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Chilcot J, Pearce CJ, Hall N, Busby AD, Hawkins J, Vraitch B, Rathjen M, Hamilton A, Bevin A, Mackintosh L, Hudson JL, Wellsted D, Jones J, Sharma S, Norton S, Ormandy P, Palmer N, Farrington K. The identification and management of depression in UK Kidney Care: Results from the Mood Maps Study. J Ren Care 2024; 50:297-306. [PMID: 38341770 DOI: 10.1111/jorc.12489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/08/2024] [Accepted: 01/22/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND Depression is common in people with chronic kidney disease, yet little is known about how depression is identified and managed as part of routine kidney care. OBJECTIVES The primary objective was to survey all UK adult kidney centres to understand how depression is identified and managed. A secondary objective was to broadly describe the variability in psychosocial care. DESIGN Online survey. METHODS The survey comprised of three sections: (1) general kidney care, (2) psychological provision and (3) social work provision. RESULTS 48/68 (71%) of centres responded to the general survey with 20 and 13 responses from psychological and social work module respectively. Only 31.4% reported having both in centre psychological and social work practitioners. Three centres reported no access to psychosocial provision. Of the 25 centres who reported on pathways, 36.0% reported having internal pathways for the identification and management of depression. Within services with psychological provision, screening for depression varied across modality/group (e.g., 7.1% in mild/moderate chronic kidney disease vs. 62.5% in kidney donors). Cognitive Behavioural Therapy and Acceptance and Commitment Therapy were the most common interventions offered. Most psychosocial services were aware of the National Institute for Health and Care Excellence guidelines for managing depression in long-term conditions (n = 18, 94.7%) yet few fully utilised (n = 6, 33.3%). Limited workforce capacity was evident. CONCLUSIONS There is considerable variability in approaches taken to identify and treat depression across UK kidney services, with few services having specific pathways designed to detect and manage depression. Workforce capacity remains a significant issue.
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Affiliation(s)
- Joseph Chilcot
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Christina J Pearce
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Natalie Hall
- Centre for Health Services and Clinical Research, School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, UK
| | - Amanda D Busby
- Centre for Health Services and Clinical Research, School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, UK
| | - Janine Hawkins
- Centre for Health Services and Clinical Research, School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, UK
| | - Balvinder Vraitch
- Renal Department, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom, United Kingdom
| | - Mandy Rathjen
- Renal Department, Edinburgh Royal Infirmary, Edinburgh, United Kingdom, United Kingdom
| | - Alexander Hamilton
- Exeter Kidney Unit, Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter, Devon, UK
- Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - Amanda Bevin
- Kent & Canterbury Kidney Care Centre, Kent & Canterbury Hospital, Canterbury, UK
| | - Lucy Mackintosh
- Centre for Health Services and Clinical Research, School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, UK
| | - Joanna L Hudson
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - David Wellsted
- Centre for Health Services and Clinical Research, School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, UK
| | - Julia Jones
- Centre for Research in Public Health and Community Care, School of Health and Social Work, University of Hertfordshire, Hatfield, UK
| | - Shivani Sharma
- Centre for Health Services and Clinical Research, School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, UK
| | - Sam Norton
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Paula Ormandy
- School of Health and Society, University of Salford, Salford, UK
| | | | - Ken Farrington
- Centre for Health Services and Clinical Research, School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, UK
- Renal Medicine, Lister Hospital, Stevenage, UK
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Wichart J, Yoeun P, Chin T, Evernden C, Berendonk C, Kerr J, Birchall A, Boschee B, Defoe K, Dhaliwal J, KarisAllen T, Kennedy M, McDonald A, Mierzejewski MK, Schick-Makaroff K. Pharmacological treatment for mental health illnesses in adults receiving dialysis: A scoping review. Fundam Clin Pharmacol 2024. [PMID: 38877814 DOI: 10.1111/fcp.13022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 05/28/2024] [Accepted: 06/03/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Pharmacologic management of mental health illnesses in patients receiving dialysis is complex and lacking data. OBJECTIVE Our objective was to synthesize published data for the treatment of depression, bipolar and related disorders, schizophrenia or psychotic disorders, and anxiety disorders in adults receiving hemodialysis or peritoneal dialysis. METHODS We undertook a scoping review, searching the following databases: Medline, Embase, CINAHL, PsycINFO, Cochrane Library, Scopus, and Web of Science. Data on patients who received only short-term dialysis, a kidney transplant, or non-pharmacologic treatments were excluded. RESULTS Seventy-three articles were included: 41 focused on depression, 16 on bipolar disorder, 13 on schizophrenia and psychotic disorders, 1 on anxiety disorders, and 2 addressing multiple mental health illnesses. The majority of depression studies reported on selective serotonin reuptake inhibitors (SSRIs) as a treatment. Sertraline had the most supporting data with use of doses from 25 to 200 mg daily. Among the remaining SSRIs, escitalopram, citalopram, and fluoxetine were studied in controlled trials, whereas paroxetine and fluvoxamine were described in smaller reports and observational trials. There are limited published data on other classes of antidepressants and on pharmacological management of anxiety. Data on treatment for patients with bipolar disorder or schizophrenia and related disorders are limited to case reports. CONCLUSION Over half of the studies included were case reports, thus limiting conclusions. More robust data are required to establish effect sizes of pharmacological treatments prior to providing specific recommendations for their use in treating mental health illnesses in patients receiving dialysis.
