-term depression symptoms and health-related quality of life (HRQOL). However, no studies have been conducted among adolescents and young adults with childhood-onset ESKD in Japan. METHODS This multicenter study included 45 adolescents and young adults aged 16-39 years who developed ESKD at age < 20 years. Depression symptoms were measured using the Beck Depression Inventory (BDI)-II. The Short Form-36 Health Survey (SF-36) was used to assess HRQOL. Factors associated with depression and HRQOL were analyzed. RESULTS Depression (BDI-II score ≥ 14) was observed in 13 (29%) patients. Patient's SF-36 physical component summary (PCS) and mental component summary (MCS) scores were comparable with those for the general population. Lower estimated glomerular filtration rate, higher BDI-II scores, and lower body mass index were associated with lower PCS scores. BDI-II scores were negatively correlated with MCS scores. We observed a trend that unemployment was associated with lower MCS scores. CONCLUSIONS Depression is frequently observed among adolescents and young adults with childhood-onset ESKD. Regular screening for psychosocial concerns, maintaining stable graft functions, and achieving optimal nutritional status may contribute to improved well-being among these patients.
Collapse
|
7
|
Alshogran OY, Altawalbeh SM, Khalil AA. Comparison of two self-report scales to assess anxiety and depressive symptoms in hemodialysis patients. Arch Psychiatr Nurs 2022; 41:208-213. [PMID: 36428051 DOI: 10.1016/j.apnu.2022.08.004] [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: 03/01/2022] [Revised: 08/12/2022] [Accepted: 08/21/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Psychiatric illness is prevalent among hemodialysis (HD) patients. This study compared the assessment of anxiety and depressive symptoms among HD patients using two self-administered scales; hospital anxiety and depression scale (HADS) and brief symptom inventory (BSI). METHODS A cross-sectional study was conducted among a convenience sample of HD patients (n = 352) from different dialysis centers in Jordan. Patients were interviewed in dialysis units, and demographics, clinical status, disease, and dialysis history data were collected. Symptoms of anxiety (HADS-A ≥ 8 and BSI-A ≥ 0.82) and depression (HADS-D ≥ 8 and BSI-D ≥ 0.82) were also measured. RESULTS The mean age of participants was 52.2 ± 15.6 years. The majority had been receiving HD three times daily and for >2 years. A significant moderate-strong correlation was observed between HADS-A and BSI-A (r = 0.753, p < 0.0001) as well as HADS-D and BSI-D (r = 0.588, p < 0.0001). Anxiety prevalence was 43.7 % using HADS-A ≥ 8 and 80.7 % using BSI-A ≥ 0.82, while depression prevalence was 53.1 % using HADS-D ≥ 8 and 51.7 % using BSI-D ≥ 0.82. When HADS was used as a standard, the operating characteristics reveal that a higher cut-off for BSI-A is recommended (≥1.58) for better anxiety screening. DISCUSSION Specific and suitable cut-off points need to be further explored and validated for HADS and BSI scales among patients undergoing dialysis.
Collapse
Affiliation(s)
- Osama Y Alshogran
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan.
| | - Shoroq M Altawalbeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Amani A Khalil
- Department of Clinical Nursing, School of Nursing, The University of Jordan, Amman 11942, Jordan
| |
Collapse
|
8
|
Anderson BM, Qasim M, Correa G, Evison F, Gallier S, Ferro CJ, Jackson TA, Sharif A. Depression is associated with frailty and lower quality of life in haemodialysis recipients, but not with mortality or hospitalization. Clin Kidney J 2022; 16:342-354. [PMID: 36755846 PMCID: PMC9900564 DOI: 10.1093/ckj/sfac241] [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: 06/28/2022] [Indexed: 11/12/2022] Open
Abstract
Background Frailty and depression are highly prevalent in haemodialysis recipients, exhibit a reciprocal relationship, and are associated with increased mortality and hospitalization, and lower quality of life. Despite this, there has been little exploration of the relationship between depression and frailty upon patient outcomes. We aimed to explore the relationship between depression and frailty, and their associations with mortality, hospitalization and quality of life. Methods We performed a prospective cohort study of prevalent haemodialysis recipients linked to national datasets for outcomes including mortality and hospitalization. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9), frailty using the Clinical Frailty Scale (CFS) and quality of life using the EuroQol 5-Dimension (EQ-5D) Summary Index. Results A total of 485 prevalent haemodialysis recipients were recruited, with 111 deaths and 1241 hospitalizations during follow-up. CFS was independently associated with mortality [hazard ratio (HR) 1.31; 95% confidence interval (CI) 1.08, 1.59; P = .006], hospitalization [incidence rate ratio (IRR) 1.13; 95% CI 1.03, 1.25; P = .010] and lower quality of life (Coef. -0.401; 95% CI -0.511, -0.292; P < .001). PHQ-9 score was independently associated with lower quality of life (Coef. -0.042; 95% CI -0.063, -0.021; P < .001), but not mortality (HR 1.00; 95% CI 0.96, 1.04; P = .901) or hospitalization (IRR 0.99; 95% CI 0.97, 1.01; P = .351). In an adjusted model including CFS, moderate depression was associated with reduced hospitalization (IRR 0.72; 95% CI 0.56, 0.93; P = .013). Conclusions With the addition of frailty, depression was associated with lower hospital admissions, but poorer quality of life. The relationship between frailty and depression, and their influence on outcomes is complex, requiring further study.
Collapse
Affiliation(s)
- Benjamin M Anderson
- Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, UK,Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Muhammad Qasim
- Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, UK,Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Gonzalo Correa
- Department of Nephrology, Hospital del Salvador, Santiago, Chile
| | - Felicity Evison
- Department of Health Informatics, Queen Elizabeth Hospital, Birmingham, UK
| | - Suzy Gallier
- Department of Health Informatics, Queen Elizabeth Hospital, Birmingham, UK,PIONEER: HDR-UK hub in Acute Care, Edgbaston, Birmingham, UK
| | - Charles J Ferro
- Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, UK,Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Thomas A Jackson
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK,Department of Healthcare for Older People, Queen Elizabeth Hospital, Birmingham, UK
| | - Adnan Sharif
- Correspondence to: Adnan Sharif; E-mail: , Twitter: @AdnanSharif1979
| |
Collapse
|
9
|
Almutary H. Depression, sleep disturbance, and quality of life in patients undergoing dialysis therapy. Appl Nurs Res 2022; 67:151610. [DOI: 10.1016/j.apnr.2022.151610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 05/30/2022] [Accepted: 06/21/2022] [Indexed: 10/17/2022]
|
10
|
Taylor EM, Robertson N, Lightfoot CJ, Smith AC, Jones CR. Nature-Based Interventions for Psychological Wellbeing in Long-Term Conditions: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063214. [PMID: 35328901 PMCID: PMC8954238 DOI: 10.3390/ijerph19063214] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 02/28/2022] [Accepted: 03/03/2022] [Indexed: 12/16/2022]
Abstract
Background: With the global burden of disease increasing, particularly in relation to often preventable chronic diseases, researchers and clinicians are keen to identify interventions that can mitigate ill health and enhance the psychological wellbeing of people living with long-term conditions (LTCs). It is long established that engagement with nature can support human health and wellbeing, and in recent years, nature-based interventions (NBIs) have been advanced as of potential benefit. This review thus sought to systematically appraise published evidence of the application of NBIs to address psychological wellbeing for those living with LTCs. Methods: A systematic search of three databases, PsycINFO, MEDLINE and SCOPUS, was undertaken, and the BestBETs quality assessment checklist was used to appraise methodological quality of elicited studies. Results: Of 913 studies identified, 13 studies (12 using quantitative methods, one qualitative) were used. Included papers reported use of a variety of psychological outcomes alongside more circumscribed physiological outcomes. Quality appraisal showed modest robustness, some methodological weaknesses and a dominance of application in developed countries, yet synthesis of studies suggested that reported psychological and physiological outcomes present a strong argument for NBIs having a promising and positive impact on psychological wellbeing. Conclusions: NBIs have positive psychological and physiological impacts on people with LTCs, suggesting they may be a suitable addition to current maintenance treatment. Future research should focus on minimising study bias and increasing the potential for cross-cultural applications.
