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Zhou P, Wang S, Yan Y, Lu Q, Pei J, Guo W, Yang X, Li Y. Association between chronic diseases and depression in the middle-aged and older adult Chinese population-a seven-year follow-up study based on CHARLS. Front Public Health 2023; 11:1176669. [PMID: 37546300 PMCID: PMC10403076 DOI: 10.3389/fpubh.2023.1176669] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/30/2023] [Indexed: 08/08/2023] Open
Abstract
Background With the aging of the Chinese population, the prevalence of depression and chronic diseases is continually growing among middle-aged and older adult people. This study aimed to investigate the association between chronic diseases and depression in this population. Methods Data from the China Health and Retirement Longitudinal Study (CHARLS) 2011-2018 longitudinal survey, a 7-years follow-up of 7,163 participants over 45 years old, with no depression at baseline (2011). The chronic disease status in our study was based on the self-report of the participants, and depression was defined by the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10). The relationship between baseline chronic disease and depression was assessed by the Kaplan-Meier method and Cox proportional hazards regression models. Results After 7-years follow-up, 41.2% (2,951/7163, 95% CI:40.1, 42.3%) of the participants reported depression. The analysis showed that participants with chronic diseases at baseline had a higher risk of depression and that such risk increased significantly with the number of chronic diseases suffered (1 chronic disease: HR = 1.197; 2 chronic diseases: HR = 1.310; 3 and more chronic diseases: HR = 1.397). Diabetes or high blood sugar (HR = 1.185), kidney disease (HR = 1.252), stomach or other digestive diseases (HR = 1.128), and arthritis or rheumatism (HR = 1.221) all significantly increased the risk of depression in middle-aged and older adult Chinese. Conclusion The present study found that suffering from different degrees of chronic diseases increased the risk of depression in middle-aged and older adult people, and these findings may benefit preventing depression and improving the quality of mental health in this group.
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Affiliation(s)
- Pengfei Zhou
- Department of Information, Medical Support Center, The General Hospital of Western Theater Command, Chengdu, Sichuan, China
- School of Public Health, Southwest Medical University, Luzhou, Sichuan, China
| | - Shuai Wang
- Department of Outpatient, The General Hospital of Western Theater Command, Chengdu, Sichuan, China
| | - Ya Yan
- Department of Information, Medical Support Center, The General Hospital of Western Theater Command, Chengdu, Sichuan, China
| | - Qiang Lu
- Department of Information, Medical Support Center, The General Hospital of Western Theater Command, Chengdu, Sichuan, China
| | - Jiaxing Pei
- Department of Information, Medical Support Center, The General Hospital of Western Theater Command, Chengdu, Sichuan, China
- School of Public Health, Southwest Medical University, Luzhou, Sichuan, China
| | - Wang Guo
- Department of Information, Medical Support Center, The General Hospital of Western Theater Command, Chengdu, Sichuan, China
- Department of Statistics, College of Mathematics, Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Xiaoguang Yang
- Department of Information, Medical Support Center, The General Hospital of Western Theater Command, Chengdu, Sichuan, China
| | - Yunming Li
- Department of Information, Medical Support Center, The General Hospital of Western Theater Command, Chengdu, Sichuan, China
- School of Public Health, Southwest Medical University, Luzhou, Sichuan, China
- Department of Statistics, College of Mathematics, Southwest Jiaotong University, Chengdu, Sichuan, China
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Knowles SR, Apputhurai P, Jenkins Z, O'flaherty E, Ierino F, Langham R, Ski CF, Thompson DR, Castle DJ. Impact of chronic kidney disease on illness perceptions, coping, self-efficacy, psychological distress and quality of life. PSYCHOL HEALTH MED 2023; 28:1963-1976. [PMID: 36794381 DOI: 10.1080/13548506.2023.2179644] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 02/07/2023] [Indexed: 02/17/2023]
Abstract
Chronic kidney disease (CKD) negatively impacts psychological well-being and quality of life (QoL). Underpinned by the Common Sense Model (CSM), this study evaluated the potential mediating role of self-efficacy, coping styles and psychological distress on the relationship between illness perceptions and QoL in patients living with CKD. Participants were 147 people with stage 3-5 kidney disease. Measures included eGFR, illness perceptions, coping styles, psychological distress, self-efficacy and QoL. Correlational analyses were performed, followed by regression modelling. Poorer QoL was associated with greater distress, engagement in maladaptive coping, poorer illness perceptions and lower self-efficacy. Regression analysis revealed that illness perceptions predicted QoL, with psychological distress acting as a mediator. The proportion of variance explained was 63.8%. These findings suggest that psychological interventions are likely to enhance QoL in CKD, if they target the mediating psychological processes associated with illness perceptions and psychological distress.
