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Lee JG, Park MK, Kim YH, Kim YW, Jin K, Park SW, Seo MK, Kim YH. The Correlations among Depressive Symptoms, Cognitive Performance and Serum BDNF Levels in the Patients with Chronic Kidney Disease. Psychiatry Investig 2018; 15:186-192. [PMID: 29475220 PMCID: PMC5900401 DOI: 10.30773/pi.2017.03.09] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 02/18/2017] [Accepted: 03/09/2017] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE In the current study, we investigated whether there are relations among depressive symptoms, cognitive performance and serum BDNF levels in the patients with chronic kidney disease (CKD). METHODS Sixty patients with CKD and 65 healthy controls participated. Depressive symptoms were evaluated with Beck depression inventory (BDI) and Hamilton Depression Rating Scale (HDRS). Mini-Mental State Examination included in the Korean version of the Consortium to Establish a Registry for Alzheimer's disease (MMSE-KC) assessment packet was used for the evaluation of overall cognitive function. To assess memory function, the Korean version of the Hopkins Verbal Learning Test (K-HVLT) was used. BDNF levels were measured using an enzyme-linked immunosorbent assay (ELISA) kit. RESULTS The CKD patients showed more depressive symptoms when compared with controls. The depressive symptoms and cognitive function were not associated with serum BDNF levels in the CKD patients. CONCLUSION In the current study, CKD patients had more depressive symptoms when compared controls. However, the serum BDNF levels of CKD patients were not associated with depressive symptoms and cognitive functions. These findings suggested that the serum BDNF levels may not be reflect the cognitive function and depressive mood state in the CKD patients.
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Affiliation(s)
- Jung Goo Lee
- Department of Psychiatry, School of Medicine, Inje University Haeundae Paik Hospital, Busan, Republic of Korea.,Paik Institute for Clinical Research, Inje University, Busan, Republic of Korea.,Department of Health Science and Technology, Graduate School of Inje University, Busan, Republic of Korea
| | - Min Kyung Park
- Department of Psychiatry, Jurye Jayeon Hospital, Busan, Republic of Korea
| | - Yeong Hoon Kim
- Department of Nephrology, School of Medicine, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Yang-Wook Kim
- Department of Medicine, School of Medicine, Inje University Haeundae Paik Hospital, Busan, Republic of Korea
| | - Kyubok Jin
- Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Sung Woo Park
- Paik Institute for Clinical Research, Inje University, Busan, Republic of Korea.,Department of Health Science and Technology, Graduate School of Inje University, Busan, Republic of Korea.,Department of Convergence Biomedical Science, School of Medicine, Inje University, Busan, Republic of Korea
| | - Mi Kyoung Seo
- Paik Institute for Clinical Research, Inje University, Busan, Republic of Korea
| | - Young Hoon Kim
- Department of Psychiatry, Gongju National Hospital, Gonju, Republic of Korea
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Lerma A, Perez-Grovas H, Bermudez L, Peralta-Pedrero ML, Robles-García R, Lerma C. Brief cognitive behavioural intervention for depression and anxiety symptoms improves quality of life in chronic haemodialysis patients. Psychol Psychother 2017; 90:105-123. [PMID: 27435635 DOI: 10.1111/papt.12098] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 03/04/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Psychological treatment of depression in end-stage renal disease (ESRD) has focused on severely depressed patients. We designed and tested a brief (5 weeks) cognitive behavioural intervention (CBI) to reduce mild and moderate depression and anxiety symptoms in patients with ESRD. DESIGN For the purpose of this study, a single-blind, randomized controlled design was used to compare patients with ESRD under haemodialysis treatment with and without the CBI. METHODS Depression and anxiety symptoms were screened in 152 subjects (18-60 years old, 84 male). Sixty participants (age 41.8 ± 14.7, 29 males) with mild or moderate scores of depression (Beck Depression Inventory) and anxiety (Beck Anxiety Inventory) were randomly assigned to CBI or the control group. CBI techniques consisted of positive self-reinforcement, deep breathing, muscle relaxation, and cognitive restructuring. Depression, anxiety, quality of life (QoL), and cognitive distortion scores were evaluated at baseline, after 5 weeks (end of treatment) and after 4-week follow-up. All scores were compared by ANOVA for repeated measures with post-hoc tests adjusted by Bonferroni's method (p < .05 was considered significant). RESULTS At follow-up, depression, anxiety, and cognitive distortions had decreased, and QoL had increased in the intervention group, and there were no changes in the control group. Clinical utility was 33% for depression and 43% for anxiety. CONCLUSIONS A brief CBI of 5 weeks is effective for decreasing mild or moderate depression and anxiety symptoms and improving QoL in ESRD haemodialysis patients. PRACTITIONER POINTS A brief, systematic and structured cognitive behavioural intervention (CBI) decreases anxiety and depression symptoms and improves quality of life in patients with end-stage renal disease (ESRD) who are being treated with haemodialysis. These benefits are not achieved when anxiety and depression symptoms are identified but not treated psychologically. This CBI consisted of cognitive restructuring of the distorted thoughts (perfectionism, catastrophic thinking, negative self-labelling, and dichotomous thinking) that are correlated with depression and anxiety symptoms and that can be assessed by a validated questionnaire designed for patients with ESRD. The handbooks that were developed for this study are structured and systematic. They could be valuable in supporting the efforts and participation of non-specialized health professionals in CBI such as nurses, physicians, social workers, and psychologists, raising the possibility of further application in a variety of clinical populations. Both the therapy and the client workbooks are available in Spanish upon request.