Collapse
Affiliation(s)
- Eleanor M. Taylor
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester LE1 7HA, UK;
- Correspondence: (E.M.T.); (C.R.J.)
| | - Noelle Robertson
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester LE1 7HA, UK;
| | - Courtney J. Lightfoot
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK; (C.J.L.); (A.C.S.)
| | - Alice C. Smith
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK; (C.J.L.); (A.C.S.)
| | - Ceri R. Jones
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester LE1 7HA, UK;
- Correspondence: (E.M.T.); (C.R.J.)
| |
Collapse
|
11
|
Gregg LP, Trombello JM, McAdams M, Hedayati SS. Diagnosis and Management of Depression in Patients With Kidney Disease. Semin Nephrol 2022; 41:505-515. [PMID: 34973695 DOI: 10.1016/j.semnephrol.2021.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Depression disproportionately affects patients with kidney disease, including those with nondialysis chronic kidney disease, end-stage kidney disease requiring dialysis, and kidney transplant recipients. Patients across the spectrum of kidney disease should be screened for depression every 6 to 12 months using self-report questionnaires, followed by an interview with a clinician to confirm the presence of sadness or anhedonia when depressive symptoms are identified. Pharmacologic treatment with selective serotonin reuptake inhibitors has not consistently shown benefit compared with placebo and may be associated with serious adverse outcomes including cardiovascular events, bleeding, and fractures. However, based on the availability of alternative therapies, a watchful trial with close monitoring for therapeutic and adverse effects is reasonable. Several clinical trials have suggested that cognitive behavioral therapy and physical activity improve depressive symptoms when compared with a control group. Given the low risk associated with these therapies, they should be recommended to patients who have access and are amenable to such interventions. Future trials are needed to study therapeutic options for depression in nondialysis chronic kidney disease, peritoneal dialysis, or kidney transplant recipients, as well as alternative pharmacologic therapy and combination therapies. Given improvement in depressive symptoms with placebo in existing trials, inclusion of a control group is paramount.
Collapse
Affiliation(s)
- L Parker Gregg
- Selzman Institute for Kidney Health, Department of Medicine, Baylor College of Medicine, Houston, TX; Division of Nephrology, Department of Medicine, Michael E. DeBakey VA Medical Center, Houston, TX; Center for Innovations in Quality, Effectiveness and Safety, Houston, TX
| | - Joseph M Trombello
- Center for Depression Research and Clinical Care, Department of Psychiatry, Division of Psychology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Meredith McAdams
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - S Susan Hedayati
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX.
| |
Collapse
|
12
|
Carswell CE, Reid J, Walsh I, Johnston W, Lee JB, McAneney H, Mullan R, Nelson H, Matthews M, Weatherup E, Spencer A, Michelo J, Quail A, Kielty G, Mackenzie A, Elliott J, Noble H. Development of a complex arts-based intervention for patients with end-stage kidney disease whilst receiving haemodialysis. Pilot Feasibility Stud 2021; 7:127. [PMID: 34134778 PMCID: PMC8207758 DOI: 10.1186/s40814-021-00868-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 06/07/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Patients with end-stage kidney disease who receive haemodialysis experience a protracted treatment regimen that can result in an increased risk of depression and anxiety. Arts-based interventions could address this unique issue; however, no arts-based interventions have been developed for delivery within a haemodialysis unit and evaluation within a randomised controlled trials (RCTs). AIM To develop a complex arts-based intervention for patients with end-stage kidney disease whilst receiving haemodialysis. METHODS The development process utilised the Arts in Health framework (Fancourt, 2017). The framework was addressed through the establishment of an interdisciplinary advisory group, collaboration and consultation with stakeholders, a scoping and realist review, shadowing of artists-in-residence, personal arts practice and logic modelling. RESULTS The intervention involved six 1-h long, one-to-one facilitated sessions focused on creative writing and visual art. Patients could choose between art form and self-select a subject matter. The sessions had a primary focus on skill development and were delivered using principles derived from the psychological theory of flow. CONCLUSION The Arts in Health framework provided an appropriate and pragmatic approach to intervention development. Complex arts-based interventions can be developed for the purpose of evaluation within a trial framework. This intervention was designed to strike a balance between standardised components, and a person-centred approach necessary to address existential boredom.