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Affiliation(s)
- Simon R Knowles
- School of Health Sciences, Swinburne University, Melbourne, Australia
| | | | - Zoe Jenkins
- Mental Health Services, St. Vincent's Hospital, Melbourne, Australia
| | - Emmet O'flaherty
- Nephrology Service, St. Vincent's Hospital, Melbourne, Australia
| | - Francesco Ierino
- Nephrology Service, St. Vincent's Hospital, Melbourne, Australia
| | - Robyn Langham
- St. Vincent's Hospital, University of Melbourne Department of Medicine, Melbourne, Australia
| | - Chantal F Ski
- Department of Psychiatry, The University of Melbourne, Melbourne, Australia
- Integrated Care Academy, University of Suffolk, Ipswich, UK
| | - David R Thompson
- Department of Psychiatry, The University of Melbourne, Melbourne, Australia
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - David J Castle
- Mental Health Services, St. Vincent's Hospital, Melbourne, Australia
- Centre for Complex Interventions, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
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Lie DNW, Chan KW, Tang AHN, Chan ATP, Chan GCW, Lai KN, Tang SCW. Long-term outcomes of add-on direct renin inhibition in igA nephropathy: a propensity score-matched cohort study. J Nephrol 2023; 36:407-416. [PMID: 36630006 DOI: 10.1007/s40620-022-01530-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/20/2022] [Indexed: 01/12/2023]
Abstract
INTRODUCTION The long-term clinical outcomes in biopsy proven IgAN patients treated with aliskiren on top of a maximally tolerated dose of ACEi/ARB remain unknown. METHODS Patients with IgAN treated with a direct renin inhibitor and ACEi/ARB for at least 6 months were compared with a 1:1 propensityscore-matched cohort (including MEST-C score and the 12-months pre-exposure slope of eGFR matching) who received ACEi/ARB without aliskiren exposure to compute the hazard ratio of reaching the primary endpoint of a composite of 40% reduction in eGFR, initiation of KRT and all-cause mortality. Secondary outcome measures included changes in mean UPCR, blood pressure, eGFR, incidence of hyperkalemia and other adverse events during follow-up. RESULTS After a median follow-up of 2.5 years, 8/36 (22.2%) aliskiren-treated patients and 6/36 (16.7%) control patients reached the primary composite outcome (HR = 1.60; 95% CI 0.52-4.88; P = 0.412). Aliskiren treatment increased the risk of ≥ 40% eGFR decline (HR = 1.60; 95% CI 0.52-4.88; P = 0.412), and hyperkalemia (HR = 8.60; 95% CI 0.99-73.64; P = 0.050). At 10.8 years, renal composite outcome was reached in 69.4% vs 58.3% (HR = 2.16; 95% CI 1.18-3.98; P = 0.013) of patients in the aliskiren and control groups, respectively. The mean UPCR reduction between treatment and control was not statistically different (52.7% vs 42.5%; 95% CI 0.63-2.35; P = 0.556). The mean intergroup difference in eGFR decline over 60 months was 7.75 ± 3.95 ml/min/1.73 m2 greater in the aliskiren group (12.83 vs 5.08; 95% CI - 0.17 to 15.66; P = 0.055). CONCLUSION Among patients with IgAN, add-on aliskiren was associated with less favorable long-term kidney outcomes despite an initial anti-proteinuric effect.
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Affiliation(s)
- Davina N W Lie
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 4/F Professorial Block, 102 Pokfulam Road, Hong Kong SAR, China
| | - Kam Wa Chan
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 4/F Professorial Block, 102 Pokfulam Road, Hong Kong SAR, China
| | - Alexander H N Tang
- Department of Pathology, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
| | - Anthony T P Chan
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 4/F Professorial Block, 102 Pokfulam Road, Hong Kong SAR, China
| | - Gary C W Chan
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 4/F Professorial Block, 102 Pokfulam Road, Hong Kong SAR, China
| | - Kar Neng Lai
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 4/F Professorial Block, 102 Pokfulam Road, Hong Kong SAR, China
| | - Sydney Chi-Wai Tang
- Division of Nephrology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 4/F Professorial Block, 102 Pokfulam Road, Hong Kong SAR, China.
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Uyar B. The analysis of immunosuppressant therapy adherence, depression, anxiety, and stress in kidney transplant recipients in the post-transplantation period. Transpl Immunol 2022; 75:101686. [PMID: 35961441 DOI: 10.1016/j.trim.2022.101686] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/06/2022] [Accepted: 08/07/2022] [Indexed: 12/11/2022]
Abstract
AIM Our study aimed to analyze the immunosuppressant therapy adherence, anxiety, stress, and depression in kidney transplant recipients in the post-transplantation period. METHOD This study was conducted as descriptive and cross-sectional research with the participation of 260 recipients who underwent kidney transplantation and were already discharged from the hospital (n = 260). In the data collection process, we used the Personal Information Form, the Immunosuppressant Therapy Adherence Scale (ITAS), and the Depression Anxiety Stress Scale (DASS)-21. The One-Way Analysis of Variance (ANOVA), Chi-Squared test, post hoc and Pearson Correlation analysis methods were used in data analysis. FINDINGS In our study all participant kidney transplant recipients, 45.4% were age 46-64 years and 81.5% were men. As the recipients' age levels increased, their immunosuppressant therapy adherence levels decreased (p < 0.05). Similarly, kidney recipients with at least 3 adverse events (infection, gastrointestinal problems, edema, blood disorders etc.) had a higher DASS-21 score and a lower ITAS score than those with low side effects. ITAS had a strong negative relationship with DASS-21 (p < 0.05). Recipients' depression, stress, and anxiety scores were, in general, above the medium level. CONCLUSION Adherence to the immunosuppressive drug regimen after kidney transplantation and depression, anxiety and stress are in a bidirectional relationship. At the same time, the side effects of immunosuppressive drugs can trigger the development of depression, anxiety and stress. After kidney transplant, recipients are at risk for the development of depression, anxiety, and stress. We recommend early detection of this condition and taking preventive and symptom-reducing interventions.
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Affiliation(s)
- Betül Uyar
- Department of Psychiatry, Faculty of Medicine, Dicle University, Diyarbakır, Turkey.