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Affiliation(s)
- Abel Lerma
- University Center of Health Sciences, University of Guadalajara, Guadalajara, Jalisco, Mexico.,Direction of Epidemiological and Psychosocial Research, National Institute of Psychiatry "Ramón de la Fuente", Distrito Federal, Mexico
| | - Héctor Perez-Grovas
- Department of Nephrology, National Institute of Cardiology "Ignacio Chávez", Distrito Federal, Mexico
| | - Luis Bermudez
- London Medical, Medical and Equipment Services, Distrito Federal, Mexico
| | - María L Peralta-Pedrero
- Coordination of High Specialty Medical Units, Mexican Institute of Social Security, Distrito Federal, Mexico
| | - Rebeca Robles-García
- Direction of Epidemiological and Psychosocial Research, National Institute of Psychiatry "Ramón de la Fuente", Distrito Federal, Mexico
| | - Claudia Lerma
- Department of Electromechanical Instrumentation, National Institute of Cardiology "Ignacio Chávez", Distrito Federal, Mexico
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Friedli K, Almond M, Day C, Chilcot J, Gane MDS, Davenport A, Guirguis A, Fineberg N, Spencer B, Wellsted D, Farrington K. A study of sertraline in dialysis (ASSertID): a protocol for a pilot randomised controlled trial of drug treatment for depression in patients undergoing haemodialysis. BMC Nephrol 2015; 16:172. [PMID: 26503099 PMCID: PMC4621949 DOI: 10.1186/s12882-015-0170-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 10/14/2015] [Indexed: 11/17/2022] Open
Abstract
Background The prevalence of depression in people receiving haemodialysis is high with estimates varying between 20 and 40 %. There is little research on the effectiveness of antidepressants in dialysis patients with the few clinical trials suffering significant methodological issues. We plan to carry out a study to evaluate the feasibility of conducting a randomised controlled trial in patients on haemodialysis who have diagnosed Major Depressive Disorder. Methods/Design The study has two phases, a screening phase and the randomised controlled trial. Patients will be screened initially with the Beck Depression Inventory to estimate the number of patients who score 16 or above. These patients will be invited to an interview with a psychiatrist who will invite those with a diagnosis of Major Depressive Disorder to take part in the trial. Consenting patients will be randomised to either Sertraline or placebo. Patients will be followed-up for 6 months. Demographic and clinical data will be collected at screening interview, baseline interview and 2 weeks, and every month (up to 6 months) after baseline. The primary outcome is to evaluate the feasibility of conducting a randomised, double blind, placebo pilot trial in haemodialysis patients with depression. Secondary outcomes include estimation of the variability in the outcome measures for the treatment and placebo arms, which will allow for a future adequately powered definitive trial. Analysis will primarily be descriptive, including the number of patients eligible for the trial, drug exposure of Sertraline in haemodialysis patients and the patient experience of participating in this trial. Discussion There is an urgent need for this research in the dialysis population because of the dearth of good quality and adequately powered studies. Research with renal patients is particularly difficult as they often have complex medical needs. This research will therefore not only assess the outcome of anti-depressants in haemodialysis patients with depression but also the process of running a randomised controlled trial in this population. Hence, the outputs of this feasibility study will be used to inform the design and methodology of a definitive study, adequately powered to determine the efficacy of anti-depressants in patient on haemodialysis with depression. Trial registration ISRCTN registry ISRCTN06146268 and EudraCT reference: 2012-000547-27.