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Affiliation(s)
- Jenny Wichart
- Pharmacy Services, Alberta Health Services, Calgary, Alberta, Canada
| | - Peter Yoeun
- Pharmacy Services, Alberta Health Services, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Tracy Chin
- Pharmacy Services, Alberta Health Services, South Health Campus, Calgary, Alberta, Canada
| | - Christopher Evernden
- Pharmacy Services, Alberta Health Services, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Charlotte Berendonk
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alberta, Canada
| | - Jodi Kerr
- Pharmacy Services, Medicine Hat Regional Hospital, Medicine Hat, Alberta, Canada
| | - Alexandra Birchall
- DTC OR/PACU, Alberta Health Services, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Belinda Boschee
- Pharmacy Services, Alberta Health Services, Sheldon M. Chumir Medical Centre, Calgary, Alberta, Canada
| | - Kimberly Defoe
- Alberta Health Services, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Jasleen Dhaliwal
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alberta, Canada
| | - Tasia KarisAllen
- Pharmacy Services, Alberta Health Services, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Megan Kennedy
- Sperber Health Sciences Library, University of Alberta Library, Edmonton, Alberta, Canada
| | - Alexis McDonald
- Pharmacy Services, Alberta Health Services, Chinook Regional Hospital, Lethbridge, Alberta, Canada
| | - Monika K Mierzejewski
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alberta, Canada
| | - Kara Schick-Makaroff
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alberta, Canada
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Bossola M, Mariani I, Antocicco M, Pepe G, Petrosino A, Di Stasio E. Selective Serotonin Reuptake Inhibitors and Symptoms of Depression in Patients on Chronic Hemodialysis: A Systematic Review. J Clin Med 2024; 13:3334. [PMID: 38893046 PMCID: PMC11172416 DOI: 10.3390/jcm13113334] [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: 05/19/2024] [Revised: 05/24/2024] [Accepted: 06/04/2024] [Indexed: 06/21/2024] Open
Abstract
Objective: The use of selective serotonin reuptake inhibitors (SSRIs) is common among hemodialysis patients who receive treatment for depression. However, studies on the efficacy of SSRIs in patients on chronic hemodialysis are few and have led to conflicting results. The present systematic review aims to evaluate, in randomized, controlled studies (RCSs), the efficacy of SSRI administration in reducing symptoms of depression in patients on chronic hemodialysis when compared with placebo or psychological interventions. Method: Research was run on December 2023 in the following databases: Ovid MEDLINE (1985 to present); Ovid EMBASE (1985 to present); Cochrane Library (Wiley); and PubMed (1985 to present). The primary outcome was the frequency and severity of the symptoms of depression assessed through the Beck Depression Inventory (BDI) or the Hamilton Depression Rating Scale (HAMD). The secondary outcome was the prevalence of adverse events. Results: Seven studies totaling 433 patients were included. The number of patients in each individual study ranged from 13 to 120. The length of studies ranged from 8 weeks to 6 months. Heterogeneous data precluded informative meta-analysis. Three studies compared sertraline with a placebo. Of these, two demonstrated that sertraline was better than the placebo in reducing the symptoms of depression while one showed no statistically significant differences between sertraline and the placebo. One study, comparing fluoxetine with a placebo showed that the symptoms of depression did not differ significantly at 8 weeks. In another study, escitalopram administration led to a significantly greater reduction in the Hamilton Depression Rating Scale score compared to a placebo, as well as in the Hamilton Anxiety Rating Scale score. In one study, citalopram and psychological interventions were both effective in reducing the symptoms of depression and anxiety and, in another study, sertraline was modestly more effective than CBT at 12 weeks in reducing the symptoms of depression. Conclusions: SSRIs may be effective in reducing the symptoms of depression in patients on chronic hemodialysis. SSRI administration, at the dosage used in the studies included in the present systematic review, seems safe in most hemodialysis patients. However, the paucity of studies and the limited number of patients included in the trials may suggest that further randomized, controlled studies are needed to determine if SSRIs may be used routinely in daily clinical practice in such a population.