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5
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Nagel T, Dingwall KM, Sweet M, Kavanagh D, Majoni SW, Sajiv C, Cass A. The stay strong app as a self-management tool for first nations people with chronic kidney disease: a qualitative study. BMC Nephrol 2022; 23:244. [PMID: 35804297 PMCID: PMC9270837 DOI: 10.1186/s12882-022-02856-x] [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: 10/14/2021] [Accepted: 06/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The high burden of chronic kidney disease in First Nations peoples requires urgent attention. Empowering people to self-manage their own condition is key, along with promotion of traditional knowledge and empowerment of First Nations communities. This study explores the potential of a culturally responsive tool, already found to have high acceptability and feasibility among First Nations people, to support self-management for First Nations people with kidney failure. The Stay Strong app is a holistic wellbeing intervention. This study explores the suitability of the Stay Strong app to support self-management as shown by the readiness of participants to engage in goal setting. Data were collected during a clinical trial which followed adaption of research tools and procedures through collaboration between content and language experts, and community members with lived experience of kidney failure. METHODS First Nations (i.e., Aboriginal and Torres Strait Islander) participants receiving haemodialysis in the Northern Territory (n = 156) entered a three-arm, waitlist, single-blind randomised controlled trial which provided collaborative goal setting using the Stay Strong app at baseline or at 3 months. Qualitative data gathered during delivery of the intervention were examined using both content and thematic analysis. RESULTS Almost all participants (147, 94%) received a Stay Strong session: of these, 135 (92%) attended at least two sessions, and 83 (56%) set more than one wellbeing goal. Using a deductive approach to manifest content, 13 categories of goals were identified. The three most common were to: 'connect with family or other people', 'go bush/be outdoors' and 'go home/be on country'. Analysis of latent content identified three themes throughout the goals: 'social and emotional wellbeing', 'physical health' and 'cultural connection'. CONCLUSION This study provides evidence of the suitability of the Stay Strong app for use as a chronic condition self-management tool. Participants set goals that addressed physical as well as social and emotional wellbeing needs, prioritising family, country, and cultural identity. The intervention aligns directly with self-management approaches that are holistic and prioritise individual empowerment. Implementation of self-management strategies into routine care remains a key challenge and further research is needed to establish drivers of success.
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Affiliation(s)
- Tricia Nagel
- Menzies School of Health Research, Charles Darwin University, Casuarina, PO Box 41096, Darwin, NT, 0811, Australia.
| | - Kylie M Dingwall
- Menzies School of Health Research, Charles Darwin University, Alice Springs, NT, 0870, Australia
| | - Michelle Sweet
- Menzies School of Health Research, Charles Darwin University, Alice Springs, NT, 0870, Australia
| | - David Kavanagh
- Centre for Children's Health Research and School of Psychology & Counselling, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, 4101, Australia
| | - Sandawana W Majoni
- Menzies School of Health Research, Charles Darwin University, Casuarina, PO Box 41096, Darwin, NT, 0811, Australia.,Department of Nephrology, Royal Darwin Hospital, Northern Territory Department of Health, Darwin, NT, 0810, Australia.,Northern Territory Medical Program, Flinders University, Darwin, NT, 0815, Australia
| | - Cherian Sajiv
- Central Australian Renal Services, Alice Springs Hospital, Northern Territory Department of Health, Alice Springs, NT, 0870, Australia
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, Casuarina, PO Box 41096, Darwin, NT, 0811, Australia
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Aatif T, Achour I, Arache W, Zajjari Y, Montasser D, Mehssani J, El Kabbaj D. Anxiety and Depression Disorders in Adults on Chronic Hemodialysis. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2022; 33:566-573. [PMID: 37929550 DOI: 10.4103/1319-2442.388191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Mood disorders are common in end-stage renal disease (ESRD) and may increase morbidity and mortality in adults on chronic hemodialysis (HD), affecting their quality of life (QOL). We aimed to investigate the prevalence of and factors associated with anxiety and depression in ESRD patients on chronic HD. Thirty-nine HD patients were assessed for anxiety and depression using the Hospital Anxiety and Depression Scale (HADS) questionnaire. The HADS scores were correlated with demographic, clinical, and laboratory parameters. According to the HADS scores, depression and anxiety were found, respectively, in 11 (28.2%) and in nine (23.1%) patients. Both depression and anxiety were found in four (10.3%) patients. The average depression score was 7.4 ± 4.2; the average anxiety score was 7.7 ± 4.6. The depression score correlated significantly with the number of medications (r = 0.46, P = 0.003) and phosphatase alcalin (r = -0.37; P = 0.022); the anxiety score correlated significantly with the number of medications only (r = 0.36, P = 0.022). The risk factors associated with anxiety were age [odds ratio (OR) = 1.12; 95% confidence interval (CI): 1.01-1.2; P = 0.025] and sleep disturbances (OR = 6.74; 95% CI: 1.49-30.4; P = 0.016), and only diabetes was a risk factor associated with depression (OR = 4.4; 95% CI: 1.94-16.9; P = 0.009). The screening and management of depression and anxiety would improve the QOL of patients on chronic HD.
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Affiliation(s)
- Taoufiq Aatif
- Department of Nephrology, Dialysis, and Renal Transplantation, Mohammed V Military Hospital, Rabat, Morocco
| | - Ichraq Achour
- Department of Nephrology, Dialysis, and Renal Transplantation, Mohammed V Military Hospital, Rabat, Morocco
| | - Wafaa Arache
- Department of Nephrology, Dialysis, and Renal Transplantation, Mohammed V Military Hospital, Rabat, Morocco
| | - Yassir Zajjari
- Department of Nephrology, Dialysis, and Renal Transplantation, Mohammed V Military Hospital, Rabat, Morocco
| | - Dina Montasser
- Department of Nephrology, Dialysis, and Renal Transplantation, Mohammed V Military Hospital, Rabat, Morocco
| | - Jamal Mehssani
- Department of Psychiatry, Mohammed V Military Hospital, Rabat, Morocco
| | - Driss El Kabbaj
- Department of Nephrology, Dialysis, and Renal Transplantation, Mohammed V Military Hospital, Rabat, Morocco
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Ibrahim MB, Abdelaal Badawi SE, Alameri RA. Assessment of Pain and Anxiety During Arteriovenous Fistula Cannulation Among Hemodialysis Patients: A Cross-Sectional Study in Saudi Arabia. J Multidiscip Healthc 2022; 15:705-718. [PMID: 35411149 PMCID: PMC8994604 DOI: 10.2147/jmdh.s344256] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/21/2022] [Indexed: 11/23/2022] Open
Abstract
Background The number of hemodialysis patients has dramatically increased over the years. The cost of healthcare provision to those patients has been rising as well. In addition, pain management during arteriovenous fistula (AVF) cannulation is an important aspect of nursing care. Patients’ outcomes and appropriate pain control are one of the most critical issues in healthcare. Purpose To measure the level of pain and anxiety associated with arteriovenous fistula cannulation among hemodialysis patients. Methods A correlational cross-sectional research design was used in this study at the Hemodialysis Unit at King Fahad Hospital of the university, Al-Khobar, in the Eastern region of the Kingdom of Saudi Arabia using a self-administered questionnaire. Ethical approval was obtained. A convenience sample of 117 HD patients from the previous mentioned setting were included in the study. The data were collected using three tools: sociodemographic characteristics, Numerical Analogue Scale (NAS), and Hospital Anxiety and Depression Scale (HADS). Using IBM SPSS software package version 25.0, statistical significance of the obtained results was judged at the 5% level. Results According to the results, most of the participants experienced a mild to moderate level of pain and anxiety during arteriovenous fistula cannulation. Furthermore, there was a positive association between the level of pain and anxiety, with statistical significance (p<0.001). Conclusion Based on the results of the study, most of the study participants’ level of pain and anxiety during AVF cannulation ranged between mild and moderate.
