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Tsuruya K, Arima H, Iseki K, Hirakata H. Association of dialysis-related amyloidosis with lower quality of life in patients undergoing hemodialysis for more than 10 years: The Kyushu Dialysis-Related Amyloidosis Study. PLoS One 2021; 16:e0256421. [PMID: 34428227 PMCID: PMC8384206 DOI: 10.1371/journal.pone.0256421] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 08/07/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Dialysis-related amyloidosis (DRA) commonly develops in patients undergoing long-term dialysis and can lead to a decline in activities of daily living and quality of life (QOL), mainly owing to orthopedic complications. METHODS First, we determined utility scores of the EuroQol 5-Dimensions 3-Levels (EQ-5D-3L) questionnaire in 1,323 patients with DRA who had undergone dialysis for more than 10 years and compared the score between those with and without DRA. Second, a 2-year follow-up was also performed, in which patients were divided into three groups: those complicated by DRA from the beginning, those with newly developed DRA within the 2-year period, and those not complicated by DRA throughout the survey period; changes in the EQ-5D-3L utility score were compared. In the group already complicated by DRA at the survey baseline, changes in the EQ-5D-3L utility score were compared according to the dialysis treatment method. RESULTS A total of 1,314 and 931 patients were included in the first and second studies, respectively. EQ-5D-3L utility scores among patients diagnosed with DRA were significantly lower than scores in those not diagnosed with DRA. The reduction in the EQ-5D-3L utility score over the 2-year follow-up was significantly greater in patients newly complicated by DRA during the follow-up period after enrollment but not in those complicated by DRA from the beginning, as compared with patients not complicated by DRA throughout the survey period. The reduction in utility score tended to be lower in patients routinely treated with a β2-microglobulin adsorption column than in untreated patients with DRA. CONCLUSION Complication by DRA in patients undergoing long-term hemodialysis was significantly associated with a decline in QOL.
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Affiliation(s)
- Kazuhiko Tsuruya
- Department of Nephrology, Nara Medical University, Kashihara, Japan
- Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Fukuoka University, Fukuoka, Japan
| | - Kunitoshi Iseki
- Clinical Research Support Center, Nakamura Clinic, Urasoe, Japan
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2
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Liao CY, Chung CH, Lu KC, Cheng CY, Yang SS, Chien WC, Wu CC. Taking Sleeping Pills and the Risk of Chronic Kidney Disease: A Nationwide Population-Based Retrospective Cohort Study. Front Pharmacol 2021; 11:524113. [PMID: 33584251 PMCID: PMC7873926 DOI: 10.3389/fphar.2020.524113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 11/16/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Sleeping disorder has been associated with chronic kidney disease (CKD); however, the correlation between sleeping pills use and CKD has not been investigated in-depth yet. This study elucidated the potential association of sleeping pill use with the risk of CKD and CKD progression to end-stage renal disease (ESRD) requiring dialysis. Methods: This study was based on a population-based cohort that included 209,755 sleeping pill users among 989,753 individuals. After applying the exclusion criteria, 186,654 sleeping pill users and 373,308 nonusers were enrolled to monitor the occurrence of CKD. Using a cumulative daily dose, we analyzed the types of sleeping pills related to the risk of CKD and ESRD. Propensity score matching and analysis using Cox proportional hazards regression were performed with adjustments for sex, age, and comorbidities. Results: Sleeping pill use was related to increased CKD risk after adjusting for underlying comorbidities (adjusted hazard ratio [aHR] = 1.806, 95% confidence interval [CI]: 1.617-2.105, p < 0.001). With the exception of hyperlipidemia, most comorbidities correlated with an increased risk of CKD. Persistent use of sleeping pills after CKD diagnosis increased the risk of concurrent ESRD (aHR = 7.542; 95% CI: 4.267-10.156; p < 0.001). After the subgroup analysis for sleeping pill use, brotizolam (p = 0.046), chlordiazepoxide (p < 0.001), clonazepam (p < 0.001), diazepam (p < 0.001), dormicum (p < 0.001), estazolam (p < 0.001), fludiazepam (p < 0.001), flunitrazepam (p < 0.001), nitrazepam (p < 0.001), trazodone (p < 0.001), zolpidem (p < 0.001), and zopiclone (p < 0.001) were found to have significant correlation with increased CKD risk. Conclusion: Sleeping pill use was related to an increased risk of CKD and ESRD. Further studies are necessary to corroborate these findings.
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Affiliation(s)
- Chen-Yi Liao
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan.,Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Hsiang Chung
- School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
| | - Kuo-Cheng Lu
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Division of Nephrology, Department of Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Cheng-Yi Cheng
- PET Center and Department of Nuclear Medicine, Tri-Service General Hospital, Taipei, Taiwan.,School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Sung-Sen Yang
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Wu-Chien Chien
- School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chia-Chao Wu
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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3
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Influence of unstable psychological condition on the quality of life of hemodialysis patients. RENAL REPLACEMENT THERAPY 2020. [DOI: 10.1186/s41100-020-00271-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Purpose
Hemodialysis patients tend to be in “unstable psychological conditions” because of complications and physical activity restriction. This study aimed to investigate unusual psychological factors and their influence on the quality of life (QOL) of hemodialysis patients.
Methods
This study targeted 55 patients who had experienced > 1 year of stable maintenance outpatient hemodialysis. The Hospital Anxiety and Depression Scale (HADS) was used to evaluate unusual psychological conditions. The Kidney Disease Quality of Life Short Form (KDQOL-SF) was used to evaluate QOL. Participants were grouped into “unstable psychological conditions” if HADS indicated that “depression is suspected” or “suspected depression, anxiety stated” (“Anxiety/Depression group”); this group was then compared to the “Stable group”.
Results
A total of 18 participants (32.7%) were included in the “Anxiety/Depression group”, and all QOL scores in this group were lower than those in the “Stable group”. In particular, a significantly low value was shown in the respective criteria such as “effects of kidney disease,” “social support,” and “general health perceptions”.
Conclusions
A possibility was suggested that the major causes were the restrictions of social activity by hospital visits and treatment and unique psychological conditions.
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4
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Asghar MS, Ahsan MN, Jawed R, Rasheed U, Ali Naqvi SA, Hassan M, Yaseen R, Mallick N, Zehra M, Saleem M. A Comparative Study on the Use of Alprazolam and Melatonin for Sleep Disturbances in Hemodialysis Patients. Cureus 2020; 12:e11754. [PMID: 33403184 PMCID: PMC7773292 DOI: 10.7759/cureus.11754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background and objectives Sleep disorders are prevalent in end-stage renal disease (ESRD) involving the majority of patients undergoing hemodialysis. The main objective of treating sleep disorders in patients of ESRD is to correct subjective and objective sleep quality, decrease fatigue and daytime sleepiness, and enhance daytime functioning. Irrespective of the adverse effects reported, benzodiazepines are widely utilized among patients with sleep disorders in end-stage renal disease. Melatonin is a newer agent being studied for use in hemodialysis patients for improvement of sleep quality. The aim of our observational study is to witness the effectiveness of both benzodiazepine and exogenous melatonin as a treatment of sleep disorders in patients undergoing hemodialysis. Materials and methods We conducted a comparative, observational study in ESRD patients who are on hemodialysis. These patients were selected from attendees of the hemodialysis unit, nephrology department of a tertiary care hospital, including those who were on regular hemodialysis, thrice-weekly in frequency for at least once per year, and taking regular sleep medications for at least three months with frequently reported drug dosages of alprazolam 0.5 mg once daily or melatonin 3 mg once daily (before bedtime). The subjective sleep assessment was done by utilizing four scales, including the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), and Stanford Sleepiness Scale (SSS). Results A total of 117 hemodialysis-dependent patients met the inclusion criteria, among whom 79 patients were using alprazolam while 38 were using melatonin for their disturbed sleep. The mean age of the study participants was 49.12 ± 12.75, comprising 72 males (61.53%) and 45 females (38.46%). The duration of the diagnosis of chronic kidney disease (CKD), duration of onset of hemodialysis, and estimated glomerular filtration rate (eGFR) was comparable in both groups. Both groups had similar laboratory markers except for higher hemoglobin in the melatonin group (p=0.028) and high parathyroid hormone (PTH) levels in the alprazolam group (p=0.001). PSQI scores were 8.76 ± 3.09 in the alprazolam group and 7.32 ± 2.65 in the melatonin group (p=0.015). In the sub-scores, there were no differences in sleep latency (p=0.481) and daytime dysfunction (p=0.662) while sleep efficiency (p=0.167) and subjective sleep quality (p=0.132) were not statistically significant. The significant differences were lower scores of sleep duration (p=0.040) and sleep disturbance (p=0.003) in the melatonin group. The ESS scores revealed no significant difference in either group (p=0.074). With respect to the ISI and SSS, higher scores were obtained in the alprazolam group. Overall, 89 study participants had reported poor sleep quality, out of which 81% were using alprazolam, and 65% were using melatonin (p=0.071). A total of 50 study participants exhibited excessive daytime sleepiness with 45% of them were using alprazolam and 36% were using melatonin. About 54% of the alprazolam using hemodialysis patients had moderate insomnia while 50% of the melatonin using patients had sub-threshold insomnia (p=0.062). Conclusion As melatonin use has shown better sleep quality and less insomnia severity as compared to alprazolam use in our study, it is postulated that the sleep-wake cycle should be commonly targeted by pharmacological therapy in ESRD.