Collapse
Affiliation(s)
| | - Joanne Reid
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Ian Walsh
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | | | - Jenny B Lee
- College of the Arts, Center for Arts in Medicine, University of Florida, Gainesville, USA
| | - Helen McAneney
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Robert Mullan
- Antrim Area Hospital, Northern Health and Social Care Trust, Antrim, UK
| | - Hugh Nelson
- Northern Health and Social Care Trust, Antrim, UK
| | - Michael Matthews
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | | | | | - Jean Michelo
- Northern Ireland Kidney Patient Association, Belfast, UK
| | | | | | | | | | - Helen Noble
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| |
Collapse
|
13
|
Nagalingam K. Depression in patients on haemodialysis. J Ren Care 2021; 47:72. [PMID: 33963684 DOI: 10.1111/jorc.12375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Karen Nagalingam
- Acute Kidney Injury Nurse Specialist, Lister Hospital, The University of Hertfordshire, Hatfield, Hertfordshire, UK
| |
Collapse
|
14
|
Al Naamani Z, Gormley K, Noble H, Santin O, Al Maqbali M. Fatigue, anxiety, depression and sleep quality in patients undergoing haemodialysis. BMC Nephrol 2021; 22:157. [PMID: 33910523 PMCID: PMC8080199 DOI: 10.1186/s12882-021-02349-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/08/2021] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Patients undergoing haemodialysis may experience troubling symptoms such as fatigue, anxiety, depression and sleep quality, which may affect their quality of life. The main objective of this study is to determine the prevalence of fatigue, anxiety, depression and sleep quality among patients receiving haemodialysis during the coronavirus disease 2019 (COVID-19) pandemic, and to explore the contributing predictors. METHODS A cross-sectional and descriptive correlational design using Qualtrics software was performed. Data were collected using the Functional Assessment of Cancer Therapy-Fatigue (FACT-F), the Hospital Anxiety and Depression Scale (HADS) and the Pittsburgh Sleep Quality Index (PSQI). Logistic regression analyses were used to explore the predictors that were associated with fatigue, anxiety, depression and sleep quality. RESULTS Of the 123 patients undergoing haemodialysis who participated, 53.7% (n = 66) reported fatigue, 43.9% (n = 54) reported anxiety, 33.3% (n = 41) reported depression and 56.9% (n = 70) reported poor sleep. Fatigue, anxiety and sleep quality (P < .05) were significantly associated with being female, and whether family members or relatives were suspected or confirmed with COVID-19. Logistic regression showed that being within the age group 31-40, having a secondary education level, anxiety, depression and sleep quality were the main predictors affecting the fatigue group. CONCLUSION Fatigue, anxiety, depression and sleep quality are significant problems for patients receiving haemodialysis during the COVID-19 pandemic. Appropriate interventions to monitor and reduce fatigue, psychological problems and sleep quality amongst these patients are needed. This can help to strengthen preparations for responding to possible future outbreaks or pandemics of infectious diseases for patients receiving haemodialysis.
Collapse
Affiliation(s)
| | - Kevin Gormley
- College of Nursing and Midwifery, Mohammed Bin Rashid University of Medicine and Health Science, Dubai, UAE
| | - Helen Noble
- School of Nursing and Midwifery, Queens's University Belfast, Belfast, UK
| | - Olinda Santin
- School of Nursing and Midwifery, Queens's University Belfast, Belfast, UK
| | | |
Collapse
|
15
|
Alshogran OY, Al-Eitan LN, Altawalbeh SM, Aman HA. Association of DRD4 exon III and 5-HTTLPR VNTR genetic polymorphisms with psychiatric symptoms in hemodialysis patients. PLoS One 2021; 16:e0249284. [PMID: 33784353 PMCID: PMC8009383 DOI: 10.1371/journal.pone.0249284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/15/2021] [Indexed: 01/01/2023] Open
Abstract
Mental illness is prevalent among hemodialysis (HD) patients. Given that the dopaminergic and serotonergic pathways are involved in the etiology of psychiatric disease, this study evaluated the genetic association of dopamine D4 receptor (DRD4) and serotonin transporter (SLC6A4) genes with psychiatric symptom susceptibility among HD patients. Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety and depressive symptoms among patients (n = 265). Genetic polymorphisms of DRD4 (48 bp VNTR) and SLC6A4 (5-HTTLPR VNTR and rs25531) were examined using a conventional polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique, as appropriate. Significant differences were observed in the distribution of 5-HTTLPR genotypes, SLC6A4 tri-allelic-phased genotype, and DRD4-Exon III VNTR genotypes/alleles between patients with anxiety symptoms versus those with normal/borderline conditions (p<0.05). Binary logistic regression analyses showed that the heterozygous 4,5 VNTR genotype of DRD4 was associated with a higher risk of anxiety symptoms after adjusting for other covariates (odds ratio = 4.25, p = 0.028). None of the studied polymorphisms was linked to depression in HD patients. Collectively, the current findings provide genetic clues to psychopathology in HD patients and suggest that the DRD4 exon III VNTR polymorphism is involved in the etiology of anxiety in this patient population.
Collapse
Affiliation(s)
- Osama Y. Alshogran
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Laith N. Al-Eitan
- Department of Applied Biological Sciences, Jordan University of Science and Technology, Irbid, Jordan
- Department of Biotechnology and Genetic Engineering, Jordan University of Science and Technology, Irbid, Jordan
| | - Shoroq M. Altawalbeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Hatem A. Aman
- Department of Applied Biological Sciences, Jordan University of Science and Technology, Irbid, Jordan
| |
Collapse
|
16
|
Muscat P, Weinman J, Farrugia E, Camilleri L, Chilcot J. Illness perceptions predict mortality in patients with predialysis chronic kidney disease: a prospective observational study. BMC Nephrol 2020; 21:537. [PMID: 33302894 PMCID: PMC7727218 DOI: 10.1186/s12882-020-02189-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 11/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Illness perceptions have been shown to predict a range of psychosocial and clinical outcomes in kidney disease; including quality of life, distress, treatment adherence and even survival in end-stage renal disease patients on dialysis. The aim of this study was to evaluate whether illness perceptions impact mortality in incident predialysis Chronic Kidney Disease (CKD) patients. METHODS Over the study period between September 2015 and June 2019, a total of 200 participants with predialysis CKD were recruited from the Nephrology Outpatient's clinics at Mater Dei Hospital, Malta. The participants were followed up until June 2019, and the mortality information was collected. Cox proportional hazards models were used to examine the association between illness perceptions, and mortality risk, after adjustment for covariates including distress, kidney function, co-morbidity and psychological distress. RESULTS Of the 200 cases available for analysis, there were 43 deaths. The mean survival time was 718.55 days (min. 3 days, max. 1297 days). The cumulative survival 1-year post the assessment of the Revised Illness Perceptions Questionnaire (IPQ-R) was 93%. Stronger identity beliefs (HR = 1.199, 95% CI: 1.060-1.357, p = 0.004), perceptions of a chronic timeline (HR = 1.065, 95% CI: 1.003-1.132, p = 0.041), personal control beliefs (HR = 0.845, 95% CI: 0.748-0.955, p = 0.007) and perceptions of control over the treatment (HR = 0.812, 95% CI: 0.725-0.909, p = 0.000) demonstrated a significant association with mortality after controlling covariates. In a subsequent saturated model, perceived identity, chronic timeline and treatment control perceptions remained significant predictors of mortality, together with serum albumin, comorbidities and urea. CONCLUSIONS CKD patients' perceptions of treatment control, perceptions of a chronic timeline and perceived illness identity predict survival independently of clinical prognostic factors, including kidney function and co-morbidity. Illness perceptions are important and potentially modifiable risk factors in CKD. Further studies are required to test whether the assessment and the implementation of psychological interventions aimed to modify maladaptive illness perceptions influence clinical outcomes in CKD.
Collapse
Affiliation(s)
- Priscilla Muscat
- Renal Unit, Nephrology Department, Mater Dei Hospital, Msida, MSD 2090, Malta.