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Affiliation(s)
- Maryam Bakr Ibrahim
- Home Healthcare Administration, Ministry of Health, Madinah, Kingdom of Saudi Arabia
| | | | - Rana Ali Alameri
- Department of Fundamental Nursing, College of Nursing, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
- Correspondence: Rana Ali Alameri, Tel +9661333 32934, Email
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Khodarahimi S, Veiskarami HA, Mazraeh N, Sheikhi S, Rahimian Bougar M. Mental Health, Social Support, and Death Anxiety in Patients With Chronic Kidney Failure. J Nerv Ment Dis 2021; 209:809-813. [PMID: 34238892 DOI: 10.1097/nmd.0000000000001386] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Purpose: This study aimed to investigate the relationship between mental health, perceived social support, and death anxiety, and the predictive roles of mental health and perceived social support in the explanation of death anxiety in a sample of adults with chronic kidney disease. Methods: A demographic questionnaire, the Symptom Check List-25, the Social Support Survey Scale, and the Death Anxiety Scale (DAS) were used in the present study. The sample consisted of 58 adult patients with chronic kidney failure. Results: Findings showed that mental health had significantly positive relationships to the total score of the death anxiety and the fear of death, the fear of pain and disease, and the death thoughts subscales of the DAS. Social support had a significant negative relationship to the total score of the death anxiety and the fear of pain and disease, the death thoughts, and the transient time and the short life subscales of the DAS. Mental health and combined mental health and social support explained 14% and 21% of death anxiety variation in patients with chronic kidney failure, respectively. Conclusion: Mental health and social support constructs can relatively predict the variations of death anxiety in patients with chronic kidney failure.
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9
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AlAwwa I, Ibrahim S, Obeid A, Alfraihat N, Al-Hindi R, Jallad S, Al-Awwa A. Comparison of pre- and post-hemodialysis PHQ-9 depression scores in patients with end-stage renal disease: A cross-sectional study. Int J Psychiatry Med 2021; 56:433-445. [PMID: 33161785 DOI: 10.1177/0091217420973489] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES An overlap between the somatic symptoms of depression and those of uremia seen in end-stage renal disease (ESRD) patients may affect the diagnosis of depression. This study aims to evaluate the effect of hemodialysis on the diagnosis of depression among patients on maintenance hemodialysis as dialysis diminishes the uremic symptoms, and to compare depression scores before and after dialysis. METHODS This was a cross-sectional analytic study conducted from November 2018 through April 2019, in three tertiary hospitals. Consenting participants aged 18 years or older, who had received hemodialysis for at least three months were included. The Patient Health Questionnaire (PHQ-9) tool was used to collect patients' data and to identify symptoms of depression Pre- and post-hemodialysis. Depression scores were compared using the paired sample Wilcoxon rank test or the McNemar test, where appropriate. RESULTS Overall, 163 participants were enrolled in the study. The average age of the participants was 56.5 years old, whereas 44.8% were females. The prevalence of depressive symptoms before hemodialysis was 48.5%, with prevalence of mild, moderate and moderately severe of 34.4%, 11.7% and 2.5%, respectively. On the other hand, the prevalence of depressive symptoms after hemodialysis was 46.6% with 36.8%, 9.2% and 0.6% of the participants reporting mild, moderate and moderately severe symptoms, respectively. We found no significant difference in depression scores before and after dialysis (p-values > 0.05). CONCLUSION Our study supports the fact that the prevalence of depression is high among patients with ESRD on maintenance hemodialysis. We didn't find a significant difference in depression scores among hemodialysis patients before and after dialysis, with negligible effect of uremic symptoms on the diagnosis of depression. We suggest adopting routine screening of depression among this high-risk group of patients.