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Affiliation(s)
| | | | - Rumael Jawed
- Internal Medicine, Liaquat National Hospital, Karachi, PAK
| | - Uzma Rasheed
- Internal Medicine, Liaquat National Hospital, Karachi, PAK
| | | | - Maira Hassan
- Internal Medicine, Liaquat National Hospital, Karachi, PAK
| | - Rabail Yaseen
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Najia Mallick
- Surgery, Dow University of Health Sciences, Karachi, PAK
| | - Mahrukh Zehra
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
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5
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Mathieu C, Joly P, Jacqmin-Gadda H, Wanneveich M, Bégaud B, Pariente A. Patterns of Benzodiazepine Use and Excess Risk of All-Cause Mortality in the Elderly: A Nationwide Cohort Study. Drug Saf 2020; 44:53-62. [PMID: 33125663 DOI: 10.1007/s40264-020-00992-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Despite the risks associated with their use, benzodiazepines remain used more widely than wisely. In this context, a better understanding of how their patterns of use can be associated with an increased risk of death appears essential. Indeed, the studies that investigated this association so far are inconsistent and question the influence of potential biases. OBJECTIVE The objective of this study was to investigate the association of various patterns of benzodiazepine use with all-cause mortality. METHODS A nationwide cohort of non-prevalent benzodiazepine users aged ≥ 65 years was identified using French healthcare insurance system claims databases. Exposure to benzodiazepines considered short-term, chronic (defined as a cumulated ≥ 6-month period over the previous 12 months), ongoing, and discontinued use. Using a Cox model, adjusted hazard ratios for all-cause mortality were estimated according to benzodiazepine patterns of use; exposure and confounders were treated as time-dependent variables. RESULTS In the cohort of 54,958 individuals aged ≥ 65 years, adjusted hazard ratios for all-cause mortality and benzodiazepines were 2.26 (95% confidence interval 1.96-2.61) for short-term use, 3.86 (3.04-4.90) for chronic use-discontinued, and 3.05 (2.17-4.29) for chronic use-ongoing. At age 80 years, these were 1.62 (1.48-1.79), 2.00 (1.82-2.19) and 1.13 (1.02-1.26), respectively. Adjusted hazard ratios show similar decreases with age for all patterns of benzodiazepine use. CONCLUSIONS These findings confirm the existence of an excess risk of mortality associated with benzodiazepine use and provide pattern- and age-specific estimates. Higher risks were observed for patients aged < 80 years, short-term use, or chronic use recently interrupted. If the two latter can relate to an indication bias, the associations found for ongoing chronic use and short-term use conversely support a potential causal hypothesis.
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Affiliation(s)
- Clément Mathieu
- Univ. Bordeaux, INSERM, BPH, U1219, Team Pharmacoepidemiology, Univ. Bordeaux, F-33000, Bordeaux, France
| | - Pierre Joly
- Univ. Bordeaux, INSERM, BPH, U1219, Team Biostatistics, Univ. Bordeaux, F-33000, Bordeaux, France
| | - Hélène Jacqmin-Gadda
- Univ. Bordeaux, INSERM, BPH, U1219, Team Biostatistics, Univ. Bordeaux, F-33000, Bordeaux, France
| | - Mathilde Wanneveich
- Univ. Bordeaux, INSERM, BPH, U1219, Team Biostatistics, Univ. Bordeaux, F-33000, Bordeaux, France
| | - Bernard Bégaud
- Univ. Bordeaux, INSERM, BPH, U1219, Team Pharmacoepidemiology, Univ. Bordeaux, F-33000, Bordeaux, France.,CHU Bordeaux, Pôle de Santé Publique, Centre de Pharmacovigilance de Bordeaux, Service de Pharmacologie Médicale, 33000, Bordeaux, France
| | - Antoine Pariente
- Univ. Bordeaux, INSERM, BPH, U1219, Team Pharmacoepidemiology, Univ. Bordeaux, F-33000, Bordeaux, France. .,CHU Bordeaux, Pôle de Santé Publique, Centre de Pharmacovigilance de Bordeaux, Service de Pharmacologie Médicale, 33000, Bordeaux, France.
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6
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Muzaale AD, Daubresse M, Bae S, Chu NM, Lentine KL, Segev DL, McAdams-DeMarco M. Benzodiazepines, Codispensed Opioids, and Mortality among Patients Initiating Long-Term In-Center Hemodialysis. Clin J Am Soc Nephrol 2020; 15:794-804. [PMID: 32457228 PMCID: PMC7274292 DOI: 10.2215/cjn.13341019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 03/16/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Mortality from benzodiazepine/opioid interactions is a growing concern in light of the opioid epidemic. Patients on hemodialysis suffer from a high burden of physical/psychiatric conditions, which are treated with benzodiazepines, and they are three times more likely to be prescribed opioids than the general population. Therefore, we studied mortality risk associated with short- and long-acting benzodiazepines and their interaction with opioids among adults initiating hemodialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS The cohort of 69,368 adults initiating hemodialysis (January 2013 to December 2014) was assembled by linking US Renal Data System records to Medicare claims. Medicare claims were used to identify dispensed benzodiazepines and opioids. Using adjusted Cox proportional hazards models, we estimated the mortality risk associated with benzodiazepines (time varying) and tested whether the benzodiazepine-related mortality risk differed by opioid codispensing. RESULTS Within 1 year of hemodialysis initiation, 10,854 (16%) patients were dispensed a short-acting benzodiazepine, and 3262 (5%) patients were dispensed a long-acting benzodiazepine. Among those who were dispensed a benzodiazepine during follow-up, codispensing of opioids and short-acting benzodiazepines occurred among 3819 (26%) patients, and codispensing of opioids and long-acting benzodiazepines occurred among 1238 (8%) patients. Patients with an opioid prescription were more likely to be subsequently dispensed a short-acting benzodiazepine (adjusted hazard ratio, 1.66; 95% confidence interval, 1.59 to 1.74) or a long-acting benzodiazepine (adjusted hazard ratio, 1.11; 95% confidence interval, 1.03 to 1.20). Patients dispensed a short-acting benzodiazepine were at a 1.45-fold (95% confidence interval, 1.35 to 1.56) higher mortality risk compared with those without a short-acting benzodiazepine; among those with opioid codispensing, this risk was 1.90-fold (95% confidence interval, 1.65 to 2.18; Pinteraction<0.001). In contrast, long-acting benzodiazepine dispensing was inversely associated with mortality (adjusted hazard ratio, 0.84; 95% confidence interval, 0.72 to 0.99) compared with no dispensing of long-acting benzodiazepine; there was no differential risk by opioid dispensing (Pinteraction=0.72). CONCLUSIONS Codispensing of opioids and short-acting benzodiazepines is common among patients on dialysis, and it is associated with higher risk of death.