- 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, SE1 9RT, UK.
| | - John Weinman
- Institute of Pharmaceutical Science, Pharmaceutical Sciences Clinical Academic Group King's College London, 5th floor, Franklin -Wilkins Building. 150 Stamford Street, London, SE19NH, UK
| | - Emanuel Farrugia
- Renal Unit, Nephrology Department, Mater Dei Hospital, Msida, MSD 2090, Malta
| | - Liberato Camilleri
- Statistics and Operations Research Department University of Malta, Msida, MSD 2080, Malta
| | - 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, SE1 9RT, UK.
| |
Collapse
|
17
|
Daniel SC, Azuero A, Gutierrez OM, Heaton K. Examining the relationship between nutrition, quality of life, and depression in hemodialysis patients. Qual Life Res 2020; 30:759-768. [PMID: 33108580 DOI: 10.1007/s11136-020-02684-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2020] [Indexed: 01/13/2023]
Abstract
PURPOSE Lifestyle changes associated with end-stage renal disease may be a factor in depression and quality of life (QOL) for patients receiving hemodialysis. This cross-sectional study examined the relationship between nutritional status, QOL, and depression in 124 hemodialysis patients. METHODS Nutritional markers included serum albumin, normalized protein catabolic rate (nPCR), body mass index (BMI), body fat percentage, and daily protein intake. Physical and Mental dimension scores of the Kidney Disease QOL-Short Form (KDQOL-SF), and the Center for Epidemiological Studies of Depression (CESD) survey were used to measure QOL and depression, respectively. Data were analyzed using regression analyses. Measures of effect size were used for interpretation. RESULTS Nutritional status indicators explained a moderate amount of the variability of the Physical dimension of QOL (crude R2 = .14, covariate-adjusted ΔR2 = .06) but had weak explanatory ability for the Mental dimension of QOL (crude R2 = .05, covariate-adjusted ΔR2 = .02) and CESD (crude R2 = .02, covariate-adjusted ΔR2 = .005). Additional findings suggested the presence of non-linear relationships between protein intake and both the Physical and Mental QOL dimension scores. Longer dialysis vintage was also correlated with lower psychosocial patient outcomes. CONCLUSION While nutritional status is an important element in predicting hemodialysis patient outcomes, its relationship to depression and QOL, in this sample, demonstrated only moderate explanatory ability. However, dialysis vintage and level of education had a significant relationship with depression and QOL. These findings suggest that patients with longer dialysis vintage and limited health literacy require unique plans of care. Future studies aimed at understanding the interrelationships between non-modifiable patient characteristics and psychosocial outcomes are imperative.
Collapse
Affiliation(s)
- Shawona C Daniel
- University of Alabama at Birmingham-School of Nursing, Birmingham, AL, USA.
| | - Andres Azuero
- University of Alabama at Birmingham-School of Nursing, Birmingham, AL, USA
| | | | - Karen Heaton
- University of Alabama at Birmingham-School of Nursing, Birmingham, AL, USA
| |
Collapse
|
18
|
Keskindag B, Farrington K, Oygar DD, Mertan B, Hucker A, Sharma S. Illness perceptions of Turkish Cypriot patients receiving haemodialysis: A qualitative study. J Ren Care 2020; 47:113-122. [PMID: 33040486 DOI: 10.1111/jorc.12351] [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: 06/23/2020] [Revised: 09/01/2020] [Accepted: 09/04/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Illness perceptions refer to cognitive appraisals that help patients understand and make sense of their condition. Although their importance in health behaviour and outcomes has been evidenced, less is known about cultural influences on mental representations of kidney failure amongst patients receiving haemodialysis in different settings. OBJECTIVE To explore the illness perceptions of Turkish patients receiving haemodialysis in North Cyprus (Turkish Cypriots). DESIGN A qualitative study involving individual semistructured interviews. PARTICIPANTS Fourteen patients receiving haemodialysis, recruited from three state hospitals in North Cyprus. APPROACH All interviews were conducted in Turkish, audio-recorded, and transcribed verbatim. They were analysed inductively in the original language using reflexive thematic analysis. Once the analysis was completed, it was translated into English. Quality assurance was integral to the research process to retain semantic equivalence. FINDINGS Three themes were developed. "Illness appraisal" highlighted a lack of factual knowledge about kidney failure and how this is related to attempts at sense-making, whilst retaining hope for the future. "Life-changing effects" centred around the negative consequences of haemodialysis across multiple domains (e.g., emotional and physical). "Active coping strategies" focused on mechanisms that patients adopt to manage the burden of haemodialysis, particularly approaches that are culturally rooted. CONCLUSION There is a need for better communication to address the lack of individual patient knowledge about kidney failure. Haemodialysis is described as a burdensome treatment though existing coping mechanisms suggest that psycho-spiritual interventions may be advantageous to aid adjustment for Turkish Cypriots receiving haemodialysis.
Collapse
Affiliation(s)
- Buse Keskindag
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK.,Department of Psychology, Bahçeşehir Cyprus University, Nicosia, North Cyprus
| | - Ken Farrington
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Duriye D Oygar
- Department of Nephrology, Burhan Nalbantoglu State Hospital, Nicosia, North Cyprus
| | - Biran Mertan
- Department of Psychology, Bahçeşehir Cyprus University, Nicosia, North Cyprus
| | - Abigail Hucker
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Shivani Sharma
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| |
Collapse
|
19
|
Hong CT, Hsieh YC, Liu HY, Chiou HY, Chien LN. Association Between Anemia and Dementia: A Nationwide, Populationbased Cohort Study in Taiwan. Curr Alzheimer Res 2020; 17:196-204. [DOI: 10.2174/1567205017666200317101516] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 01/06/2020] [Accepted: 01/29/2020] [Indexed: 11/22/2022]
Abstract
Background:
In addition to the traditional risk predictors, whether anemia is an early biomarker
of dementia, needs to be confirmed.
Objective:
This population-based cohort study aimed to investigate the dementia risk in patients with
newly diagnosed anemia using data from the Taiwan National Health Insurance Research Database.
Methods:
All newly diagnosed anemia patients (n = 26,343) with no history of stroke hospitalization,
central nervous disease other than dementia, psychiatric disorders, traumatic brain injury, major operations,
or blood loss diseases, were enrolled. A group of non-anemic controls, 1:4 matched with anemic
patients on the basis of demographics and comorbidities, was also included. A competing risk analysis
was used to evaluate the dementia risk in anemic patients compared to that of their matched controls.
Results:
The adjusted subdistribution hazard ratio (SHR) of dementia risk in anemic patients was 1.14
(95% confidence interval [CI]: 1.08~1.21, p<0.001). Patients with iron supplements tended to exhibit a
lower dementia risk (adjusted SHR: 0.84; 95% CI: 0.75~0.94, p=0.002) compared to patients without
iron supplement. A subgroup analysis showed that a positive association between dementia and anemia
existed in females, those aged 70 years and older, and patients without hypertension, diabetes, or hyperlipidemia.
Conclusion:
The present population-based cohort study identified that newly diagnosed anemia is a risk
factor for dementia and also that iron supplementation was able to reduce the risk of dementia in people
with iron deficiency anemia.