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Affiliation(s)
- Izzat AlAwwa
- Internal Medicine and Nephrology, University of Jordan School of Medicine, Amman, Jordan
| | - Sarah Ibrahim
- Deanship of Research, University of Jordan, Amman, Jordan
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Desmond HE, Lindner C, Troost JP, Held Z, Callaway A, Oh GJ, Lafayette R, O'Shaughnessy M, Elliott M, Adler SG, Kamil ES, Pesenson A, Selewski DT, Gipson PE, Carlozzi NE, Gipson DS, Massengill SF. Association between Psychiatric Disorders and Glomerular Disease. GLOMERULAR DISEASES 2021; 1:118-128. [PMID: 36751494 PMCID: PMC9677713 DOI: 10.1159/000516359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/06/2021] [Indexed: 01/20/2023]
Abstract
Introduction Patients with chronic health conditions, particularly chronic kidney disease, are at heightened risk for psychiatric disorders; yet, there are limited data on those with primary glomerular disease. Methods This study included patients with glomerular disease enrolled in the kidney research network multisite patient registry. Registry data include encounter, diagnoses, medication, laboratory, and vital signs data extracted from participants' electronic health records. ICD-9/10 diagnosis codes were used to identify a subset of psychiatric disorders focused on anxiety, mood, and behavioral disorders. Time-varying Cox proportional hazard models were used to analyze time from the onset of kidney disease to diagnosis of psychiatric disorder. Adjusted models retained significant covariates from the full list of potential confounders, including age, sex, race, ethnicity, time-varying treatment, the estimated glomerular filtration rate, and proteinuria (urine protein-to-creatinine ratio [UPCR]). Analogous models examined diagnosis of psychiatric disorder as a predictor of time to end-stage kidney disease (ESKD). Results Data were available for 950 participants, with a median of 58 months of follow-up. 110 (12%) participants were diagnosed with psychiatric disorder during the follow-up. The estimated rate of psychiatric diagnosis after kidney disease was 14.7 cases per 1,000 person-years and was highest among those of adolescent age at the time of kidney disease diagnosis. Adjusted analyses found adolescent age (vs. adult, hazard ratio [HR] = 3.11, 95% confidence interval [CI] 1.87-5.17) and Asian race (vs. white, HR = 0.34, 95% CI 0.16-0.71) were associated with psychiatric diagnosis. A higher UPCR per 1 log unit (HR 1.13, 95% CI 1.01-1.27) and a higher total number of oral medications were associated with psychiatric disorder (p < 0.001). Psychiatric diagnosis was also associated with progression to ESKD (HR = 2.45, 95% CI 1.53-3.92) in adjusted models. Discussion/Conclusion Psychiatric disorders were documented in approximately one-eighth of patients with glomerular disease and correlated with clinical disease characteristics such as age, race, proteinuria, and oral medication burden. These findings suggest mental health screening is warranted in patients of all ages with glomerular disease.
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Affiliation(s)
- Hailey E. Desmond
- Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA,*Hailey E. Desmond,
| | - Clare Lindner
- Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Jonathan P. Troost
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Zack Held
- Division of Pediatric Nephrology, Department of Pediatrics, Levine Children's Hospital, Atrium Health, Charlotte, North Carolina, USA
| | | | - Gia J. Oh
- Department of Pediatric Nephrology, Randall Children's Hospital at Legacy Emanuel Medical Center, Legacy Health, Portland, Oregon, USA
| | - Richard Lafayette
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California, USA
| | | | - Matthew Elliott
- Metrolina Nephrology Associates, Charlotte, North Carolina, USA
| | - Sharon G. Adler
- Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-University of California, Torrance, California, USA
| | - Elaine S. Kamil
- Division of Pediatric Nephrology, Department of Pediatrics, Cedars-Sinai Medical Center, David Geffen School of Medicine at the University of California, Los Angeles, California, USA
| | | | - David T. Selewski
- Division of Nephrology, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Patrick E. Gipson
- Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA,Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Noelle E. Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Debbie S. Gipson
- Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Susan F. Massengill
- Division of Pediatric Nephrology, Department of Pediatrics, Levine Children's Hospital, Atrium Health, Charlotte, North Carolina, USA
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Brief Mindfulness Intervention vs. Health Enhancement Program for Patients Undergoing Dialysis: A Randomized Controlled Trial. Healthcare (Basel) 2021; 9:healthcare9060659. [PMID: 34205915 PMCID: PMC8228217 DOI: 10.3390/healthcare9060659] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Between 20–50% of patients undergoing maintenance dialysis for end-stage kidney disease experience symptoms of depression and/or anxiety, associated with increased mortality, greater health care utilization, and decreased quality of life. It is unknown whether mindfulness-based interventions can improve depression and anxiety symptoms in patients receiving this treatment. Methods: We conducted an 8-week multicenter randomized controlled trial comparing a brief mindfulness intervention (BMI) vs. an active control (Health Enhancement Program [HEP]) in 55 patients receiving dialysis with symptoms of depression and/or anxiety. The primary outcome was change in Patient Health Questionnaire-9 (PHQ-9) depression scores, with a primary analysis in participants with baseline PHQ-9 ≥ 10, and a secondary analysis including all participants. The secondary outcome was change in Generalized Anxiety Disorder-7 (GAD-7) anxiety scores with corresponding primary and secondary analyses. Results: Both BMI and HEP reduced depressive symptoms, with no difference between trial arms (PHQ-9 change = −7.0 vs. −6.1, p = 0.62). BMI was more effective than HEP in reducing anxiety (GAD-7 change = −8.7 vs. −1.4, p = 0.01). Secondary analyses revealed no differences between arms. Conclusions: For patients undergoing dialysis, both BMI and HEP may be helpful interventions for depression symptoms, and BMI may be superior to HEP for anxiety symptoms. Mindfulness-based and other psychosocial interventions may be further evaluated in those undergoing dialysis as treatment options for symptoms of depression and anxiety.
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Dingwall KM, Sweet M, Cass A, Hughes JT, Kavanagh D, Howard K, Barzi F, Brown S, Sajiv C, Majoni SW, Nagel T. Effectiveness of Wellbeing Intervention for Chronic Kidney Disease (WICKD): results of a randomised controlled trial. BMC Nephrol 2021; 22:136. [PMID: 33866968 PMCID: PMC8054368 DOI: 10.1186/s12882-021-02344-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 04/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background End stage kidney disease (ESKD) is associated with many losses, subsequently impacting mental wellbeing. Few studies have investigated the efficacy of psychosocial interventions for people with ESKD and none exist for Indigenous people, a population in which the ESKD burden is especially high. Methods This three-arm, waitlist, single-blind randomised controlled trial examined efficacy of the Stay Strong App in improving psychological distress (Kessler distress scale; K10), depressive symptoms (adapted Patient Health Questionnaire; PHQ-9), quality of life (EuroQoL; EQ. 5D) and dialysis adherence among Indigenous Australians undergoing haemodialysis in central and northern Australia (Alice Springs and Darwin), with follow up over two 3-month periods. Effects of immediate AIMhi Stay Strong App treatment were compared with those from a contact control app (The Hep B Story) and treatment as usual (TAU). Control conditions received the Stay Strong intervention after 3 months. Results Primary analyses of the full sample (N = 156) showed statistically significant decreases in K10 and PHQ-9 scores at 3 months for the Hep B Story but not for the Stay Strong app or TAU. Restricting the sample to those with moderate to severe symptoms of distress or depression (K10 > =25 or PHQ-9 > =10) showed significant decreases in K10 and PHQ-9 scores for both Stay Strong and Hep B Story. No significant differences were observed for the EQ-5D or dialysis attendance. Conclusions Findings suggest that talking to people about their wellbeing and providing information relevant to kidney health using culturally adapted, locally relevant apps improve the wellbeing of people on dialysis. Further research is required to replicate these findings and identify active intervention components. Trial registration ACTRN12617000249358; 17/02/2017.