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Affiliation(s)
- Abimereki D. Muzaale
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Matthew Daubresse
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sunjae Bae
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Nadia M. Chu
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Krista L. Lentine
- Department of Medicine, St. Louis University School of Medicine, St. Louis, Missouri
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mara McAdams-DeMarco
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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7
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Fang HF, Lee TY, Hui KC, Yim HCH, Chi MJ, Chung MH. Association between Sedative-hypnotics and Subsequent Cancer in Patients with and without Insomnia: A 14-year Follow-up Study in Taiwan. J Cancer 2019; 10:2288-2298. [PMID: 31258732 PMCID: PMC6584417 DOI: 10.7150/jca.30680] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 03/21/2019] [Indexed: 12/17/2022] Open
Abstract
Background: The aim of this population-based 14-year historical and prospective study was to determine the relationships between the usage of sedative-hypnotics, including benzodiazepines and nonbenzodiazepines, and the risk of subsequent cancer in patients with or without insomnia among the Taiwanese population. Methods: A total of 43,585 patients were recruited, 21,330 of whom had been diagnosed with insomnia and 8,717 who had been prescribed sedative-hypnotics during this study's following period of 2002 to 2015. Information from the claims data, namely basic demographic details, drug prescriptions, comorbidities, and patients' survival, was extracted from the National Health Insurance Research Database for χ2 analysis. A Cox proportional hazards model was used to compute the 14-year cancer-free survival rates after adjustment for confounding factors. Results: Patients with insomnia who used sedative-hypnotics had an adjusted hazard ratio of 1.49 compared with patients with insomnia who did not use any sedative-hypnotics, and patients without insomnia who used sedative-hypnotics had an adjusted hazard ratio of 1.68 compared with patients without insomnia who did not use any sedative-hypnotics. Regarding site-specific risk, patients with insomnia who used sedative-hypnotics had an increased risk of oral and breast cancers, and patients without insomnia who received sedative-hypnotics prescriptions had an increased risk of liver and breast cancers. The cancer-free survival rate of patients who had used sedative-hypnotics was significantly lower than that of patients who had never used sedative-hypnotics. Conclusions: The use of sedative-hypnotics in patients either with or without insomnia was associated with subsequent cancer development in the Taiwanese population. Increased risks of oral, liver, and breast cancer were found in the patients with the use of sedative-hypnotics. The use of sedative-hypnotics should be discouraged for treating patients with or without insomnia in Taiwan.
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Affiliation(s)
- Hui-Fen Fang
- Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
| | - Tzu-Yin Lee
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - King Cheung Hui
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Howard Chi Ho Yim
- Microbiome Research Centre, St George & Sutherland Clinical School, University of New South Wales, Sydney, Australia
| | - Mei-Ju Chi
- School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Min-Huey Chung
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.,Department of Nursing, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
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Hara Y, Sonoda K, Hashimoto K, Fuji K, Yamada Y, Kamijo Y. Influence of arteriovenous fistula on daily living behaviors involving the upper limbs in hemodialysis patients: a cross-sectional questionnaire study. BMC Nephrol 2018; 19:284. [PMID: 30348105 PMCID: PMC6198435 DOI: 10.1186/s12882-018-1097-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 10/12/2018] [Indexed: 11/30/2022] Open
Abstract
Background Arteriovenous fistulae can restrict daily living behaviors involving the upper limbs in hemodialysis patients, but no studies have investigated the detailed effects of an arteriovenous fistula on routine life activities. Accordingly, many medical caregivers are unable to explain the effects of an arteriovenous fistula on daily life, particularly during non-dialysis periods, because they cannot observe them directly. Methods Thirty outpatients undergoing hemodialysis at 2 facilities scored the difficulty due to an arteriovenous fistula in performing 48 living behaviors during non-dialysis and 10 behaviors during dialysis into 5 grades in a comprehensive questionnaire survey. These behaviors were selected based on an open-answer pre-questionnaire administered to the 30 patients beforehand. The scores were also compared between dominant arm and non-dominant arm arteriovenous fistula groups. Results During non-dialysis, the difficulty scores of behaviors restricted out of concern for arteriovenous fistula obstruction (wear a wristwatch, hang a bag on the arm, carry a baby or a dog in the arms, wear a short-sleeved shirt, etc.) increased. The difficulties of “wear a wristwatch” and “hang a bag on the arm” were significantly higher in the non-dominant arm arteriovenous fistula group (both P < 0.05). In contrast, scores related to motor function (write, eat or drink, scratch an itch, etc.) increased remarkably during dialysis because of connection of the arteriovenous fistula to the dialysis machine. The difficulties of “write” and “eat or drink” were significantly higher in the dominant arm arteriovenous fistula group (both P < 0.05). Conclusions Several key daily living behaviors restricted by an arteriovenous fistula were identified in this questionnaire survey. These results will be useful for pre-operative explanation of arteriovenous fistula surgery and arm selection in end-stage renal disease patients. Electronic supplementary material The online version of this article (10.1186/s12882-018-1097-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yuuta Hara
- Department of Nephrology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Kosuke Sonoda
- Department of Nephrology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Koji Hashimoto
- Department of Nephrology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Kazuaki Fuji
- Department of Nephrology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Yosuke Yamada
- Department of Nephrology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan.
| | - Yuji Kamijo
- Department of Nephrology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan.
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9
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Chihara I, Ae R, Kudo Y, Uehara R, Makino N, Matsubara Y, Sasahara T, Aoyama Y, Kotani K, Nakamura Y. Suicidal patients presenting to secondary and tertiary emergency departments and referral to a psychiatrist: a population-based descriptive study from Japan. BMC Psychiatry 2018; 18:112. [PMID: 29699589 PMCID: PMC5921746 DOI: 10.1186/s12888-018-1690-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 04/16/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Japan, although many suicidal studies were previously conducted in tertiary emergency department (ED) settings, no published studies have reported on suicidal patients presenting to the secondary EDs. The aim of the study was to describe the characteristics of suicidal patients and the referral rates to a psychiatrist overall and by type of facility. METHODS Questionnaires were sent to all secondary and tertiary EDs in Tochigi prefecture, Japan. Data were collected for cases who presented in September 2009. Chi-square, Fisher's exact, and t-tests compared the results by gender and type of ED. RESULTS All 74 EDs responded to the survey. There were 81 patients who attempted or died by suicide (36 men and 45 women). The most common method of suicide attempt was drug overdose (57%) followed by stabbing (17%). About a half used prescription drugs to attempt or die by suicide. The majority had a history of psychiatric disorders, and 35% had previous suicide attempt. About a half were admitted to medical or surgical unit; 33% were discharged home; and 9% died. After excluding those who died, 53% were referred to a psychiatrist, but 47% were not referred to a psychiatrist. The referral rate was lower for cases seen at secondary EDs (38%) compared to tertiary EDs (67%). CONCLUSION Although professional organizations suggest that suicidal patients are seen by a psychiatrist, many were not, especially at secondary EDs. Further research is needed to assure that suicidal patients presenting to EDs receive appropriate psychiatric assessment and follow-up after discharge.
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Affiliation(s)
- Izumi Chihara
- 0000000123090000grid.410804.9Division of Public Health, Center for Community Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498 Japan
| | - Ryusuke Ae
- 0000000123090000grid.410804.9Division of Public Health, Center for Community Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498 Japan
| | - Yuka Kudo
- 0000000123090000grid.410804.9Division of Public Health, Center for Community Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498 Japan ,0000 0004 1936 9959grid.26091.3cDepartment of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan
| | - Ritei Uehara
- 0000000123090000grid.410804.9Division of Public Health, Center for Community Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498 Japan
| | - Nobuko Makino
- 0000000123090000grid.410804.9Division of Public Health, Center for Community Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498 Japan
| | - Yuri Matsubara
- 0000000123090000grid.410804.9Division of Public Health, Center for Community Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498 Japan
| | - Teppei Sasahara
- 0000000123090000grid.410804.9Division of Public Health, Center for Community Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498 Japan
| | - Yasuko Aoyama
- 0000000123090000grid.410804.9Division of Public Health, Center for Community Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498 Japan
| | - Kazuhiko Kotani
- 0000000123090000grid.410804.9Division of Public Health, Center for Community Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498 Japan
| | - Yosikazu Nakamura
- Division of Public Health, Center for Community Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
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10
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Zhou Y, Yin P, Li B, Li J, Huang N, Wu H, Ullah H, Yang X, Yu X. Effect of Sedative-Hypnotic Medicines on Mortality in Peritoneal Dialysis Patients with Sleep Disorders: A Retrospective Cohort Study. Blood Purif 2018; 45:95-101. [PMID: 29402860 DOI: 10.1159/000484922] [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: 04/24/2017] [Accepted: 11/02/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Sedative-hypnotic medication is widely used among continuous ambulatory peritoneal dialysis (CAPD) patients with sleep disorders; however, its effect on mortality has rarely been investigated. METHODS Logistic regression was employed to identify factors associated with sedative-hypnotic medication, whose effect on mortality was evaluated by Cox proportional hazards models. RESULTS A total of 146 CAPD patients with sleep disorders were recruited, of which 46 patients (31.5%) used either benzodiazepines or zolpidem. Sedative-hypnotic medication was more frequently used by older patients and those with longer duration of CAPD therapy and there was no significant association between sedative-hypnotic medicines and all-cause mortality after adjusting for age, gender, diabetes, cardiovascular disease, and duration of CAPD. CONCLUSION Sedative-hypnotic medication was more often used by older patients and patients with a longer duration of CAPD. There was no association between these agents and all-cause mortality in CAPD patients with sleep disorders.