Collapse
Affiliation(s)
- Chien-Tai Hong
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Yi-Chen Hsieh
- College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Hung-Yi Liu
- Health and Clinical Research Data Center, School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Hung-Yi Chiou
- Department of Applied Molecular Epidemiology, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Li-Nien Chien
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan
| |
Collapse
|
20
|
de Alencar SBV, Dias LDA, Dias VDA, de Lima FM, Montarroyos UR, de Petribú KCL. Quality of life may be a more valuable prognostic factor than depression in older hemodialysis patients. Qual Life Res 2020; 29:1829-1838. [PMID: 32062755 DOI: 10.1007/s11136-020-02445-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2020] [Indexed: 01/23/2023]
Abstract
PURPOSE Depression and impairment of quality of life (QoL) reduce the survival of individual on hemodialysis (HD). However, few studies evaluated the impact of these conditions on the survival of older patients undergoing HD. METHODS A retrospective cohort study was performed including patients aged ≥ 60 years on HD in Recife, Brazil, assessed in 2013 and monitored until 2017. Depression was evaluated with the Mini-International Neuropsychiatric Interview and QoL with the Control, Autonomy, Self-realization, and Pleasure Questionnaire (CASP-16). Survival differences according to the depression and QoL status were measured by Kaplan-Meier analysis and Cox regression. Death Certificates were analyzed to assess the cause of death. RESULTS A total of 171 patients were included (mean age 68.7 ± 6.9 years). The mean follow-up time was 3 years (maximum 4.5 years) and there were 98 deaths (57.3% of the sample). In a multivariate model that included depression and QoL, only QoL impairment was associated with a higher risk of death (HR 1.62, p = 0.035). Among CASP domains, only "Control" was associated with survival (HR 0.90, p = 0.014). Depression was unrelated to the cause of death, but there was a trend for death by endocrine diseases if QoL was impaired (p = 0.057). CONCLUSION QoL impairment is a key predictor of prognosis in older patients on HD and may be more important than depression. It is important that teams dealing with this population include in protocols an assessment of QoL, in order to offer a range of care according to the needs of these patients.
Collapse
Affiliation(s)
- Saulo Barbosa Vasconcelos de Alencar
- Postgraduate in Health Sciences Program, Universidade de Pernambuco, Av. Gov. Agamenon Magalhães, S/N - Santo Amaro, Recife, PE, 50100-010, Brazil.
| | - Luana do Amaral Dias
- Postgraduate in Health Sciences Program, Universidade de Pernambuco, Av. Gov. Agamenon Magalhães, S/N - Santo Amaro, Recife, PE, 50100-010, Brazil
| | - Victor do Amaral Dias
- Postgraduate in Health Sciences Program, Universidade de Pernambuco, Av. Gov. Agamenon Magalhães, S/N - Santo Amaro, Recife, PE, 50100-010, Brazil
| | - Fábia Maria de Lima
- Postgraduate in Health Sciences Program, Universidade de Pernambuco, Av. Gov. Agamenon Magalhães, S/N - Santo Amaro, Recife, PE, 50100-010, Brazil
| | - Ulisses Ramos Montarroyos
- Postgraduate in Health Sciences Program, Universidade de Pernambuco, Av. Gov. Agamenon Magalhães, S/N - Santo Amaro, Recife, PE, 50100-010, Brazil
| | - Kátia Cristina Lima de Petribú
- Postgraduate in Health Sciences Program, Universidade de Pernambuco, Av. Gov. Agamenon Magalhães, S/N - Santo Amaro, Recife, PE, 50100-010, Brazil
| |
Collapse
|
21
|
Gregg LP, Carmody T, Le D, Martins G, Trivedi M, Hedayati SS. A Systematic Review and Meta-Analysis of Depression and Protein-Energy Wasting in Kidney Disease. Kidney Int Rep 2019; 5:318-330. [PMID: 32154453 PMCID: PMC7056860 DOI: 10.1016/j.ekir.2019.12.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/17/2019] [Accepted: 12/16/2019] [Indexed: 12/20/2022] Open
Abstract
Introduction Depression comorbid with chronic disease may be mediated by inflammation. We sought to characterize relationships between inflammatory biomarkers and depressive symptoms in patients with chronic kidney disease and end-stage kidney disease. Methods A systematic literature search was conducted by 2 authors up to March 19, 2019, for studies of patients with chronic kidney disease or end-stage kidney disease evaluating circulating inflammatory biomarkers associated with depression of chronic disease: albumin, C-reactive protein (CRP), high-sensitivity CRP, interleukin-6 (IL-6), tumor necrosis factor-α, and interleukin-1. Standardized mean differences in biomarkers between individuals with and without depression were computed and analyzed using mixed effects models. Correlations between biomarkers and the severity of depressive symptoms were computed. Results Thirty-four studies (5652 participants) compared biomarkers between depressed and nondepressed individuals. Individuals with depression had lower albumin levels (standardized mean difference, −0.37; 95% confidence interval [CI], −0.61 to −0.13), higher CRP levels (standardized mean difference, 0.76; 95% CI, 0.16–1.37), and higher IL-6 levels (standardized mean difference, 0.42; 95% CI, 0.21–0.63). Studies were heterogeneous for albumin, CRP, high-sensitivity CRP, and tumor necrosis factor-α. Twenty-three studies (3047 participants) investigated correlations between biomarkers and depressive symptoms. The severity of depressive symptoms correlated with albumin (Z = −0.25; 95% CI, −0.36 to −0.14), high-sensitivity CRP (Z = 0.28; 95% CI, 0.13–0.43), and IL-6 (Z = 0.34; 95% CI, 0.18–0.49). There was heterogeneity across studies of IL-6. Only 6 studies (321 participants) investigated the effect of antidepressant treatment on inflammatory biomarkers, which was insufficient to combine in meta-analysis. Conclusion Lower albumin and higher IL-6 were associated with both the presence and severity of depression, CRP with the presence of depression, and high-sensitivity CRP with the severity of depressive symptoms. The effect of interventions to lower inflammation in patients with kidney disease and depression deserves investigation.