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Affiliation(s)
- Kylie M Dingwall
- Menzies School of Health Research, Charles Darwin University, Alice Springs, NT, 0870, Australia.
| | - Michelle Sweet
- Menzies School of Health Research, Charles Darwin University, Alice Springs, NT, 0870, Australia
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, 0811, Australia
| | - Jaquelyne T Hughes
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, 0811, Australia.,Division of Medicine, Royal Darwin Hospital, Darwin, NT, 0811, Australia.,Department of Nephrology, Royal Darwin Hospital, Northern Territory Department of Health, Darwin, NT, 0810, Australia
| | - David Kavanagh
- Centre for Children's Health Research and School of Psychology & Counselling, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, 4101, Australia
| | - Kirsten Howard
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia
| | - Federica Barzi
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, 0811, Australia
| | - Sarah Brown
- Western Desert Nganampa Walytija Palyantjaku Tjutaku, Alice Springs, NT, 0870, Australia
| | - Cherian Sajiv
- Central Australian Renal Services, Alice Springs Hospital, Northern Territory Department of Health, Alice Springs, NT, 0870, Australia
| | - Sandawana W Majoni
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, 0811, Australia.,Department of Nephrology, Royal Darwin Hospital, Northern Territory Department of Health, Darwin, NT, 0810, Australia.,Northern Territory Medical Program, Flinders University, Darwin, NT, 0815, Australia
| | - Tricia Nagel
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, 0811, Australia
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Evans JM, Glazer A, Lum R, Heale E, MacKinnon M, Blake PG, Walsh M. Implementing a Patient-Reported Outcome Measure for Hemodialysis Patients in Routine Clinical Care: Perspectives of Patients and Providers on ESAS-r:Renal. Clin J Am Soc Nephrol 2020; 15:1299-1309. [PMID: 32843371 PMCID: PMC7480546 DOI: 10.2215/cjn.01840220] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 06/15/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES The Edmonton Symptom Assessment System Revised: Renal is a patient-reported outcome measure used to assess physical and psychosocial symptom burden in patients treated with maintenance dialysis. Studies of patient-reported outcome measures suggest the need for deeper understanding of how to optimize their implementation and use. This study examines patient and provider perspectives of the implementation process and the influence of the Edmonton Symptom Assessment System Revised: Renal on symptom management, patient-provider communication, and interdisciplinary communication. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Eight in-facility hemodialysis programs in Ontario, Canada, assessed patients using the Edmonton Symptom Assessment System Revised: Renal every 4-6 weeks for 1 year. Screening and completion rates were tracked, and pre- and postimplementation surveys and midimplementation interviews were conducted with patients and providers. A chart audit was conducted 12 months postimplementation. RESULTS In total, 1459 patients completed the Edmonton Symptom Assessment System Revised: Renal; 58% of eligible patients completed the preimplementation survey (n=718), and 56% of patients who completed the Edmonton Symptom Assessment System Revised: Renal at least once completed the postimplementation survey (n=569). Provider survey response rates were 71% (n=514) and 54% (n=319), respectively. Nine patients/caregivers from three sites and 48 providers from all sites participated in interviews. A total of 1207 charts were audited. Seven of eight sites had mean screening rates over 80%, suggesting that routine use of the Edmonton Symptom Assessment System Revised: Renal in clinical practice is feasible. However, the multiple data sources painted an inconsistent picture of the value and effect of the Edmonton Symptom Assessment System Revised: Renal. The Edmonton Symptom Assessment System Revised: Renal standardized symptom screening processes across providers and sites; improved patient and provider symptom awareness, particularly for psychosocial symptoms; and empowered patients to raise issues with providers. Yet, there was little, if any, statistically significant improvement in the metrics used to assess symptom management, patient-provider communication, and interdisciplinary communication. CONCLUSIONS The Edmonton Symptom Assessment System Revised: Renal patient-reported outcome measure may be useful to standardize symptom screening, enhance awareness of psychosocial symptoms among patients and providers, and empower patients rather than to reduce symptom burden.