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Affiliation(s)
- Karin Friedli
- Centre for Lifespan and Chronic Illness Research, Department of Psychology, School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, AL10 9AB, UK.
| | - Michael Almond
- Southend University Hospital NHS Foundation Trust, Prittlewell Chase, Westcliff - On - Sea, Essex, SSO ORY, UK. .,Postgraduate Medical School, University of Hertfordshire, College Lane Campus, Hatfield, AL10 9AB, UK.
| | - Clara Day
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Queen Elizabeth Medical Centre, Birmingham, B15 2TH, UK.
| | - Joseph Chilcot
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5th floor Bermondsey Wing, Guy's Campus, London Bridge, London, SE1 9RT, UK.
| | - Maria da Silva Gane
- Centre for Lifespan and Chronic Illness Research, Department of Psychology, School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, AL10 9AB, UK. .,Renal Unit, Lister Hospital, East & North Herts NHS Trust, Coreys Mill Lane, Stevenage, SG1 4AB, UK.
| | - Andrew Davenport
- University College London Centre for Nephrology, Royal Free Hampstead NHS Trust, Rowland Hill Street, London, NW3 2PF, UK.
| | - Ayman Guirguis
- Renal Unit, Lister Hospital, East & North Herts NHS Trust, Coreys Mill Lane, Stevenage, SG1 4AB, UK. .,Hertfordshire Partnership University NHS Foundation Trust, Rosanne House, Welwyn Garden City, AL8 6HG, UK. .,Postgraduate Medical School, University of Hertfordshire, College Lane Campus, Hatfield, AL10 9AB, UK.
| | - Naomi Fineberg
- Hertfordshire Partnership University NHS Foundation Trust, Rosanne House, Welwyn Garden City, AL8 6HG, UK. .,Postgraduate Medical School, University of Hertfordshire, College Lane Campus, Hatfield, AL10 9AB, UK.
| | - Benjamin Spencer
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Weston Education Centre, 10 Cutcombe Street, London, SE5 9RJ, UK. .,South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, SE5 8AZ, UK.
| | - David Wellsted
- Centre for Lifespan and Chronic Illness Research, Department of Psychology, School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, AL10 9AB, UK.
| | - Ken Farrington
- Renal Unit, Lister Hospital, East & North Herts NHS Trust, Coreys Mill Lane, Stevenage, SG1 4AB, UK. .,Postgraduate Medical School, University of Hertfordshire, College Lane Campus, Hatfield, AL10 9AB, UK.
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Indicators and correlates of psychological disturbance in Chinese patients receiving maintenance hemodialysis: a cross-sectional study. Int Urol Nephrol 2015; 47:679-89. [PMID: 25627912 DOI: 10.1007/s11255-015-0910-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 01/06/2015] [Indexed: 10/24/2022]
Abstract
PURPOSE Depression and anxiety have been considered as the most common comorbidities in maintenance hemodialysis (MHD) patients. This study aimed to assess mental disorder in hemodialysis patients and to study the indicators and correlates of psychological disturbance among patients receiving MHD in China. METHODS A cross-sectional study was conducted in 187 outpatients undergoing regular hemodialysis for at least 3 months. All the participants completed the Hospital Anxiety and Depression Scale (HADS), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue, Chinese mainland version), Pittsburgh Sleep Quality Index (PSQI), Family APGAR Index (PAGAR), Family Adaptability and Cohesion Evaluation Scale (FACES II, Chinese version) and the Social Functioning Questionnaire (SFQ). RESULTS Based on the cutoff point of HADS-D/A ≥ 8, 51 (27.3%) and 29 (15.5%) patients reported depression and anxiety, respectively; 26 (13.9%) of all reported both depression and anxiety. Depressive patients had lower economic status, less subsidies, less than 3 years duration on hemodialysis and comorbidities when compared to patients without depression (all P < 0.05). HADS-D showed positive correlations with HADS-A, PSQI and SFQ and negative correlations with FACIT-Fatigue, PAGAR, family cohesion and adaptability (all P < 0.001). Patients with better family cohesion showed higher level of psychosocial well-being no matter their economic status. Binary logistic regression analysis demonstrated that anxiety (OR 1.80, P < 0.001) and bad social functioning (OR 1.31, P < 0.001) were independently associated with depression. CONCLUSION More attention should be paid on assessment and management psychological disturbance, and development family/social/medical supporting system for Chinese patients receiving MHD.