Collapse
Affiliation(s)
- L Parker Gregg
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Division of Nephrology, Medical Service, Veterans Affairs North Texas Health Care System, Dallas, Texas, USA
| | - Thomas Carmody
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Dustin Le
- Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Gerard Martins
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Madhukar Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - S Susan Hedayati
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| |
Collapse
|
22
|
Maharjan SRS, Davenport A. The effects of supported shared‐care and hemodialysis self‐care on patient psychological well‐being, interdialytic weight gain, and blood pressure control. Hemodial Int 2019; 24:29-35. [DOI: 10.1111/hdi.12799] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/15/2019] [Accepted: 10/29/2019] [Indexed: 12/14/2022]
Affiliation(s)
| | - Andrew Davenport
- UCL Department of NephrologyRoyal Free Hospital, University College London London NW3 2PF UK
| |
Collapse
|
23
|
Natale P, Palmer SC, Ruospo M, Saglimbene VM, Rabindranath KS, Strippoli GFM. Psychosocial interventions for preventing and treating depression in dialysis patients. Cochrane Database Syst Rev 2019; 12:CD004542. [PMID: 31789430 PMCID: PMC6886341 DOI: 10.1002/14651858.cd004542.pub3] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND People with end-stage kidney disease (ESKD) treated with dialysis are frequently affected by major depression. Dialysis patients have prioritised depression as a critically important clinical outcome in nephrology trials. Psychological and social support are potential treatments for depression, although a Cochrane review in 2005 identified zero eligible studies. This is an update of the Cochrane review first published in 2005. OBJECTIVES To assess the effect of using psychosocial interventions versus usual care or a second psychosocial intervention for preventing and treating depression in patients with ESKD treated with dialysis. SEARCH METHODS We searched Cochrane Kidney and Transplant's Register of Studies up to 21 June 2019 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs of psychosocial interventions for prevention and treatment of depression among adults treated with long-term dialysis. We assessed effects of interventions on changes in mental state (depression, anxiety, cognition), suicide, health-related quality of life (HRQoL), withdrawal from dialysis treatment, withdrawal from intervention, death (any cause), hospitalisation and adverse events. DATA COLLECTION AND ANALYSIS Two authors independently selected studies for inclusion and extracted study data. We applied the Cochrane 'Risk of Bias' tool and used the GRADE process to assess evidence certainty. We estimated treatment effects using random-effects meta-analysis. Results for continuous outcomes were expressed as a mean difference (MD) or as a standardised mean difference (SMD) when investigators used different scales. Dichotomous outcomes were expressed as risk ratios. All estimates were reported together with 95% confidence intervals (CI). MAIN RESULTS We included 33 studies enrolling 2056 participants. Twenty-six new studies were added to this 2019 update. Seven studies originally excluded from the 2005 review were included as they met the updated review eligibility criteria, which have been expanded to include RCTs in which participants did not meet criteria for depression as an inclusion criterion. Psychosocial interventions included acupressure, cognitive-behavioural therapy, counselling, education, exercise, meditation, motivational interviewing, relaxation techniques, social activity, spiritual practices, support groups, telephone support, visualisation, and voice-recording of a psychological intervention. The duration of study follow-up ranged between three weeks and one year. Studies included between nine and 235 participants. The mean study age ranged between 36.1 and 73.9 years. Random sequence generation and allocation concealment were at low risk of bias in eight and one studies respectively. One study reported low risk methods for blinding of participants and investigators, and outcome assessment was blinded in seven studies. Twelve studies were at low risk of attrition bias, eight studies were at low risk of selective reporting bias, and 21 studies were at low risk of other potential sources of bias. Cognitive behavioural therapy probably improves depressive symptoms measured using the Beck Depression Inventory (4 studies, 230 participants: MD -6.10, 95% CI -8.63 to -3.57), based on moderate certainty evidence. Cognitive behavioural therapy compared to usual care probably improves HRQoL measured either with the Kidney Disease Quality of Life Instrument Short Form or the Quality of Life Scale, with a 0.5 standardised mean difference representing a moderate effect size (4 studies, 230 participants: SMD 0.51, 95% CI 0.19 to 0.83) , based on moderate certainty evidence. Cognitive behavioural therapy may reduce major depression symptoms (one study) and anxiety, and increase self-efficacy (one study). Cognitive behavioural therapy studies did not report hospitalisation. We found low-certainty evidence that counselling may slightly reduce depressive symptoms measured with the Beck Depression Inventory (3 studies, 99 participants: MD -3.84, 95% CI -6.14 to -1.53) compared to usual care. Counselling reported no difference in HRQoL (one study). Counselling studies did not measure risk of major depression, suicide, or hospitalisation. Exercise may reduce or prevent major depression (3 studies, 108 participants: RR 0.47, 95% CI 0.27 to 0.81), depression of any severity (3 studies, 108 participants: RR 0.69, 95% CI 0.54 to 0.87) and improve HRQoL measured with Quality of Life Index score (2 studies, 64 participants: MD 3.06, 95% CI 2.29 to 3.83) compared to usual care with low certainty. With moderate certainty, exercise probably improves depression symptoms measured with the Beck Depression Inventory (3 studies, 108 participants: MD -7.61, 95% CI -9.59 to -5.63). Exercise may reduce anxiety (one study). No exercise studies measured suicide risk or withdrawal from dialysis. We found moderate-certainty evidence that relaxation techniques probably reduce depressive symptoms measured with the Beck Depression Inventory (2 studies, 122 participants: MD -5.77, 95% CI -8.76 to -2.78). Relaxation techniques reported no difference in HRQoL (one study). Relaxation studies did not measure risk of major depression or suicide. Spiritual practices have uncertain effects on depressive symptoms measured either with the Beck Depression Inventory or the Brief Symptom Inventory (2 studies, 116 participants: SMD -1.00, 95% CI -3.52 to 1.53; very low certainty evidence). No differences between spiritual practices and usual care were reported on anxiety (one study), and HRQoL (one study). No study of spiritual practices evaluated effects on suicide risk, withdrawal from dialysis or hospitalisation. There were few or no data on acupressure, telephone support, meditation and adverse events related to psychosocial interventions. AUTHORS' CONCLUSIONS Cognitive behavioural therapy, exercise or relaxation techniques probably reduce depressive symptoms (moderate-certainty evidence) for adults with ESKD treated with dialysis. Cognitive behavioural therapy probably increases health-related quality of life. Evidence for spiritual practices, acupressure, telephone support, and meditation is of low certainty . Similarly, evidence for effects of psychosocial interventions on suicide risk, major depression, hospitalisation, withdrawal from dialysis, and adverse events is of low or very low certainty.