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Affiliation(s)
- Jenna M. Evans
- DeGroote School of Business, McMaster University, Hamilton, Ontario, Canada
| | - Alysha Glazer
- Ontario Renal Network, Ontario Health, Toronto, Ontario, Canada
| | - Rebecca Lum
- Ontario Renal Network, Ontario Health, Toronto, Ontario, Canada
| | - Esti Heale
- Ontario Renal Network, Ontario Health, Toronto, Ontario, Canada
| | | | - Peter G. Blake
- Ontario Renal Network, Ontario Health, Toronto, Ontario, Canada
- Victoria Hospital, London Health Sciences Centre, London, Ontario, Canada
| | - Michael Walsh
- Ontario Renal Network, Ontario Health, Toronto, Ontario, Canada
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, Ontario, Canada
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Abstract
The development of dialysis by early pioneers such as Willem Kolff and Belding Scribner set in motion several dramatic changes in the epidemiology, economics and ethical frameworks for the treatment of kidney failure. However, despite a rapid expansion in the provision of dialysis — particularly haemodialysis and most notably in high-income countries (HICs) — the rate of true patient-centred innovation has slowed. Current trends are particularly concerning from a global perspective: current costs are not sustainable, even for HICs, and globally, most people who develop kidney failure forego treatment, resulting in millions of deaths every year. Thus, there is an urgent need to develop new approaches and dialysis modalities that are cost-effective, accessible and offer improved patient outcomes. Nephrology researchers are increasingly engaging with patients to determine their priorities for meaningful outcomes that should be used to measure progress. The overarching message from this engagement is that while patients value longevity, reducing symptom burden and achieving maximal functional and social rehabilitation are prioritized more highly. In response, patients, payors, regulators and health-care systems are increasingly demanding improved value, which can only come about through true patient-centred innovation that supports high-quality, high-value care. Substantial efforts are now underway to support requisite transformative changes. These efforts need to be catalysed, promoted and fostered through international collaboration and harmonization. Dialysis is a life-saving therapy; however, costs of dialysis are high, access is inequitable and outcomes are inadequate. This Review describes the current landscape of dialysis therapy from an epidemiological, economic, ethical and patient-centred framework, and describes initiatives that are aimed at stimulating innovations in the field to one that supports high-quality, high-value care. The global dialysis population is growing rapidly, especially in low-income and middle-income countries; however, worldwide, a substantial number of people lack access to kidney replacement therapy, and millions of people die of kidney failure each year, often without supportive care. The costs of dialysis care are high and will likely continue to rise as a result of increased life expectancy and improved therapies for causes of kidney failure such as diabetes mellitus and cardiovascular disease. Patients on dialysis continue to bear a high burden of disease, shortened life expectancy and report a high symptom burden and a low health-related quality of life. Patient-focused research has identified fatigue, insomnia, cramps, depression, anxiety and frustration as key symptoms contributing to unsatisfactory outcomes for patients on dialysis. Initiatives to transform dialysis outcomes for patients require both top-down efforts (that is, efforts that promote incentives based on systems level policy, regulations, macroeconomic and organizational changes) and bottom-up efforts (that is, patient-led and patient-centred advocacy efforts as well as efforts led by individual teams of innovators). Patients, payors, regulators and health-care systems increasingly demand improved value in dialysis care, which can only come about through true patient-centred innovation that supports high-quality, high-value care.
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Nagel T, Sweet M, Dingwall KM, Puszka S, Hughes JT, Kavanagh DJ, Cass A, Howard K, Majoni SW. Adapting wellbeing research tools for Aboriginal and Torres Strait Islander people with chronic kidney disease. BMC Nephrol 2020; 21:130. [PMID: 32293331 PMCID: PMC7161120 DOI: 10.1186/s12882-020-01776-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 03/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic kidney disease is an increasingly common health problem for Aboriginal and Torres Strait Islander people. It is associated with multiple concurrent psychosocial stressors frequently resulting in negative impacts on emotional and social wellbeing. There is need for well-designed intervention studies to provide evidence of effective treatment for comorbid depression or other mental illness in this setting. Attention to early phase piloting and development work is recommended when testing complex interventions. This paper documents feasibility testing and adaptation of an existing culturally responsive brief wellbeing intervention, the Stay Strong App, and three commonly used wellbeing outcome measures, in preparation for a clinical trial testing effectiveness of the intervention. METHODS The Stay Strong App, which has not been used in the setting of Chronic Kidney Disease before, is reviewed and adapted for people with comorbid wellbeing concerns through expert consensus between research team and an Expert Panel. The outcome measures (Kessler 10, Patient Health Questionnaire 9, and EuroQoL) are valid, reliable, and commonly used tools to assess various aspects of wellbeing, which have also not been used in this context before. Feasibility and acceptability are examined and developed through 3 stages: Pilot testing in a purposive sample of five haemodialysis patients and carers; translation of outcome measures through collaboration between the Aboriginal Interpreter Service, Aboriginal and Torres Strait Islander research officers and the research team; and conversion of translated outcome measures to electronic format. RESULTS Research team and expert panel consensus led to adaptation of the Stay Strong App for renal patients through selective revision of words and images. Pilot testing identified challenges in delivery of the wellbeing measures leading to word changes and additional prompts, integration of audio translations in 11 local Indigenous languages within an interactive Outcome Measures App, and related research protocol changes. CONCLUSION Modelling the complex intervention prior to full-scale testing provided important information about the design of both the outcome measures and the intervention. These changes are likely to better support success in conduct of the clinical trial and future implementation of the intervention in clinical settings.
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Affiliation(s)
- Tricia Nagel
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia.