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Affiliation(s)
- Ying Zhou
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China.,Department of Nephrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Peiran Yin
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Bin Li
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China.,Clinical Research Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jianying Li
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Naya Huang
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Haishan Wu
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Habib Ullah
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Xiao Yang
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Xueqing Yu
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
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11
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Kazama S, Kazama JJ, Wakasugi M, Ito Y, Narita I, Tanaka M, Horiguchi F, Tanigawa K. Emotional disturbance assessed by the Self-Rating Depression Scale test is associated with mortality among Japanese Hemodialysis patients. Fukushima J Med Sci 2018; 64:23-29. [PMID: 29398691 DOI: 10.5387/fms.2016-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Emotional disturbance including depression is associated with increased mortality among dialysis patients. The Self-Rating Depression Scale (SDS) is a simple tool for assessing emotional disturbance. This study investigated the relationship between emotional conditions as assessed with the SDS test and mortality among 491 hemodialysis patients. At baseline, 183 (37.3%), 180 (36.7%), 108 (22.0%), and 20 (4.1%) were classified as normal, borderline depression, depression, and severe depression, respectively. During the two years of observation period, 57 of 491 (11.6%) died. The SDS scores in the non-survivors were significantly higher than those in the survivors (p<0.0001). Logistic analyses showed that the diagnoses made by the SDS test were associated with significantly greater risks for all-cause mortality (99%CI: 1.905-3.698 for that without adjustment, 1.999-4.382 for that with full adjustment). When the SDS score = 50 was selected as the cut off value, the test screened two-year all cause death with sensitivity = 57.9% and the specificity = 78.1%. In conclusion, hemodialysis patients had high prevalence of emotional disturbance assessed by the SDS test, and high SDS score was significantly associated with all-cause mortality. These findings underscore the importance of screening for emotional conditions using the SDS test among hemodialysis patients.
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Affiliation(s)
- Sakumi Kazama
- Futaba Emergency and General Medical Support Center, Fukushima Medical University
| | | | - Minako Wakasugi
- Department of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences
| | - Yumi Ito
- Department of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences
| | - Ichiei Narita
- Department of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences
| | | | - Fumi Horiguchi
- Department of Gynecology, Tokyo Dental College Ichikawa General Hospital
| | - Koichi Tanigawa
- Futaba Emergency and General Medical Support Center, Fukushima Medical University
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12
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Chen IM, Lin PH, Wu VC, Wu CS, Shan JC, Chang SS, Liao SC. Suicide deaths among patients with end-stage renal disease receiving dialysis: A population-based retrospective cohort study of 64,000 patients in Taiwan. J Affect Disord 2018; 227:7-10. [PMID: 29045916 DOI: 10.1016/j.jad.2017.10.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 09/30/2017] [Accepted: 10/04/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Patients with end-stage renal disease (ESRD) who receive dialysis may experience increased distress and risk of suicide. METHODS This population-based retrospective cohort study linked Taiwan's national register of ESRD patients on dialysis and the cause-of-death mortality data file. A separate multiple-cause-of-death data file was used to investigate the detailed suicide methods used. Standardized mortality ratios (SMRs) were calculated for the overall patient group and by sex, age, year of initiating dialysis, method of suicide, and time since initiation of dialysis. RESULTS Among 63,854 ESRD patients on dialysis, 133 died by suicide in Taiwan in 2006-2012; the suicide rate was 76.3 per 100,000 patient-years. The SMR for suicide was 2.38 (95% confidence interval [CI] 1.99-2.82) in this patient group. Suicide risk was highest in the first year of dialysis (SMR = 3.15, 95% CI 2.39-4.08). The risk of suicide by cutting was nearly 20 times (SMR = 19.91, 95% CI 12.88-29.39) that of the general population. Detailed information on death certificates indicated that three quarters of patients who killed themselves by cutting cut vascular accesses used for hemodialysis. LIMITATIONS Information on risk factors such as socioeconomic position and mental disorders was unavailable. CONCLUSION In a country where the national health insurance program covers most expenses associated with dialysis treatment, the suicide risk in ESRD patients on dialysis still increased nearly 140%. Adequate support for ESRD patients initiating dialysis and the assessment of risk of cutting vascular access as a potential means of suicide could be important strategies for suicide prevention.
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Affiliation(s)
- I-Ming Chen
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan; Division of Psychosomatic Medicine, Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Po-Hsien Lin
- Department of Psychiatry, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Vin-Cent Wu
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi-Shin Wu
- Division of Psychosomatic Medicine, Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Jia-Chi Shan
- Department of Psychiatry, Cathay General Hospital, Taipei, Taiwan
| | - Shu-Sen Chang
- Institute of Health Behaviors and Community Sciences, and Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan.
| | - Shih-Cheng Liao
- Division of Psychosomatic Medicine, Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan; Taiwan Suicide Prevention Center, Taiwanese Society of Suicidology in contract with Ministry of Health and Welfare, Executive Yuan, Taiwan.
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13
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Fabrizi F, Messa P, Martin P. Health-Related Quality of Life in Dialysis Patients with HCV Infection. Int J Artif Organs 2018; 32:473-81. [DOI: 10.1177/039139880903200801] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Measuring the impact of chronic kidney disease (CKD) treatment on patient quality of life has become increasingly recognized as an important outcome measure. Despite improvements in the treatment of chronic kidney disease, health-related quality of life (HRQOL) is lower than in the general population. HRQOL measures, particularly the Physical Component Summary (PCS), have predictive validity for risk of both mortality and hospitalization in dialysis populations. For every 10-point lower PCS score, the relative risk (RR) of death increases by 29% (RR=1.29; 95% Cl=1.23 to 1.35; p<0.001) and the risk of hospitalization increases by 15% (RR=1.15; 95% Cl=1.11 to 1.19, p<0.001), according to the Dialysis Outcomes and Practice Patterns Study (DOPPS). Hepatitis C virus (HCV) infection remains prevalent among dialysis patients with a recent meta-analysis showing that anti-HCV seropositive status was an independent and significant risk factor for death in patients on maintenance dialysis. Seven studies with 11,589 unique patients on maintenance dialysis were identified; the summary estimate for adjusted relative risk (aRR) (all-cause mortality) was 1.34 with a 95% confidence interval (CI) of 1.13–1. 59. In non-uremic populations HCV diminishes HRQOL, and individuals with HCV scored lower than controls across all scales of the short form 36 (SF-36). Patients achieving sustained virological responses (SVR) scored higher across all scales versus patients without SVR, especially in the physical health domains. Whether the adverse influence of HCV on survival in dialysis population is related to the negative impact of HCV on HRQOL requires further research. Information on HRQOL indices in patients with HCV on maintenance dialysis is extremely limited but the available evidence shows that HCV infection impairs HRQOL, especially in mental aspects, among patients on maintenance hemodialysis.
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Affiliation(s)
- Fabrizio Fabrizi
- Division of Nephrology, Maggiore Hospital, IRCCS Foundation, Milan - Italy
- Division of Hepatology, School of Medicine, University of Miami, Miami, Florida - USA
| | - Piergiorgio Messa
- Division of Nephrology, Maggiore Hospital, IRCCS Foundation, Milan - Italy
| | - Paul Martin
- Division of Hepatology, School of Medicine, University of Miami, Miami, Florida - USA
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14
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Uvais NA, Shihabudheen P, Naeem A. Pattern of psychotropic drugs prescription in patients on hemodialysis: A single centre experience from South India. Asian J Psychiatr 2018; 31:90-91. [PMID: 29453148 DOI: 10.1016/j.ajp.2018.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 02/03/2018] [Accepted: 02/03/2018] [Indexed: 10/18/2022]
Affiliation(s)
- N A Uvais
- Department of Neuropsychiatry, Iqraa International Hospital and Research Centre, Calicut, Kerala, India.
| | - P Shihabudheen
- Department of Medicine, Iqraa International Hospital and Research Centre, Calicut, Kerala, India.
| | - A Naeem
- Iqraa International Hospital and Research Centre, Calicut, Kerala, India.
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15
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Abstract
Sleeping pills, more formally defined as hypnotics, are sedatives used to induce and maintain sleep. In a review of publications for the past 30 years, descriptive epidemiologic studies were identified that examined the mortality risk of hypnotics and related sedative-anxiolytics. Of the 34 studies estimating risk ratios, odds ratios, or hazard ratios, excess mortality associated with hypnotics was significant (p < 0.05) in 24 studies including all 14 of the largest, contrasted with no studies at all suggesting that hypnotics ever prolong life. The studies had many limitations: possibly tending to overestimate risk, such as possible confounding by indication with other risk factors; confusing hypnotics with drugs having other indications; possible genetic confounders; and too much heterogeneity of studies for meta-analyses. There were balancing limitations possibly tending towards underestimates of risk such as limited power, excessive follow-up intervals with possible follow-up mixing of participants taking hypnotics with controls, missing dosage data for most studies, and over-adjustment of confounders. Epidemiologic association in itself is not adequate proof of causality, but there is proof that hypnotics cause death in overdoses; there is thorough understanding of how hypnotics euthanize animals and execute humans; and there is proof that hypnotics cause potentially lethal morbidities such as depression, infection, poor driving, suppressed respiration, and possibly cancer. Combining these proofs with consistent evidence of association, the great weight of evidence is that hypnotics cause huge risks of decreasing a patient's duration of survival.