Collapse
Affiliation(s)
- Patrizia Natale
- University of BariDepartment of Emergency and Organ TransplantationBariItaly
- The University of SydneySydney School of Public HealthSydneyAustralia
| | - Suetonia C Palmer
- University of Otago ChristchurchDepartment of Medicine2 Riccarton AvePO Box 4345ChristchurchNew Zealand8140
| | - Marinella Ruospo
- University of BariDepartment of Emergency and Organ TransplantationBariItaly
- The University of SydneySydney School of Public HealthSydneyAustralia
| | - Valeria M Saglimbene
- University of BariDepartment of Emergency and Organ TransplantationBariItaly
- The University of SydneySydney School of Public HealthSydneyAustralia
| | | | - Giovanni FM Strippoli
- University of BariDepartment of Emergency and Organ TransplantationBariItaly
- The University of SydneySydney School of Public HealthSydneyAustralia
- The Children's Hospital at WestmeadCochrane Kidney and Transplant, Centre for Kidney ResearchWestmeadNSWAustralia2145
| | | |
Collapse
|
24
|
Chilcot J, Farrington K. Self-reported antidepressant use in haemodialysis patients is associated with increased mortality independent of concurrent depression severity. Clin Kidney J 2019; 13:1109-1110. [PMID: 33391758 PMCID: PMC7769514 DOI: 10.1093/ckj/sfz160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 10/14/2019] [Indexed: 01/10/2023] Open
Affiliation(s)
- Joseph Chilcot
- Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ken Farrington
- Renal Unit, Lister Hospital, Stevenage, UK.,Centre for Health Services and Clinical Research, University of Hertfordshire, Hatfield, UK
| |
Collapse
|
25
|
Ng CZ, Tang SC, Chan M, Tran BX, Ho CS, Tam WW, Ho RC. A systematic review and meta-analysis of randomized controlled trials of cognitive behavioral therapy for hemodialysis patients with depression. J Psychosom Res 2019; 126:109834. [PMID: 31525637 DOI: 10.1016/j.jpsychores.2019.109834] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 09/08/2019] [Accepted: 09/09/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this meta-analysis was to examine the efficacy of cognitive behavioral therapy (CBT) for hemodialysis patients with comorbid depression and to identify which other aspects, including anxiety and quality of life, can be improved through intervention. METHODS A systematic literature review was performed using multiple databases (PubMed, EMBase, PsycINFO, CENTRAL). The inclusion criteria included randomized controlled trials (RCTs) of CBT conducted in hemodialysis patients with depression. Study reporting quality was assessed with the Cochrane tool and Review Manager version 5.3 was used to obtain pooled results. RESULTS Eight RCTs, with a total sample size of 540 participants, met the inclusion criteria. Compared with control groups, the CBT groups had statistically significant improvements in depression (standardized mean differences [SMD] = -0.68, 95% confidence interval [CI] (-0.94 to -0.42), P < .001), anxiety (SMD = -0.99, 95%CI (-1.99 to 0.00), P = .05) and quality of life (SMD = 0.34, 95%CI (0.13 to 0.54), P < .001). CONCLUSIONS The results of this meta-analysis showed that CBT could have an effective role in reducing symptoms of depression and anxiety as well as improving quality of life in hemodialysis patients with comorbid depression.
Collapse
Affiliation(s)
- Chong Zheng Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Sydney C Tang
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Meanne Chan
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Bach X Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Viet Nam; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Cyrus S Ho
- Department of Psychological Medicine, National University Health System, Singapore
| | - Wilson W Tam
- Alice Lee School of Nursing, National University of Singapore, Singapore
| | - Roger C Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 119077, Singapore; Biomedical Global Institute of Healthcare Research & Technology (BIGHEART), National University of Singapore, 119228, Singapore; Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 700000, Viet Nam; Faculty of Education, Huaibei Normal University, 100 Dongshan Road, Huaibei, Anhui 235000, China.
| |
Collapse
|
26
|
Chilcot J, Farrington K. The Case for Selective Withdrawal of Antidepressants in Patients with Advanced Kidney Disease. J Am Soc Nephrol 2019; 30:1339-1340. [PMID: 31160515 PMCID: PMC6622428 DOI: 10.1681/asn.2019030308] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Joseph Chilcot
- Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom;
| | - Ken Farrington
- Renal Unit, Lister Hospital, Stevenage, United Kingdom; and
- Postgraduate Medicine, The University of Hertfordshire, Hatfield, United Kingdom
| |
Collapse
|
27
|
Wen X, Wang Y, Zhao Q, Zhang H, Shi H, Wang M, Lu P. Nonpharmacological Interventions for Depressive Symptoms in End-Stage Renal Disease: A Systematic Review. West J Nurs Res 2019; 42:462-473. [PMID: 31248356 DOI: 10.1177/0193945919857540] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Depressive symptoms are common in patients with end-stage renal disease, which can affect treatment and prognosis. We aimed to evaluate the effects of nonpharmacological interventions for depressive symptoms in end-stage renal disease. Eligible studies were identified using PubMed, Web of Science, the Cochrane Library, Embase, and PsycNET (up to March 2019). We identified 24 studies including 1,376 patients. We found that psychological intervention (-0.60, 95% confidence interval [CI] = [-0.87, -0.33]), exercise (-1.13, 95% CI = [-1.56, -0.69]), and manual acupressure (-0.26, 95% CI = [-0.50, 0.03]) were associated with a significant effect on depressive symptoms. However, few studies reported adverse events, and conclusions about safety should be drawn cautiously. While the available data show that nonpharmacological interventions are potential strategies to alleviate depressive symptoms of patients with end-stage renal disease, recommendation of the most efficacious interventions for this population will require future randomized controlled trials with large-scale, long-term intervention.
Collapse
Affiliation(s)
- Xin Wen
- Jilin University, Changchun, China
| | - Yu Wang
- Jilin University, Changchun, China
| | | | | | | | | | | |
Collapse
|
28
|
Chilcot J, Hudson JL. Is successful treatment of depression in dialysis patients an achievable goal? Semin Dial 2018; 32:210-214. [PMID: 30418698 DOI: 10.1111/sdi.12755] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Depression is undisputedly common among individuals with End-Stage Kidney Failure and associated with adverse outcomes. It is well recognized that effective treatments for depression are needed within routine dialysis care. But, are we any closer to successfully treating depression in dialysis patients? We consider this question here with respect to two common treatments, antidepressant medication and cognitive behavioural therapy (CBT). Currently, there are limited data from randomized placebo-controlled trials regarding the acceptability and efficacy of antidepressants. CBT trials appear to show more consistent treatment effects, albeit the feasibility of routine delivery remains unknown. No studies in dialysis patients has evaluated the combined effects of CBT with antidepressants. There is a need to consider pragmatic depression treatment trials in dialysis patients in order to increase study recruitment in order to have more reliable data from which to evaluate the evidence base. Furthermore, we need to understand why treatments work, and for whom do they work? Lastly, addressing issues surrounding treatment acceptability and implementation as part of regular care remain as key challenges that require attention if we are to improve the mental health of individuals on dialysis.