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Affiliation(s)
- Maurizio Bossola
- Servizio Emodialisi, Dipartimento di Scienze Mediche e Chirurgiche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Policlinico Universitario Fondazione Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Ilaria Mariani
- Servizio Emodialisi, Dipartimento di Scienze Mediche e Chirurgiche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Policlinico Universitario Fondazione Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Manuela Antocicco
- Policlinico Universitario Fondazione Agostino Gemelli IRCCS, 00168 Rome, Italy
- Dipartimento Scienze dell’Invecchiamento, Neurologiche, Ortopediche e Della Testa-Collo, 00168 Rome, Italy
| | - Gilda Pepe
- Servizio Emodialisi, Dipartimento di Scienze Mediche e Chirurgiche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Divisione Chirurgia d’Urgenza, Dipartimento di Scienze Mediche e Chirurgiche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Anna Petrosino
- Servizio Emodialisi, Dipartimento di Scienze Mediche e Chirurgiche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Policlinico Universitario Fondazione Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Enrico Di Stasio
- Policlinico Universitario Fondazione Agostino Gemelli IRCCS, 00168 Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Pearce CJ, Hall N, Hudson JL, Farrington K, Tucker MJR, Wellsted D, Jones J, Sharma S, Norton S, Ormandy P, Palmer N, Quinnell A, Fitzgerald L, Griffiths S, Chilcot J. Approaches to the identification and management of depression in people living with chronic kidney disease: A scoping review of 860 papers. J Ren Care 2024; 50:4-14. [PMID: 36645375 DOI: 10.1111/jorc.12458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/09/2022] [Accepted: 12/30/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Depression is prevalent across the spectrum of Chronic Kidney Disease and associated with poorer outcomes. There is limited evidence regarding the most effective interventions and care pathways for depression in Chronic Kidney Disease. OBJECTIVES To investigate how depression is identified and managed in adults with Chronic Kidney Disease. DESIGN Scoping review. METHODS Systematic search of eight databases with pre-defined inclusion criteria. Data relevant to the identification and/or management of depression in adults with Chronic Kidney Disease were extracted. RESULTS Of 2147 articles identified, 860 were included. Depression was most identified using self-report screening tools (n = 716 studies, 85.3%), with versions of the Beck Depression Inventory (n = 283, 33.7%) being the most common. A total of 123 studies included data on the management of depression, with nonpharmacological interventions being more frequently studied (n = 55, 45%). Cognitive Behavioural Therapy (n = 15) was the most common nonpharmacological intervention, which was found to have a significant effect on depressive symptoms compared to controls (n = 10). However, how such approaches could be implemented as part of routine care was not clear. There was limited evidence for antidepressants use in people with Chronic Kidney Disease albeit in a limited number of studies. CONCLUSIONS Depression is commonly identified using validated screening tools albeit differences exist in reporting practices. Evidence regarding the management of depression is mixed and requires better-quality trials of both pharmacological and nonpharmacological approaches. Understanding which clinical care pathways are used and their evidence, may help facilitate the development of kidney care specific guidelines for the identification and management of depression.
