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Wichart J, Yoeun P, Chin T, Evernden C, Berendonk C, Kerr J, Birchall A, Boschee B, Defoe K, Dhaliwal J, KarisAllen T, Kennedy M, McDonald A, Mierzejewski MK, Schick-Makaroff K. Pharmacological treatment for mental health illnesses in adults receiving dialysis: A scoping review. Fundam Clin Pharmacol 2024. [PMID: 38877814 DOI: 10.1111/fcp.13022] [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: 11/28/2023] [Revised: 05/28/2024] [Accepted: 06/03/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Pharmacologic management of mental health illnesses in patients receiving dialysis is complex and lacking data. OBJECTIVE Our objective was to synthesize published data for the treatment of depression, bipolar and related disorders, schizophrenia or psychotic disorders, and anxiety disorders in adults receiving hemodialysis or peritoneal dialysis. METHODS We undertook a scoping review, searching the following databases: Medline, Embase, CINAHL, PsycINFO, Cochrane Library, Scopus, and Web of Science. Data on patients who received only short-term dialysis, a kidney transplant, or non-pharmacologic treatments were excluded. RESULTS Seventy-three articles were included: 41 focused on depression, 16 on bipolar disorder, 13 on schizophrenia and psychotic disorders, 1 on anxiety disorders, and 2 addressing multiple mental health illnesses. The majority of depression studies reported on selective serotonin reuptake inhibitors (SSRIs) as a treatment. Sertraline had the most supporting data with use of doses from 25 to 200 mg daily. Among the remaining SSRIs, escitalopram, citalopram, and fluoxetine were studied in controlled trials, whereas paroxetine and fluvoxamine were described in smaller reports and observational trials. There are limited published data on other classes of antidepressants and on pharmacological management of anxiety. Data on treatment for patients with bipolar disorder or schizophrenia and related disorders are limited to case reports. CONCLUSION Over half of the studies included were case reports, thus limiting conclusions. More robust data are required to establish effect sizes of pharmacological treatments prior to providing specific recommendations for their use in treating mental health illnesses in patients receiving dialysis.
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Affiliation(s)
- Jenny Wichart
- Pharmacy Services, Alberta Health Services, Calgary, Alberta, Canada
| | - Peter Yoeun
- Pharmacy Services, Alberta Health Services, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Tracy Chin
- Pharmacy Services, Alberta Health Services, South Health Campus, Calgary, Alberta, Canada
| | - Christopher Evernden
- Pharmacy Services, Alberta Health Services, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Charlotte Berendonk
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alberta, Canada
| | - Jodi Kerr
- Pharmacy Services, Medicine Hat Regional Hospital, Medicine Hat, Alberta, Canada
| | - Alexandra Birchall
- DTC OR/PACU, Alberta Health Services, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Belinda Boschee
- Pharmacy Services, Alberta Health Services, Sheldon M. Chumir Medical Centre, Calgary, Alberta, Canada
| | - Kimberly Defoe
- Alberta Health Services, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Jasleen Dhaliwal
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alberta, Canada
| | - Tasia KarisAllen
- Pharmacy Services, Alberta Health Services, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Megan Kennedy
- Sperber Health Sciences Library, University of Alberta Library, Edmonton, Alberta, Canada
| | - Alexis McDonald
- Pharmacy Services, Alberta Health Services, Chinook Regional Hospital, Lethbridge, Alberta, Canada
| | - Monika K Mierzejewski
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alberta, Canada
| | - Kara Schick-Makaroff
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alberta, Canada
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Burrows B, Ma JE, Bowling CB. Is Apathy a New Risk Factor for Adverse Health Outcomes Among Older Adults With CKD? Am J Kidney Dis 2024; 83:133-135. [PMID: 38108673 DOI: 10.1053/j.ajkd.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 10/22/2023] [Indexed: 12/19/2023]
Affiliation(s)
- Brett Burrows
- Center for the Study of Aging and Human Development (the Aging Center), Duke University, Durham, North Carolina; Department of Medicine, Duke University, Durham, North Carolina
| | - Jessica E Ma
- Department of Medicine, Duke University, Durham, North Carolina
| | - C Barrett Bowling
- Center for the Study of Aging and Human Development (the Aging Center), Duke University, Durham, North Carolina; Department of Medicine, Duke University, Durham, North Carolina; Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham Veterans Affairs Health Care System, Durham, North Carolina.
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Parker CP, McMahan K, Rhodes B, Lokken K, Jain G. A Novel Nephropsychology Clinic: Partnering With Patients in the Era of Value-Based Care in Nephrology. ADVANCES IN KIDNEY DISEASE AND HEALTH 2024; 31:46-51. [PMID: 38403393 DOI: 10.1053/j.akdh.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 12/06/2023] [Accepted: 12/11/2023] [Indexed: 02/27/2024]
Abstract
CKD and end-stage kidney disease are highly prevalent and complex chronic conditions with a high disease burden that corresponds to a high cost of care. Mental health conditions have a high prevalence in this population and add to the burden of disease, increase the cost of care, and are co-related with worse clinical outcomes. Despite these clear co-relations, mental health disorders remain underdiagnosed and undertreated in this population, secondary to multiple reasons, including patient-specific factors as well as systematic issues, including difficulty in accessing mental health experts. Here we describe a novel collaborative care model for patients with advanced CKD within the nephrology clinic space, in the form of a nephropsychology clinic. We present the details of our clinic, our preliminary findings, and propose that an integrated behavioral health model offers convenience for the patient and improves workflow for the physician, allowing a pathway to timely mental health interventions.
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Affiliation(s)
- Christina Pierpaoli Parker
- Department of Psychiatry and Behavioral Neurobiology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Kristina McMahan
- Department of Psychiatry and Behavioral Neurobiology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Brody Rhodes
- Division of Nephrology, Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Kristine Lokken
- Department of Psychiatry and Behavioral Neurobiology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Gaurav Jain
- Division of Nephrology, Department of Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL.
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