Collapse
Affiliation(s)
- Joseph Chilcot
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Joanna L Hudson
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| |
Collapse
|
29
|
Self-reported depression symptoms in haemodialysis patients: Bi-factor structures of two common measures and their association with clinical factors. Gen Hosp Psychiatry 2018; 54:31-36. [PMID: 30145391 DOI: 10.1016/j.genhosppsych.2018.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/12/2018] [Accepted: 08/16/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To validate the factor structure of two common self-report depression tools in a large sample of haemodialysis (HD) patients and to examine their demographic and clinical correlates, including urine output, history of depression and transplantation. METHODS Factor structures of the Beck Depression Inventory (BDI-II) and Patient Health Questionnaire (PHQ-9) were evaluated using confirmatory factor analysis (CFA). Data was utilised from the screening phase (n = 709) of a placebo-controlled feasibility randomised control trial (RCT) of sertraline in HD patients with mild to moderate Major Depressive Disorder. Alternative factor models including bi-factor models for the BDI-II and PHQ-9 were evaluated. Coefficient omega and omega-hierarchical were calculated. RESULTS For both measures, bi-factor measurement models had the overall best fit to the data, with dominant general depression factors. Omega-hierarchical for the general BDI-II and PHQ-9 factors was 0.94 and 0.88 respectively. Both general factors had high reliability (coefficient omega = 0.97 and 0.94 respectively) and explained over 85% of the explained common variance within their respective models. BDI-II and PHQ-9 general depression factors were negatively associated with age and urine output and positively with a history of depression, antidepressant use within the last 3 months and a history of failed transplantation. In adjusted regression models, age, urine output and a history of depression remained significant. CONCLUSIONS These data suggest that both the BDI-II and PHQ-9 are sufficiently unidimensional to warrant the use of a total score. Younger age, lower urine output and a history of depression appear consistent correlates of depression severity among HD patients.
Collapse
|
30
|
Davenport A, Guirguis A, Almond M, Day C, Chilcot J, Da Silva Gane M, Fineberg N, Friedl K, Spencer B, Wellsted D, Farrington K. Postdialysis recovery time is extended in patients with greater self-reported depression screening questionnaire scores. Hemodial Int 2018; 22:369-376. [PMID: 29461016 DOI: 10.1111/hdi.12642] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 12/26/2017] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Most patients take time to recover after a hemodialysis (HD) session. It has been suggested that recovery time is associated with intradialytic hypotension and rapid solute clearances. Other studies have reported a linkage to depression. We investigated the association between recovery time and intradialytic hypotension and depression. METHODS In five UK HD units, we screened for depressive symptoms using the Beck depression inventory-II, Patient Health Questionnaire, and recorded sessional blood pressures and Kt/Vurea. FINDINGS Seven hundred and one HD patients were studied; 63.6% male, mean age 64.1 ± 16.6 years, 33.5% diabetic. About 24.1% recovered in <1 hour, 27% 1-4 hours, 15.4% 4-8 hours, 10.7% 8-12 hours, and 22.8% after 12 hours. Systolic blood pressure fell by ≥20 mmHg in 30.9% postdialysis, and to <100 mmHg in 7.6%. In multivariate analysis, patients with recovery times >1 hour were more likely to be female, have high self-reported Beck depression inventory-II scores, a past medical history of depression, and be living without a partner. Longer recovery times were also associated with very low postdialysis systolic blood pressures (<100 mmHg), and higher body weight. However, the model predicted only 18% of the variation in recovery times. We found no association between recovery times and short-term mortality risk. DISCUSSION Prolonged postdialysis recovery times are associated with higher self-reported depression scores, and very low postdialysis blood pressure. Future studies investigating changes in dialysis practice and recovery times will need to target strategies to prevent intradialytic hypotension and adjust for patient psychological status.
Collapse
Affiliation(s)
| | - Ayman Guirguis
- Centre for Health Services and Clinical Research, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK.,Renal Unit, Lister Hospital, East & North Herts NHS Trust, Stevenage, UK.,Hertfordshire Partnership University NHS Foundation Trust, Rosanne House, Welwyn Garden City, UK
| | - Michael Almond
- Southend University Hospital NHS Foundation Trust, Essex, UK
| | - Clara Day
- Department of Renal Medicine, Queen Elizabeth Hospital, Birmingham, UK
| | - Joseph Chilcot
- Health Psychology Section, Psychology Department, King's College London, London, UK
| | - Maria Da Silva Gane
- Centre for Health Services and Clinical Research, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK.,Renal Unit, Lister Hospital, East & North Herts NHS Trust, Stevenage, UK
| | - Naomi Fineberg
- Hertfordshire Partnership University NHS Foundation Trust, Rosanne House, Welwyn Garden City, UK
| | - Karin Friedl
- Centre for Health Services and Clinical Research, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Benjamin Spencer
- Department of Psychological Medicine, Weston Education Centre, Institute of Psychiatry, Psychology and 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, Hatfield, UK
| | - Ken Farrington
- Centre for Health Services and Clinical Research, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK.,Renal Unit, Lister Hospital, East & North Herts NHS Trust, Stevenage, UK
| |
Collapse
|
31
|
Hudson JL, Moss-Morris R, Norton S, Picariello F, Game D, Carroll A, Spencer J, McCrone P, Hotopf M, Yardley L, Chilcot J. Tailored online cognitive behavioural therapy with or without therapist support calls to target psychological distress in adults receiving haemodialysis: A feasibility randomised controlled trial. J Psychosom Res 2017; 102:61-70. [PMID: 28992899 DOI: 10.1016/j.jpsychores.2017.09.009] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 09/18/2017] [Accepted: 09/19/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Psychological distress is prevalent in haemodialysis (HD) patients yet access to psychotherapy remains limited. This study assessed the feasibility and acceptability of online cognitive-behavioural therapy (CBT) tailored for HD patients, with or without therapist support, for managing psychological distress. METHODS This feasibility randomised controlled trial recruited patients from a UK HD centre. Following psychological distress screens, patients with mild-moderate psychological distress (Patient Health Questionnaire PHQ-9; score: 5-19 and/or Generalised Anxiety Disorder; GAD-7 score: 5-14) who met remaining inclusion criteria were approached for consent. Consenters were individually randomised (1:1) to online-CBT or online-CBT plus three therapist support calls. Outcomes included recruitment, retention, and adherence rates. Exploratory change analyses were performed for: psychological distress, quality of life (QoL), illness perceptions, and costs. The statistician was blinded to allocation. RESULTS 182 (44%) out of 410 patients approached completed psychological distress screens. 26% found screening unacceptable; a further 30% found it unfeasible. Psychological distress was detected in 101 (55%) patients, 60 of these met remaining inclusion criteria. The primary reason for ineligibility was poor computer literacy (N=17, 53%). Twenty-five patients were randomised to the supported (N=18) or unsupported arm (N=7); 92% were retained at follow-up. No differences in psychological distress or cost-effectiveness were observed. No trial adverse events occurred. CONCLUSION Online CBT appears feasible but only for computer literate patients who identify with the label psychological distress. A definitive trial using the current methods for psychological distress screening and online care delivery is unfeasible. ClinicalTrials.gov Identifier: NCT02352870.
Collapse
Affiliation(s)
- Joanna L Hudson
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
| | - Rona Moss-Morris
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
| | - Sam Norton
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
| | - Federica Picariello
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
| | | | | | - Jonathan Spencer
- King's Health Economics, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK
| | - Paul McCrone
- King's Health Economics, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK.
| | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK.
| | - Lucy Yardley
- Psychology Department, University of Southampton, UK; Nuffield Department of Primary Care and Health Sciences, University of Oxford, UK.
| | - Joseph Chilcot
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
| |
Collapse
|