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Affiliation(s)
- Christina J Pearce
- Department of Psychology, Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Natalie Hall
- School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, UK
| | - Joanna L Hudson
- Department of Psychology, Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ken Farrington
- School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, UK
- Renal Unit, Lister Hospital, Stevenage, UK
| | | | - David Wellsted
- School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, UK
| | - Julia Jones
- School of Health and Social Work, University of Hertfordshire, Hatfield, UK
| | - Shivani Sharma
- School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, UK
| | - Sam Norton
- Department of Psychology, Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Paula Ormandy
- School of Health and Society, University of Salford, Salford, UK
| | - Nick Palmer
- Independent PPI lead & Kidney Care UK, Alton, UK
| | | | - Lauren Fitzgerald
- School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, UK
| | - Sophie Griffiths
- Department of Psychology, Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Joseph Chilcot
- Department of Psychology, Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Jayakumar S, Jennings S, Halvorsrud K, Clesse C, Yaqoob MM, Carvalho LA, Bhui K. A systematic review and meta-analysis of the evidence on inflammation in depressive illness and symptoms in chronic and end-stage kidney disease. Psychol Med 2023; 53:5839-5851. [PMID: 36254747 DOI: 10.1017/s0033291722003099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Depression affects approximately 27% of adults with chronic kidney disease (CKD) and end-stage kidney failure (ESKF). Depression in this population is associated with impaired quality of life and increased mortality. The extent of inflammation and the impact on depression in CKD/ESKF is yet to be established. Through a systematic literature review and meta-analysis, we aim to understand the relationship between depression and inflammation in CKD/ESKF patients. METHODS We searched nine electronic databases for published studies until January 2022. Titles and abstracts were screened against inclusion and exclusion criteria. Data extraction and study quality assessment was carried out independently by two reviewers. A meta-analysis was carried out where appropriate; otherwise a narrative review of studies was completed. RESULTS Sixty studies met our inclusion criteria and entered the review (9481 patients included in meta-analysis). Meta-analysis of cross-sectional associations revealed significantly higher levels of pro-inflammatory biomarkers; C-reactive protein; Interleukin 6 (IL-6) and tumour necrosis factor-alpha in patients with depressive symptoms (DS) compared to patients without DS. Significantly lower levels of anti-inflammatory cytokine IL-10 were found in patients with DS compared to patients without DS. Considerable heterogeneity was detected in the analysis for most inflammatory markers. CONCLUSION We found evidence for an association of higher levels of pro-inflammatory and lower anti-inflammatory cytokines and DS in patients with CKD/ESKF. Clinical trials are needed to investigate whether anti-inflammatory therapies will be effective in the prevention and treatment of DS in these patients with multiple comorbidities.
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Affiliation(s)
- Simone Jayakumar
- Center for Psychiatry and Mental Health, Wolfson Institute of Population Health, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
- Department of Clinical Pharmacology, William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Stacey Jennings
- Center for Psychiatry and Mental Health, Wolfson Institute of Population Health, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | | | - Christophe Clesse
- Center for Psychiatry and Mental Health, Wolfson Institute of Population Health, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
- Department of Clinical Pharmacology, William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Muhammad Magdi Yaqoob
- Translational Medicine and Therapeutics, William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Livia A Carvalho
- Department of Clinical Pharmacology, William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Kamaldeep Bhui
- Center for Psychiatry and Mental Health, Wolfson Institute of Population Health, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
- Department of Psychiatry and Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- East London NHS Foundation Trust and Oxford Health NHS Foundation Trust, London, UK
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Schick-Makaroff K, Berendonk C, Overwater J, Streith L, Lee L, Escoto M, Cukor D, Klarenbach S, Sawatzky R. How Are Albertans "Adjusting to and Coping With" Dialysis? A Cross-Sectional Survey. Can J Kidney Health Dis 2022; 9:20543581221118436. [PMID: 36046483 PMCID: PMC9421011 DOI: 10.1177/20543581221118436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Indexed: 11/15/2022] Open
Abstract