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Affiliation(s)
- Daniel F Kripke
- UCSD, 8437 Sugarman Drive, La Jolla, CA, 92037-2226, USA. .,Scripps Clinic Viterbi Family Sleep Center, La Jolla, USA.
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16
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Sugisawa H, Shimizu Y, Kumagai T, Sugisaki H, Ohira S, Shinoda T. Effects of socioeconomic status on physical and mental health of hemodialysis patients in Japan: differences by age, period, and cohort. Int J Nephrol Renovasc Dis 2016; 9:171-82. [PMID: 27471405 PMCID: PMC4948840 DOI: 10.2147/ijnrd.s107031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Study purpose Whether or not socioeconomic status (SES)-related differences in the health of hemodialysis patients differ by age, period, and birth cohort remains unclear. We examined whether SES-related gaps in physical and mental health change with age, period, and birth cohort for hemodialysis patients. Methods Data were obtained from repeated cross-sectional surveys conducted in 1996, 2001, 2006, and 2011, with members of a national patients’ association as participants. We used raking adjustment to create a database which had similar characteristics to the total sample of dialysis patients in Japan. SES was assessed using family size-adjusted income levels. We divided patients into three groups based on their income levels: below the first quartile, over the second quartile and under the third quartile, and over the fourth quartile. We used the number of dialysis complications as a physical health indicator and depressive symptoms as a mental health indicator. We used a cross-classified random-effects model that estimated fixed effects of age categories and period as level-1 factors, and random effects of birth cohort as level-2 factors. Results Relative risk of dialysis complications in respondents below the first quartile compared with ones over the fourth quartile was reduced in age categories >60 years. Mean differences in depressive symptoms between respondents below the first quartile and ones over the fourth quartile peaked in the 50- to 59-year-old age group, and were reduced in age groups >60 years. In addition, mean differences varied across periods, widening from 1996 to 2006. There were no significant birth cohort effects on income differences for dialysis complications or depressive symptoms. Conclusion The number of dialysis complications and depressive symptoms in dialysis patients were affected by income differences, and the degree of these differences changed with age category and period.
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Affiliation(s)
| | - Yumiko Shimizu
- Faculty of Nursing, The Jikei University School of Medicine, Chofu
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17
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Song JY, Oh PJ. A study on Symptom Experience, Spiritual Well-Being, and Depression in Patients Undergoing Hemodialysis. ACTA ACUST UNITED AC 2016. [DOI: 10.5762/kais.2016.17.5.660] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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18
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Lin CF, Chiou HY, Chang YH, Liu JC, Hung YN, Chuang MT, Chien LN. Risk of arteriovenous fistula failure associated with hypnotic use in hemodialysis patients: a nested case-control study. Pharmacoepidemiol Drug Saf 2016; 25:889-97. [PMID: 26799147 DOI: 10.1002/pds.3963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 11/27/2015] [Accepted: 12/13/2015] [Indexed: 01/17/2023]
Abstract
PURPOSE Hypnotic use might cause altered inflammatory processes, which have been suggested as being related to the mechanisms of arteriovenous fistula (AVF) failure. Therefore, we examined the association between the risk of AVF failure and hypnotic use in patients receiving hemodialysis (HD). METHODS A nested case-control study was conducted using data from the National Health Insurance Research Database of Taiwan. From 34 165 HD patients, 3676 patients receiving percutaneous transluminal angioplasty or surgical thrombectomy for AVF failure were matched to 14 704 control patients according to sex, age (±1 year), and the year of initial HD therapy. The risk of AVF failure was estimated based on conditional logistic regression after adjustment for the timing of AVF creation, HD frequency, comorbidities, and prescribed medications. Hypnotic use was measured prior to the date of AVF failure of case patients and the date of pseudo-AVF failure of controls. RESULTS Compared with matched controls, case patients were more likely to be exposed to hypnotics 30 days or an average daily defined dose > 0.5 within 90 days before the date of AVF failure, with an adjusted odds ratio of 1.21 (95% confidence interval [CI]: 1.09-1.35, p < 0.001) and 1.36 (95%CI: 1.13-1.63, p = 0.001), respectively. Risk of AVF failure associated with hypnotic use was also observed among HD patients who were male, were younger than 65 years, had hypertension, and did not use statins. CONCLUSIONS Hypnotic use among HD patients was associated with an increased risk of AVF failure. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Chao-Feng Lin
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Hung-Yi Chiou
- School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan
| | - Ya-Hui Chang
- Pharmacy Department of Mackay Memorial Hospital, Taipei, Taiwan
| | - Ju-Chi Liu
- Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Yen-Ni Hung
- School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Ming-Tsang Chuang
- School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan
| | - Li-Nien Chien
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan
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19
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Lan TY, Zeng YF, Tang GJ, Kao HC, Chiu HJ, Lan TH, Ho HF. The Use of Hypnotics and Mortality--A Population-Based Retrospective Cohort Study. PLoS One 2015; 10:e0145271. [PMID: 26709926 PMCID: PMC4692546 DOI: 10.1371/journal.pone.0145271] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 12/02/2015] [Indexed: 12/03/2022] Open
Abstract
Background Sleep disorders, especially chronic insomnia, have become major health problem worldwide and, as a result, the use of hypnotics is steadily increasing. However, few studies with a large sample size and long-term observation have been conducted to investigate the relationship between specific hypnotics and mortality. Methods We conducted this retrospective cohort study using data from the National Health Insurance Research Database in Taiwan. Information from claims data including basic characteristics, the use of hypnotics, and survival from 2000 to 2009 for 1,320,322 individuals were included. The use of hypnotics was divided into groups using the defined daily dose and the cumulative length of use. Hazard ratios (HRs) were calculated from a Cox proportional hazards model, with two different matching techniques to examine the associations. Results Compared to the non-users, both users of benzodiazepines (HR = 1.81; 95% confidence interval [CI] = 1.78–1.85) and mixed users (HR = 1.44; 95% CI = 1.42–1.47) had a higher risk of death, whereas the users of other non-benzodiazepines users showed no differences. Zolpidem users (HR = 0.73; 95% CI = 0.71–0.75) exhibited a lower risk of mortality in the adjusted models. This pattern remained similar in both matching techniques. Secondary analysis indicated that zolpidem users had a reduced risk of major cause-specific mortality except cancer, and that this protective effect was dose-responsive, with those using for more than 1 year having the lowest risk. Conclusions The effects of different types of hypnotics on mortality were diverse in this large cohort with long-term follow-up based on representative claims data in Taiwan. The use of zolpidem was associated with a reduced risk of mortality.
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Affiliation(s)
- Tzuo-Yun Lan
- Institute of Hospital & Health Care Administration, National Yang-Ming University, Taipei, Taiwan
- * E-mail:
| | - Ya-Fang Zeng
- Institute of Hospital & Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - Gau-Jun Tang
- Institute of Hospital & Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - Hui-Chuan Kao
- Department of Public Health, Tzu Chi University, Hualien, Taiwan
| | | | - Tsuo-Hung Lan
- Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hsiao-Feng Ho
- National Health Insurance Administration, Ministry of Health and Welfare, Taipei, Taiwan
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20
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Neutel CI, Johansen HL. Association between hypnotics use and increased mortality: causation or confounding? Eur J Clin Pharmacol 2015; 71:637-42. [PMID: 25845656 DOI: 10.1007/s00228-015-1841-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 03/24/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE Many research studies have found associations between benzodiazepines and/or z-hypnotics (BZZ) and increasing mortality, leading to a discussion about causation or confounding. This study suggests a factor that could produce this association through confounding. METHODS The Norwegian population in 2010 supplied 8862 deaths ages 41-80 and 898,289 controls. Index dates were added to control records which corresponded to death dates. BZZ use was recorded for 2 years before death/index date. RESULTS Persons exposed to BZZ were more likely (OR = 2.3) to die than those who were not. With proximity of death, increasingly larger proportions of the prospective deaths received prescriptions for BZZ, until in the last 2 months 40-45% received BZZ. The frequency of BZZ use in controls increased with age as opposed to the death cohort where all ages showed similar rates of BZZ use. In the last few months before death, the youngest age group had an OR = 5.8 for BZZ use while the oldest age group an OR = 1.8, adjusted for age and sex. Opioid use showed a similar pattern of increasing use near death. CONCLUSIONS The increased use of BZZ with approaching death is consistent with increasing symptomatic treatment in terminal illness. Thus, the association of BZZ and mortality is more likely to be due to confounding than to causality. Further evidence from this and other research includes similar use patterns for other drugs such as opioids, the lack of specificity in cause of death and the size of the association regarding age and time to death.