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Chan KE, Thadhani RI, Maddux FW. Adherence barriers to chronic dialysis in the United States. J Am Soc Nephrol 2014; 25:2642-8. [PMID: 24762400 DOI: 10.1681/asn.2013111160] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Hemodialysis patients often do not attend their scheduled treatment session. We investigated factors associated with missed appointments and whether such nonadherence poses significant harm to patients and increases overall health care utilization in an observational analysis of 44 million hemodialysis treatments for 182,536 patients with ESRD in the United States. We assessed the risk of hospitalization, emergency room visit, or intensive-coronary care unit (ICU-CCU) admission in the 2 days after a missed treatment relative to the risk for patients who received hemodialysis. Over the 5-year study period, the average missed treatment rate was 7.1 days per patient-year. In covariate adjusted logistic regression, the risk of hospitalization (odds ratio [OR], 3.98; 95% confidence interval [95% CI], 3.93 to 4.04), emergency room visit (OR, 2.00; 95% CI, 1.87 to 2.14), or ICU-CCU admission (OR, 3.89; 95% CI, 3.81 to 3.96) increased significantly after a missed treatment. Overall, 0.9 missed treatment days per year associated with suboptimal transportation to dialysis, inclement weather, holidays, psychiatric illness, pain, and gastrointestinal upset. These barriers also associated with excess hospitalization (5.6 more events per patient-year), emergency room visits (1.1 more visits), and ICU-CCU admissions (0.8 more admissions). In conclusion, poor adherence to hemodialysis treatments may be a substantial roadblock to achieving better patient outcomes. Addressing systemic and patient barriers that impede access to hemodialysis care may decrease missed appointments and reduce patient morbidity.
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Affiliation(s)
- Kevin E Chan
- Clinical Research Division, Fresenius Medical Care North America, Waltham, Massachusetts; and Nephrology Division, Massachusetts General Hospital, Boston, Massachusetts
| | - Ravi I Thadhani
- Nephrology Division, Massachusetts General Hospital, Boston, Massachusetts
| | - Franklin W Maddux
- Clinical Research Division, Fresenius Medical Care North America, Waltham, Massachusetts; and
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Chilcot J, Davenport A, Wellsted D, Firth J, Farrington K. An association between depressive symptoms and survival in incident dialysis patients. Nephrol Dial Transplant 2010; 26:1628-34. [DOI: 10.1093/ndt/gfq611] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Chilcot J, Wellsted D, Farrington K. Screening for depression while patients dialyse: an evaluation. Nephrol Dial Transplant 2008; 23:2653-9. [DOI: 10.1093/ndt/gfn105] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Williams A, Manias E. A structured literature review of pain assessment and management of patients with chronic kidney disease. J Clin Nurs 2007; 17:69-81. [PMID: 17608633 DOI: 10.1111/j.1365-2702.2007.01994.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES This paper reviews the literature concerning nurses' assessment and management of pain in adult patients with chronic kidney disease, and proposes implications for clinical practice to support the control of pain in these patients. BACKGROUND Chronic kidney disease is a worldwide public health concern with increasing incidence and prevalence, poor patient outcomes and high cost. Patients with kidney disease often experience pain. Optimal pain assessment and management are key clinical activities; however, inadequate pain control by health professionals persists. Renal failure compounds this problem because of the small margin between pain relief and toxicity, and the patient's concomitant health problems. CONCLUSIONS The literature review uses 93 articles that were published in medical- and other health-related journals, including 12 medical and pharmaceutical studies specifically relating to pain control in adults with kidney disease. Very little research has been conducted on pain in patients with kidney disease prior to requiring dialysis or kidney transplantation for survival. However, past research showed pain is common and analgesics are underprescribed in patients on dialysis in end-stage kidney disease. The review indicates that an interest in nephrotoxicity and analgesic-induced morbidity dominates over an interest in pain relief in patients with kidney disease. Most analgesics are excreted renally or by the liver, and the use of simple analgesics such as paracetamol is cautioned. RELEVANCE TO CLINICAL PRACTICE Findings from the literature review highlight specific difficulties relating to effective pain control in patients with chronic kidney disease. Research is required to identify and overcome barriers to effective pain management, including the development of specific tools to facilitate interventions that optimize analgesic outcomes in patients with chronic kidney disease.
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Affiliation(s)
- Allison Williams
- School of Nursing, The University of Melbourne, Carlton, Australia.
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