Background Depression and anxiety are commonly reported (40% and 11%-52%) among adults receiving dialysis, compared with ~10% among all Canadians. Mental health in dialysis care is underrecognized and undertreated. Objective (1) To describe preferences for mental health support reported by Albertans receiving dialysis; (2) to compare depression, anxiety, and quality-of-life (QOL) domains for people who would or would not engage in support for mental health; and (3) to explore sociodemographic, mental health, and QOL domains that explain whether people would or would not engage in support for mental health. Design A cross-sectional survey. Setting Alberta, Canada. Patients Adults receiving all modalities of dialysis (N = 2972). Measurements An online survey with questions about preferences for mental health support and patient-reported outcome measures (Patient Health Questionnaire-9 [PHQ-9], Generalized Anxiety Disorder-7 [GAD-7], and Kidney Disease QOL Instrument-36 [KDQOL-36]). Methods To address objectives 1 and 2, we conducted chi-square tests (for discrete variables) and t tests (for continuous variables) to compare the distributions of the above measures for two groups: Albertans receiving dialysis who would engage or would not engage in support for mental health. We subsequently conducted a series of binary logistic regressions guided by the purposeful variable selection approach to identify a subset of the most relevant explanatory variables for determining whether or not people are more likely to engage in support for mental health (objective 3). To further explain differences between the two groups, we analyzed open-text comments following a summative content analysis approach. Results Among 384 respondents, 72 did not provide a dialysis modality or answer the PHQ-9. The final data set included responses from 312 participants. Of these, 59.6% would consider engaging in support, including discussing medication with a family doctor (72.1%) or nephrologist (62.9%), peer support groups (64.9%), and talk therapy (60%). Phone was slightly favored (73%) over in person at dialysis (67.6%), outpatient (67.2%), or video (59.4%). Moderate to severe depressive symptoms (PHQ-9 score ≥10) was reported by 33.4%, and most respondents (63.9%) reported minimal anxiety symptoms; 36.1% reported mild to severe anxiety symptoms (GAD-7 score ≥5). The mean (SD) PHQ-9 score was 8.9 (6.4) for those who would engage in support, and lower at 5.8 (4.8) for those who would not. The mean (SD) GAD-7 score was 5.2 (5.6) for those who would engage in support and 2.8 (4.1) for those who would not. In the final logistic regression model, people who were unable to work had 2 times the odds of engaging in support than people who are able to work. People were also more likely to engage in support if they had been on dialysis for fewer years and had lower (worse) mental health scores (odds ratios = 1.06 and 1.38, respectively). The final model explained 15.5% (Nagelkerke R2) of the variance and with 66.6% correct classification. We analyzed 146 comments in response to the question, "Is there anything else you like to tell us." The top 2 categories for both groups were QOL and impact of dialysis environment. The third category differed: those who would engage wrote about support, whereas those who would not engage wrote about "dialysis is the least of my worries." Limitations A low response rate of 12.9% limits representativeness; people who chose not to participate may have different experiences of mental health. Conclusions Incorporating patients' preferences and willingness to engage in support for mental health will inform future visioning for person-centered mental health care in dialysis.
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Affiliation(s)
| | | | | | - Laura Streith
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Loretta Lee
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Manuel Escoto
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | | | - Scott Klarenbach
- Faculty of Medicine & Dentistry, Division of Nephrology, University of Alberta, Edmonton, Canada
| | - Richard Sawatzky
- School of Nursing, Trinity Western University, Langley, BC, Canada
- Centre for Health Evaluation & Outcome Sciences, St. Paul’s Hospital, Vancouver, Canada
- Sahlgrenska Academy, University of Gothenburg, Sweden
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Fernandez L, Thompson S, Berendonk C, Schick-Makaroff K. Mental Health Care for Adults Treated With Dialysis in Canada: A Scoping Review. Can J Kidney Health Dis 2022; 9:20543581221086328. [PMID: 35340771 PMCID: PMC8950027 DOI: 10.1177/20543581221086328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/25/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose of review: Mental illnesses, especially depression and anxiety, are common conditions frequently underrecognized and untreated among individuals with end-stage kidney disease. Existing tools/interventions, approaches to care, and resources to support mental health for people treated with dialysis in Canada are not well known. The aim of this scoping review was to systematically describe how mental health care is provided to adults treated with dialysis in Canada. The research questions we sought to answer were the following: (1) What mental health assessment tools and interventions for adults treated with dialysis have been investigated and utilized in Canada? (2) what is the structure and process of mental health care delivered by kidney care to adults treated with dialysis in Canada? and (3) what is the availability of mental health care resources