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Affiliation(s)
- C Ineke Neutel
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, 451 Smyth Road (Room 3105) Roger-Guindon Building, Ottawa, K1H 8M5, Ontario, Canada,
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21
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Eyler RF, Unruh ML, Quinn DK, Mary Vilay A. Psychotherapeutic Agents in End-Stage Renal Disease. Semin Dial 2015; 28:417-26. [DOI: 10.1111/sdi.12370] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Rachel F. Eyler
- School of Pharmacy; University of Connecticut; Storrs Connecticut
| | - Mark L. Unruh
- School of Medicine; University of New Mexico; Albuquerque New Mexico
| | - Davin K. Quinn
- School of Medicine; University of New Mexico; Albuquerque New Mexico
| | - Aloun Mary Vilay
- College of Pharmacy; University of New Mexico; Albuquerque New Mexico
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22
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Iseki K, Tsuruya K, Kanda E, Nomura T, Hirakata H. Effects of sleepiness on survival in Japanese hemodialysis patients: J-DOPPS study. Nephron Clin Pract 2015; 128:333-40. [PMID: 25572670 DOI: 10.1159/000366479] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 08/04/2014] [Indexed: 11/19/2022] Open
Abstract
Sleep disorder and poor sleep quality are common in chronic hemodialysis (HD) patients. They have been claimed as a cause of morbidity and mortality. The relationship between the degree of sleepiness and survival has not been studied. We studied the degree of sleepiness in 1,252 adult HD patients (age ≥20 years) recruited into the Dialysis Outcomes Practice Pattern Study in Japan (J-DOPPS III), using the Japanese version of the Epworth Sleepiness Scale (JESS) questionnaire. Demographic data were presented for three subgroups: low, intermediate, and high JESS score. Cox proportional hazard regression analysis was performed to estimate the independent effect of several variables on survival. The hazard ratio for mortality was 2.312 (95% CI 1.267-4.220; p = 0.006) for those with a high JESS score (vs. those with a low JESS score) after adjusting for age, vintage (length of time on HD), sex, diabetes, body mass index, cardiovascular disease, HD treatment regimen (time, frequency, and single-pool Kt/V), laboratory data (serum albumin, creatinine, and total cholesterol), and medication (antihypertensive drugs, erythropoietin, vitamin D, and phosphate binders). Patients ≥70 years of age with comorbid conditions (congestive heart failure, stroke, and diabetes) showed a significantly higher JESS score (≥16). The JESS score did not show interaction by age. Results showed that the degree of sleepiness is related to survival in Japanese HD patients, particularly in elderly patients.
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Affiliation(s)
- Kunitoshi Iseki
- Dialysis Unit, University Hospital of the Ryukyus, Okinawa, Japan
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23
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Yeh CY, Chen CK, Hsu HJ, Wu IW, Sun CY, Chou CC, Lee CC, Wang LJ. Prescription of psychotropic drugs in patients with chronic renal failure on hemodialysis. Ren Fail 2014; 36:1545-9. [PMID: 25154717 DOI: 10.3109/0886022x.2014.949762] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Patients on hemodialysis commonly have comorbid depression and require treatment with psychotropic drugs. This study aimed to investigate the prevalence of the use of psychotropic drugs among patients on hemodialysis and to elucidate the factors associated with use of each class of psychotropic medication. METHODS This cross-sectional study enrolled 195 hemodialysis patients with a mean age of 58.5 years. Patients were assessed using the Mini International Neuropsychiatric Interview, Hospital Anxiety and Depression Scale, Chalder Fatigue Scale and Short-form Health-related Quality of Life. We analyzed the frequency of psychiatric outpatient department visits within six months prior to interview and psychotropic drugs use within one month prior to interview, including antidepressants, antipsychotics, mood stabilizers, benzodiazepines (BZDs) and hypnotics. RESULTS Of the 195 patients, 47 (24.1%) fulfilled the DSM-IV criteria for major depressive disorder (MDD). Only 6.4% of patients diagnosed with MDD visited the psychiatry outpatient department within six months prior to interview. Of the total patients, the proportions with use of antidepressants, antipsychotics, mood stabilizers, BZDs and hypnotics were 5.6%, 1.0%, 3.1%, 42.6% and 20.0%, respectively. Having MDD was an independent factor associated with taking antidepressants (adjusted OR = 3.98, p = 0.036) and taking hypnotics (adjusted OR = 2.75, p = 0.011). CONCLUSIONS Depression is generally undetected or not well-managed among hemodialysis patients in the clinical setting. Only a small proportion of depressed patients received antidepressant treatment. BZDs and/or hypnotics might be exorbitantly prescribed. Clinicians should pay more attention to patients' emotional distress and provide appropriate treatment.
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Affiliation(s)
- Chou-Yu Yeh
- Department of Psychiatry, Chang Gung Memorial Hospital , Keelung , Taiwan
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Farrokhi F, Abedi N, Beyene J, Kurdyak P, Jassal SV. Association Between Depression and Mortality in Patients Receiving Long-term Dialysis: A Systematic Review and Meta-analysis. Am J Kidney Dis 2014; 63:623-35. [DOI: 10.1053/j.ajkd.2013.08.024] [Citation(s) in RCA: 175] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 08/21/2013] [Indexed: 01/06/2023]
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Macaron G, Fahed M, Matar D, Bou-Khalil R, Kazour F, Nehme-Chlela D, Richa S. Anxiety, depression and suicidal ideation in Lebanese patients undergoing hemodialysis. Community Ment Health J 2014; 50:235-8. [PMID: 24337520 DOI: 10.1007/s10597-013-9669-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 11/30/2013] [Indexed: 11/28/2022]
Abstract
Anxiety, depression and suicidal thoughts are highly prevalent comorbidities of end-stage-renal-disease (ESRD). There are no studies in Lebanon on the prevalence of these symptoms in Lebanese end-stage-renal-disease patients. Moreover, the association between ESRD on one hand, and anxiety, depression and suicidal ideation on the other has never been established in Lebanon. Groups of patients at a high-risk of development of these symptoms are not determined. The Hospital Anxiety and Depression Score and M.I.N.I (module C) were used to measure the prevalence of anxiety, depression and suicidal ideation in 51 patients from the dialysis center of Hotel-Dieu de France Hospital in Lebanon. In our sample, 45% of included patients suffered from symptoms of anxiety and 50% presented symptoms of depression.The prevalence of suicidal ideation as detected by the M.I.N.I. is at 37%. No patients presented with a high risk of suicide. There was a statistically significant correlation between the existence of organic comorbidities and the presence of symptoms of depression and suicidal ideation. As for anxiety, the association was marginally significant. The results obtained by our study are consistent with those found in studies performed in other societies. The profile of depression- and suicidal ideation-prone patients has been determined. It consists of patients with at least one medical comorbidity to the ESRD. This, in turn, should lead to increased awareness and better treatment of these psychiatric ailments, considering their impact on morbidity and mortality in ESRD.
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Affiliation(s)
- Gabrielle Macaron
- Department of Psychiatry, Faculty of Medicine, Hôtel-Dieu de France Hospital, Saint-Joseph University, Beirut, Lebanon
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Furuya M, Hayashino Y, Tsujii S, Ishii H, Fukuhara S. Comparative validity of the WHO-5 Well-Being Index and two-question instrument for screening depressive symptoms in patients with type 2 diabetes. Acta Diabetol 2013; 50:117-21. [PMID: 20798962 DOI: 10.1007/s00592-010-0219-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Accepted: 07/28/2010] [Indexed: 01/04/2023]
Abstract
A simple tool consisting of two questions for screening depressive symptoms has been shown to be useful in primary care settings, but its validity in patients with diabetes has yet to be evaluated. We compared the test performance of this two-question instrument with that of WHO (The World Health Organization)-5. We consecutively enrolled 153 patients with type 2 diabetes who visited a diabetes clinic in Japan. Using the Center for Epidemiologic Studies Depression Scale as a reference standard of depressive symptoms, we calculated the sensitivity and specificity of the two-question instrument and WHO-5, and compared the area under the ROC curves of these tests. The two-question instrument had a sensitivity of 53.6% (95% CI, 39.7-67.0%) and specificity of 67.7% (95% CI, 58.1-74.9%). With the conventional cutoff point equal to or less than 13 points, the WHO-5 had a sensitivity of 57.1% (95% CI, 43.2-70.3%) and specificity of 82.5% (95% CI, 81.9-94.9%). The area under the ROC curve for the WHO-5 and two-item questionnaire, an indicator of discriminatory power, was 0.81 and 0.73, respectively, showing a statistically significant difference (P = 0.0453). The two-question instrument had statistically lower discriminatory power than the WHO-5 in screening depressive symptoms in patients with diabetes. We do not recommend the use of the two-question instrument for screening depressive symptoms in patients with diabetes.