developed for adults treated with dialysis in Canada? Sources of information: Electronic databases included Medline, Embase, CINAHL, PsycINFO, Cochrane Library, Scopus, and Web of Science for peer-reviewed literature, and Google search engine for gray literature. Methods: Systematic searches were conducted to identify peer-reviewed and gray literature that focused on mental health care or support offered to adults receiving any form of dialysis in Canadian kidney care settings and/or community organizations. Mental health care and support was defined to include mental health assessment tools, interventions, resources, guidelines, and/or pathways used in dialysis in Canada. Title, abstracts, and full texts were screened independently by 2 reviewers with discrepancies resolved by additional team members. Web sites were screened by individual members. Data from included studies and Web sites were extracted based on the abovementioned research questions. Key findings: We identified 8 peer-reviewed articles from electronic databases, and 28 separate Web site addresses. Of the 8 articles, 4 investigated mental health assessment tools and 4 examined mental health interventions for individuals treated with dialysis in Canada. The mental health assessment tools that have been used are Beck Depression Inventory-II (BDI-II), Edmonton System Assessment Scale (ESAS), Edmonton System Assessment Scale revised (ESAS-r): Renal, Hospital Anxiety and Depression Scale (HADS), and Distress Assessment and Response Tool (DART), and the nonpharmacological interventions that have been investigated are intradialytic exercise, tai chi exercise program, medical music therapy, and brief mindfulness meditation. Of the 28 Web site addresses, 2 contained clinical tools for kidney care providers for the management of depression and anxiety in individuals treated with dialysis. The 26 remaining Web sites contained mental health resources for individuals with kidney disease, which presented different types of resources, including psychoeducation, peer support, and linkage to other services. Conclusion: In conclusion, we found only a limited number of studies investigating mental health assessment tools and interventions in Canada; there was a paucity of randomized controlled trials. Clinical pathways for the assessment and management of mental illness or symptoms in individuals treated with dialysis in Canada are also limited, and no clinical practice guidelines exist. Several mental health resources for people living with dialysis are available, predominantly focused on psychoeducation and peer support. Despite increasing prevalence of mental health concerns by people treated with dialysis, mental health care remains underaddressed. Limitations: It is plausible that additional literature related to mental health assessment tools, interventions, resources, guidelines, and pathways exists that we did not find during our systematic search, especially in gray literature that was limited to one search engine. In addition, health care agencies or organizations may have developed other mental health resources, which may not be available on the Internet.
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8
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van Oosten MJM, Koning D, Logtenberg SJJ, Leegte MJH, Bilo HJG, Hemmelder MH, Jager KJ, Stel VS. Chronic prescription of antidepressant medication in patients with chronic kidney disease with and without kidney replacement therapy compared with matched controls in the Dutch general population. Clin Kidney J 2021; 15:778-785. [PMID: 35371442 PMCID: PMC8967542 DOI: 10.1093/ckj/sfab242] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Indexed: 11/23/2022] Open
Abstract
Background Chronic kidney disease (CKD) is associated with a higher prevalence of depression, neuropathic pain and insomnia. These conditions are often treated pharmaceutically. In this study we aimed to determine the prevalence of chronic antidepressant use among CKD patients with and without kidney replacement therapy (KRT). Methods By using the Dutch health claims database, we were able to determine the prevalence, type and dosage of chronic antidepressant prescriptions in patients with CKD Stage G4/G5 without KRT (n = 14 905), patients on dialysis (n = 3872) and patients living on a functioning graft (n = 8796) and compared these to age-, sex- and socio-economic status (SES)-matched controls from the general population. Results Our data show that the prevalence of chronic antidepressant prescription is 5.6%, 5.3% and 4.2% in CKD Stage G4/G5, dialysis and kidney transplant patients, respectively, which is significantly higher than in matched controls. Although our data revealed more prescriptions in female patients and in the age category 45–64 years, our data did not show any association between antidepressant prescriptions and SES. Selective serotonin reuptake inhibitors were the most prescribed drugs in all patient groups and controls. Tricyclic antidepressants were more often used in patients compared with controls. Conclusion This nationwide analysis revealed that chronic antidepressant prescription in the Netherlands is higher in CKD patients with and without KRT than in controls, higher in middle-aged patients and women, unrelated to socio-economic status and lower than chronic use reported in other countries.