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Affiliation(s)
- M Furuya
- Department of Endocrinology, Tenri Hospital, Nara, Japan
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Prevalence of depression in chronic kidney disease: systematic review and meta-analysis of observational studies. Kidney Int 2013; 84:179-91. [PMID: 23486521 DOI: 10.1038/ki.2013.77] [Citation(s) in RCA: 453] [Impact Index Per Article: 41.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 12/25/2012] [Accepted: 01/03/2013] [Indexed: 01/12/2023]
Abstract
Prevalence estimates of depression in chronic kidney disease (CKD) vary widely in existing studies. We conducted a systematic review and meta-analysis of observational studies to summarize the point prevalence of depressive symptoms in adults with CKD. We searched MEDLINE and Embase (through January 2012). Random-effects meta-analysis was used to estimate the prevalence of depressive symptoms. We also limited the analyses to studies using clinical interview and prespecified criteria for diagnosis. We included 249 populations (55,982 participants). Estimated prevalence of depression varied by stage of CKD and the tools used for diagnosis. Prevalence of interview-based depression in CKD stage 5D was 22.8% (confidence interval (CI), 18.6-27.6), but estimates were somewhat less precise for CKD stages 1-5 (21.4% (CI, 11.1-37.2)) and for kidney transplant recipients (25.7% (12.8-44.9)). Using self- or clinician-administered rating scales, the prevalence of depressive symptoms for CKD stage 5D was higher (39.3% (CI, 36.8-42.0)) relative to CKD stages 1-5 (26.5% (CI, 18.5-36.5)) and transplant recipients (26.6% (CI, 20.9-33.1)) and suggested that self-report scales may overestimate the presence of depression, particularly in the dialysis setting. Thus, interview-defined depression affects approximately one-quarter of adults with CKD. Given the potential prevalence of depression in the setting of CKD, randomized trials to evaluate effects of interventions for depression on patient-centered outcomes are needed.
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Yokoyama Y, Sasaki S, Suzukamo Y, Yamazaki S, Takegami M, Kakudate N, Hasegawa T, Haga M, Kawaguchi T, Moriya T, Hotta O, Fukuhara S. Interpersonal Psychosocial Factors Associated With Underreported Dietary Energy Intake in Hemodialysis Patients. J Ren Nutr 2013; 23:37-44. [DOI: 10.1053/j.jrn.2012.01.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Revised: 01/09/2012] [Accepted: 01/14/2012] [Indexed: 11/11/2022] Open
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Wakasugi M, Kazama JJ, Yamamoto S, Kawamura K, Narita I. Cause-specific excess mortality among dialysis patients: comparison with the general population in Japan. Ther Apher Dial 2012; 17:298-304. [PMID: 23735145 DOI: 10.1111/j.1744-9987.2012.01144.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Despite significant therapeutic advances, mortality of dialysis patients remains unacceptably high. The aim of this study is to compare mortality and its causes in dialysis patients with those in the general Japanese population. We used data for 2008 and 2009 from the Japanese Society for Dialysis Therapy registry and a national Vital Statistics survey. Cardiovascular mortality was defined as death attributed to heart failure, cerebrovascular disorders, myocardial infarction, hyperkalemia/sudden death, and pulmonary thromboembolism. Non-cardiovascular mortality was defined as death attributed to infection, malignancies, cachexia/uremia, chronic hepatitis/cirrhosis, ileus, bleeding, suicide/refusal of treatment, and miscellaneous. We calculated standardized mortality ratios and age-adjusted mortality differences between dialysis patients and the general population for all-cause, cardiovascular versus non-cardiovascular, and cause-specific mortality. During the 2-year study period, there were 2,284,272 and 51,432 deaths out of 126 million people and 273,237 dialysis patients, respectively. The standardized mortality ratio for all-cause mortality was 4.6 (95% confidence interval, 4.6-4.7) for the dialysis patients compared to the general population. Age-adjusted mortality differences for cardiovascular and non-cardiovascular disease were 33.1 and 30.0 per 1000 person-years, respectively. The standardized mortality rate ratios were significant for all cause-specific mortality rates except accidental death. Our study revealed that excess mortality in dialysis patients compared to the general population in Japan is large, and differs according to age and cause of death. Cause-specific mortality studies should be planned to improve life expectancies of dialysis patients.
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Affiliation(s)
- Minako Wakasugi
- Center for Inter-organ Communication Research, Niigata University Graduate School of Medical and Dental Science, Asahimachi 1-757, Chuo-ku, Niigata 951-8510, Japan.
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Kang EW, Pike F, Ramer S, Abdel-Kader K, Myaskovsky L, Dew MA, Unruh M. The association of mental health over time with cardiac outcomes in HEMO study patients. Clin J Am Soc Nephrol 2012; 7:957-64. [PMID: 22490873 DOI: 10.2215/cjn.06730711] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Poor mental health over time is significantly associated with cardiovascular morbidity and mortality in the general population, which is the leading cause of death in dialysis patients. Most studies of dialysis patients, however, have investigated the relationship between baseline mental health measurements and all-cause mortality and not mental health measured longitudinally throughout a study and cause-specific mortality. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This study examined the association of changes in mental health over time with all-cause and cause-specific deaths and cardiac hospitalizations in the Hemodialysis study patients. Mental health was assessed at baseline and annually during the study with short form 36 mental health index scores. Poorer mental health was defined by a mental health index score≤60. RESULTS Patients with poorer mental health at baseline were more likely to have less than a high school education and be unmarried, have significantly higher index of coexistent disease scores, and report taking β-blockers and sleep medications. Low mental health scores over time were independently associated with a decrease in survival time from all-cause mortality by -0.06 (-0.10, -0.03; P<0.001), and they also significantly hastened time to first cardiac hospitalization by -0.08 (-0.13, -0.02; P=0.01) and composite of first cardiac hospitalization or cardiac death by -0.04 (-0.07, -0.02; P<0.001). CONCLUSIONS This study found an independent association between poor mental health over time and all-cause mortality, cardiac hospitalization, and the composite of cardiac death or cardiac hospitalization in hemodialysis patients. The results underscore the importance of attention to mental health related to cardiac complications and even death in dialysis patients.
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Affiliation(s)
- Ea Wha Kang
- Renal-Electrolyte Division, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Wyne A, Rai R, Cuerden M, Clark WF, Suri RS. Opioid and benzodiazepine use in end-stage renal disease: a systematic review. Clin J Am Soc Nephrol 2010; 6:326-33. [PMID: 21071517 DOI: 10.2215/cjn.04770610] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Chronic pain and psychiatric disorders are common in dialysis patients, but the extent to which opioids and benzodiazepines are used is unclear. We conducted a systematic review to determine the: (1) prevalence of opioid and benzodiazepine use among dialysis patients; (2) reasons for use; (3) effectiveness of symptom control; and (4) incidence of adverse events. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Two authors reviewed all relevant citations in MEDLINE/EMBASE/CINAHL/BIOSIS Previews/Cochrane and hand-searched bibliographies. Studies after 1990 reporting prevalence estimates for opioid and/or benzodiazepine use in ≥50 dialysis patients were included. RESULTS We identified 15 studies from 12 countries over 1995 to 2006. Sample size ranged from 75 to 12,782. Prevalence of opioid and benzodiazepine use was variable, ranging from 5 to 36% (95% CI, 4.1 to 45.5%; n=10) and 8 to 26% (95% CI, 7.1 to 27.3%; n=9), respectively. Prevalence was positively correlated with years on dialysis. Five studies reported on the same cohorts but gave different prevalence estimates. One study verified medication use through patient interviews. Reasons for use were reported in one study. Effectiveness of pain control varied from 17 to 38%, and 72 to 84% of patients with significant pain had no analgesia (n=2). No study rigorously examined for adverse events. CONCLUSIONS The prevalence of opioid and benzodiazepine use in dialysis patients is highly variable between centers. Further information is needed regarding the appropriateness of these prescriptions, adequacy of symptom control, and incidence of adverse effects in this population.
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Affiliation(s)
- Ahraaz Wyne
- University of Western Ontario, London Kidney Clinical Research Unit, Room ELL-101 Victoria Hospital, 800 Commissioners Road East, London, Ontario N6A 4G5, Canada
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Chilcot J, Wellsted D, Farrington K. Depression in End-Stage Renal Disease: Current Advances and Research. Semin Dial 2010; 23:74-82. [DOI: 10.1111/j.1525-139x.2009.00628.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Abstract
Fifteen epidemiologic studies have associated hypnotic drugs with excess mortality, especially excess cancer deaths. Until recently, insufficient controlled trials were available to demonstrate whether hypnotics actually cause any cancers. The US Food and Drug Administration (FDA) Approval History and Documents were accessed for zaleplon, eszopiclone and ramelteon. Since zolpidem was used as a comparison drug in zaleplon trials, some zolpidem data were also available. Incident cancers occurring during randomized hypnotics administration or placebo administration were tabulated. Combining controlled trials for the four drugs, there were 6190 participants given hypnotics and 2535 given placebo in parallel. There were eight mentions of incident non-melanoma skin cancers among participants receiving hypnotics but no comparable mentions of cancers among those receiving placebo (P = 0.064, one-tailed). There were also four mentions of incident tumors of uncertain malignancy among those receiving hypnotics but none among those receiving placebo, so combining uncertain and definite malignancies yielded a more significant contrast (P = 0.016). FDA files revealed that all four of the new hypnotics were associated with cancers in rodents. Three had been shown to be clastogenic. Together with the epidemiologic data and laboratory studies, the available evidence signals that new hypnotics may increase cancer risk. Due to limitations in available data, confirmatory research is needed.
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Affiliation(s)
- Daniel F Kripke
- Department of Psychiatry, University of California, San Diego and The Scripps Clinic Sleep Center, La Jolla, California 92093-0667, USA.
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Nowicki M, Zwiech R, Dryja P, Sobański W. Autonomic neuropathy in hemodialysis patients: questionnaires versus clinical tests. Clin Exp Nephrol 2009; 13:152-155. [PMID: 19153803 DOI: 10.1007/s10157-008-0121-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2007] [Accepted: 11/12/2008] [Indexed: 10/21/2022]
Abstract
AIM Uremic neuropathy (UN) is a typical complication of long-term dialysis therapy and may manifest as distal, symmetric, and both senso-motoric and autonomic nerve dysfunction. Its clinical picture is highly variable and it is not known how the symptoms of UN reported by chronic dialysis patients correspond to positive results of clinical tests for autonomic dysfunction. The objective of this study was to compare the prevalence of self-reported symptoms of autonomic neuropathy (AN) revealed in patient questionnaires with the prevalence of findings from objective clinical tests. METHODS The study group included 45 patients (26 males, 19 females), mean age 60 +/- 15.5 years, on chronic hemodialysis for 7.8 +/- 2.6 years. In all subjects, blood pressure (BPci) and heart rate (HRci) variability indexes (calculated as BP and HR during Ewing and Clarke' tests divided by HR and BP at rest) were measured using the Finapres which records beat-to-beat blood pressure and heart rate. Additionally, patients completed seven-question questionnaires which assessed the presence of most typical AN symptoms. The control group comprised 12 healthy subjects (age 52 +/- 19.5 years). RESULTS The results from the questionnaires showed that falls of BP occurred in 73% of patients, itching of skin in 42%, constipation or diarrhea in 33%, filling of stomach in 25%, and decreased sweating in 17%. Altogether 85.9% of patients reported one or more subjective symptoms of neuropathy. In contrast, modified Ewing and Clarke's test revealed that only 17.7% of participants demonstrated overt pathologies. Neither blood pressure nor heart rate changeability indexes in patients and healthy subjects showed significant differences with the exception of intense inhalation and static effort. CONCLUSIONS Our results show much higher frequency of subjective symptoms of AN in chronic dialysis patients than objective symptoms detected with clinical tests.
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Affiliation(s)
- Michał Nowicki
- Department of Nephrology, Hypertension and Kidney Transplantation, Medical University of Łódź, University Hospital #1, Kopcińskiego 22, 90-153, Lodz, Poland.
| | - Rafał Zwiech
- Department of Nephrology, Hypertension and Kidney Transplantation, Medical University of Łódź, University Hospital #1, Kopcińskiego 22, 90-153, Lodz, Poland
| | - Przemysław Dryja
- Department of Nephrology, Hypertension and Kidney Transplantation, Medical University of Łódź, University Hospital #1, Kopcińskiego 22, 90-153, Lodz, Poland
| | - Wiktor Sobański
- Department of Nephrology, Hypertension and Kidney Transplantation, Medical University of Łódź, University Hospital #1, Kopcińskiego 22, 90-153, Lodz, Poland
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Smith AJ, Sketris I, Cooke C, Gardner D, Kisely S, Tett SE. A comparison of benzodiazepine and related drug use in Nova Scotia and Australia. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2008; 53:545-52. [PMID: 18801216 DOI: 10.1177/070674370805300809] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Benzodiazepines can be a problem if used for long periods, or in at-risk populations, such as the elderly. We compared the use of benzodiazepine and related prescription medicines in Nova Scotia and Australia. METHODS The Nova Scotia Pharmacare Program and the Pharmaceutical Benefits Scheme in Australia were used to obtain dispensing data in comparable populations for all publicly subsidized benzodiazepines and related compounds. Usage was compared from 2000 to 2003, using the World Health Organization anatomical therapeutic chemical and defined daily dosage (DDD) system. We also determined differences in the types of benzodiazepines prescribed. RESULTS The use of benzodiazepines increased at a steady but comparable rate in both areas. However, the use of benzodiazepines in Nova Scotia was more than double that of Australia in 2000 (123 and 48 DDD/1000 beneficiaries per day, respectively) through 2003 (138 and 57 DDD/1000 beneficiaries per day, respectively). Eight different benzodiazepines made up 90% of the drug use in Nova Scotia by contrast to only 4 different benzodiazepines in Australia. CONCLUSIONS Large differences exist between the type and rate of benzodiazepine prescribing in Nova Scotia and Australia, with Nova Scotia reporting more than twice as much use. Benzodiazepine use in both jurisdictions is increasing. The Canadian findings are especially concerning as benzodiazepine use in the Atlantic provinces has been reported to be less than other provinces. The variations between the 2 jurisdictions may be due to factors such as fewer benzodiazepines available in Australia, differences in prescriber, patient attitudes and behaviours, or different initiatives to influence benzodiazepine use.
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Affiliation(s)
- Alesha J Smith
- School of Pharmacy, The University of Queensland, Brisbane, Australia.
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Winkelmayer WC, Mehta J, Wang PS. Benzodiazepine use and mortality of incident dialysis patients in the United States. Kidney Int 2007; 72:1388-93. [PMID: 17851463 DOI: 10.1038/sj.ki.5002548] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Benzodiazepines and other omega-receptor agonists are frequently used for sleep and anxiety disorders. We studied the rates, correlates, and safety of individual benzodiazepines and zolpidem use from the records of 3690 patients in a national cohort of Dialysis Morbidity and Mortality Study Wave 2 data. We assessed drug utilization and an association between drug use and all-cause mortality. Overall, 14% of incident dialysis patients used a benzodiazepine or zolpidem. Women, Caucasians, current smokers, and patients with chronic obstructive pulmonary disease were more likely to use these drugs, whereas patients with cerebrovascular disease were less likely to use these drugs. In adjusted analyses, benzodiazepine or zolpidem use was associated with a 15% higher mortality rate. Chronic obstructive pulmonary disease significantly modified this association, suggesting that these patients were at higher risk. No association was found between benzodiazepine use and greater risk for hip fracture. We conclude that benzodiazepine or zolpidem use is common in incident dialysis patients and may be associated with greater mortality. Further studies are needed to elucidate the safety of these drugs in the dialysis population, which may lead to cautious and restrictive utilization of omega-receptor agonists in dialysis patients.
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Affiliation(s)
- W C Winkelmayer
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02120, USA.
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2007. [DOI: 10.1002/pds.1375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Fukuhara S, Yamazaki S, Hayashino Y, Green J. Measuring health-related quality of life in patients with end-stage renal disease: why and how. ACTA ACUST UNITED AC 2007; 3:352-3. [PMID: 17519922 DOI: 10.1038/ncpneph0510] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2006] [Accepted: 04/03/2007] [Indexed: 11/08/2022]
Affiliation(s)
- Shunichi Fukuhara
- Kyoto University Graduate School of Medicine and Public Health, Department of Epidemiology and Healthcare Research, Yoshida Konoe-cho, Sakyo-ku, Kyoto, Japan.
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