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Affiliation(s)
- Manon J M van Oosten
- Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Dan Koning
- Department of Internal Medicine, Diakonessenhuis, Utrecht, The Netherlands
| | | | | | - Henk J G Bilo
- Department of Internal Medicine, University Medical Center, Groningen, and Faculty of Medicine, Groningen University, Groningen, The Netherlands
- Diabetes Research Center and Department of Epidemiology and Statistics, Isala Hospital, Zwolle, The Netherlands
| | - Marc H Hemmelder
- Department of Internal Medicine, Division of Nephrology, Maastricht Universal Medical Center and Cardiovascular Research Institute University Maastricht, Maastricht, The Netherlands
| | - Kitty J Jager
- Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Vianda S Stel
- Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Chopra P, Ayers CK, Antick JR, Kansagara D, Kondo K. The Effectiveness of Depression Treatment for Adults with ESKD: A Systematic Review. KIDNEY360 2021; 2:558-585. [PMID: 35369008 PMCID: PMC8785990 DOI: 10.34067/kid.0003142020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 01/04/2021] [Indexed: 02/04/2023]
Abstract
Adults with dialysis-dependent ESKD experience higher rates of depression than the general population, yet efficacy of depression treatments in this population is not well understood. We conducted a systematic review of the benefits and harms of depression treatment in adults with ESKD. We searched multiple data sources through June 2020 for English-language, controlled trials that compared interventions for depression in adults with ESKD to another intervention, placebo, or usual care, and reported depression treatment-related outcomes. Observational studies were included for harms. Two investigators independently screened all studies using prespecified criteria. One reviewer abstracted data on study design, interventions, implementation characteristics, and outcomes, and a second reviewer provided confirmation. Two reviewers independently assessed study quality and resolved any discords through discussion or a third reviewer. Strength of evidence (SOE) was assessed and agreed upon by review-team consensus. We qualitatively analyzed the data and present syntheses in text and tables. We included 26 RCTs and three observational studies. SSRIs were the most studied type of drug and the evidence was largely insufficient. We found moderate SOE that long-term, high-dose vitamin D3 is ineffective for reducing depression severity. Cognitive behavioral therapy is more effective than (undefined) psychotherapy and placebo for depression improvement and quality of life (low SOE), and acupressure is more effective than usual care or sham acupressure in reducing depression severity (low SOE). There is limited research evaluating treatment for depression in adults with ESKD, and existing studies may not be generalizable to adults in the United States. Studies suffer from limitations related to methodologic quality or reporting. More research replicating studies of promising interventions in US populations, with larger samples, is needed. Systematic Review registry name and registration number: PROSPERO, CRD42020140227.
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Affiliation(s)
- Pavan Chopra
- Department of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Chelsea K. Ayers
- Evidence Synthesis Program, Veterans Affairs Portland Health Care System, Portland, Oregon
| | - Jennifer R. Antick
- School of Graduate Psychology, Pacific University, Hillsboro, Oregon,Legacy Good Samaritan Medical Center, Portland, Oregon
| | - Devan Kansagara
- Department of Medicine, Oregon Health and Science University, Portland, Oregon,Evidence Synthesis Program, Veterans Affairs Portland Health Care System, Portland, Oregon,Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, Portland, Oregon
| | - Karli Kondo
- Evidence Synthesis Program, Veterans Affairs Portland Health Care System, Portland, Oregon,Research Integrity Office, Oregon Health and Science University, Portland, Oregon
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Ortiz A. The unaccomplished mission of reducing mortality in patients on kidney replacement therapy. Clin Kidney J 2020; 13:948-951. [PMID: 33391738 PMCID: PMC7769530 DOI: 10.1093/ckj/sfaa235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 10/29/2020] [Indexed: 12/21/2022] Open
Abstract
Six years ago, a comprehensive review by the EURECA-m working group of the ERA-EDTA thoroughly addressed the drivers of mortality in patients with end-stage kidney disease. Not unexpectedly, the key global driver of early death in these patients was the lack of access to kidney replacement therapy. However, and contrary to the expectations of non-nephrologists, mortality was still high when kidney replacement therapy was provided. This was due to excess cardiovascular and non-cardiovascular mortality, and the need to further characterize correctable risk factors and eventually test the impact of correcting them was emphasized. In this issue of ckj, seven reports address risk factors for death in non-dialysis chronic kidney disease (CKD), dialysis and kidney transplant patients. They characterize irreversible (e.g. sex; age; genetic variants of the KL gene encoding the anti-ageing protein Klotho) and reversible (obesity; mineral and bone disorder parameters; anti-depressant drugs, especially those that increase the QT; amputation; public health investments) factors associated with mortality of CKD patients on or off kidney replacement therapy.
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Affiliation(s)
- Alberto Ortiz
- IIS-Fundacion Jimenez Diaz UAM and School of Medicine, UAM, Madrid, Spain
- GEENDIAB, Madrid, Spain
- REDINREN, Madrid, Spain
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