| | - Michelle Sweet
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
| | - Kylie M Dingwall
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
| | - Stefanie Puszka
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
| | - Jaquelyne T Hughes
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
- Division of Medicine, Royal Darwin Hospital, Darwin, NT, 0811, Australia
| | - David J Kavanagh
- Centre for Children's Health Research, Institute of Health & Biomedical Innovation and School of Psychology & Counselling, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, 4101, Australia
| | - Alan Cass
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
| | - Kirsten Howard
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia
| | - Sandawana W Majoni
- Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
- Top End Renal Services, Royal Darwin Hospital, Northern Territory Department of Health, Darwin, NT, 0810, Australia
- Northern Territory Medical Program, Flinders University, Darwin, NT, 0815, Australia
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Keser BN, Kirman UN, Kocaaslan C, Aydin E. The association between vascular access type and depressive symptoms in geriatric hemodialysis population. Vascular 2020; 28:390-395. [DOI: 10.1177/1708538120905725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives A well-functioning vascular access is crucial for hemodialysis treatment, and arteriovenous fistula is the recommended vascular access type. Arteriovenous fistula is superior to other vascular access types in many aspects, but the effect of arteriovenous fistula on patients’ psychiatric state is not well described yet. The aim of this study is to determine whether there is an association between vascular access type and depression scores. Methods This cross-sectional study was conducted at two hemodialysis centers. Geriatric Depression Scale-15 was administered to geriatric hemodialysis patients, using ≥5 score as the cut-off value for the presence of depressive symptoms. Descriptive tests, Kolmogorov–Smirnov test, Pearson’s Chi-square test, Mann–Whitney test, Kruskal–Wallis test, Spearman’s rank correlation calculation, and multiple logistic regression analysis were performed accordingly to analyze the data. Results Of 75 participants, 34 (45.3%) were female and the mean age was 73.4 ± 5.9 years (range: 65–92). The prevalence of depressive symptoms in the geriatric hemodialysis population was 53.3%. Central venous catheter, hypertension, and increased time on hemodialysis have been found to be risk factors for higher depression scores (aOR 10.505 (95% CI 1.435–76.900), p = 0.021; aOR 9.783 (95% CI 2.508–38.169), p = 0.001; aOR 1.019 (95% CI 1.003–1.035), p = 0.017, respectively). Among patients with arteriovenous fistula, those with hypertension had higher depression scores ( p = 0.008). Conclusions Geriatric hemodialysis patients were found to have depressive symptoms commonly, and central venous catheter, hypertension, and increased time on hemodialysis have been found to be risk factors for presence of depressive symptoms. To the best of our knowledge, this is the first study highlighting that arteriovenous fistula is associated with lower depression scores and lower prevalence of depressive symptoms.
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Affiliation(s)
- Betul Nur Keser
- School of Medicine, Istanbul Medeniyet University, Goztepe Education and Research Hospital, Istanbul, Turkey
| | - Ulku Nur Kirman
- School of Medicine, Istanbul Medeniyet University, Goztepe Education and Research Hospital, Istanbul, Turkey
| | - Cemal Kocaaslan
- Cardiovascular Surgery Department, Istanbul Medeniyet University, Goztepe Education and Research Hospital, Istanbul, Turkey
| | - Ebuzer Aydin
- Cardiovascular Surgery Department, Istanbul Medeniyet University, Goztepe Education and Research Hospital, Istanbul, Turkey
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Brito DCSD, Machado EL, Reis IA, Carmo LPDFD, Cherchiglia ML. Depression and anxiety among patients undergoing dialysis and kidney transplantation: a cross-sectional study. SAO PAULO MED J 2019; 137:137-147. [PMID: 31314874 PMCID: PMC9721231 DOI: 10.1590/1516-3180.2018.0272280119] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 01/28/2019] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Depression and anxiety are the most prevalent psychological disorders among end-stage renal disease patients and are associated with various conditions that result in poorer health outcomes, e.g. reduced quality of life and survival. We aimed to investigate the prevalences of depression and anxiety among patients undergoing renal replacement therapy. DESIGN AND SETTING Cross-sectional study in Belo Horizonte, Brazil. METHODS Patients' depression and anxiety levels were assessed using the Beck Inventory. The independent variables were the 36-Item Short-Form Health Survey (SF-36), Charlson Comorbidity Index and Global Subjective Assessment, along with sociodemographic and clinical characteristics. RESULTS 205 patients were included. Depression and anxiety symptoms were detected in 41.7% and 32.3% of dialysis patients and 13.3% and 20.3% of transplantation patients, respectively. Lower SF-36 mental summary scores were associated with depression among transplantation patients (odds ratio, OR: 0.923; 95% confidence interval, CI: 0.85-0.99; P = 0.03) and dialysis patients (OR: 0.882; 95% CI: 0.83-0.93; P ≤ 0.001). Physical component summary was associated with depression among dialysis patients (OR: 0.906; 95% CI: 0.85-0.96; P = 0.001). Loss of vascular access (OR: 3.672; 95% CI: 1.05-12.78; P = 0.04), comorbidities (OR: 1.578; 95% CI: 1.09-2.27; P = 0.01) and poorer SF-36 mental (OR: 0.928; 95% CI: 0.88-0.97; P = 0.002) and physical (OR: 0.943; 95% CI: 0.89-0.99; P = 0.03) summary scores were associated with anxiety among -dialysis patients. CONCLUSIONS Depression and anxiety symptoms occurred more frequently among patients undergoing dialysis. Quality of life, comorbidities and loss of vascular access were associated factors.
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Affiliation(s)
- Daniela Cristina Sampaio de Brito
- MSc. Psychologist and Doctoral Student, Research Group on Economy and Health, Department of Preventive and Social Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
| | - Elaine Leandro Machado
- MD, PhD. Psychologist and Professor, Department of Preventive and Social Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG); and Researcher, Research Group on Economy and Health, Department of Preventive and Social Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
| | - Ilka Afonso Reis
- MD, PhD. Statistician and Professor, Department of Statistics, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG); and Researcher, Research Group on Economy and Health, Department of Preventive and Social Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
| | - Lilian Pires de Freitas do Carmo
- MD, PhD. Doctor and Professor, Department of Internal Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
| | - Mariangela Leal Cherchiglia
- MD, PhD. Doctor and Professor, Department of Preventive and Social Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG); and Coordinator, Research Group on Economy and Health, Department of Preventive and Social Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
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Dingwall KM, Nagel T, Hughes JT, Kavanagh DJ, Cass A, Howard K, Sweet M, Brown S, Sajiv C, Majoni SW. Wellbeing intervention for chronic kidney disease (WICKD): a randomised controlled trial study protocol. BMC Psychol 2019; 7:2. [PMID: 30621791 PMCID: PMC6325814 DOI: 10.1186/s40359-018-0264-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 10/23/2018] [Indexed: 11/20/2022] Open
Abstract
Background Incidence of end stage kidney disease (ESKD) for Indigenous Australians is especially high in remote and very remote areas of Australia (18 and 20 times the rate of comparable non-Indigenous people). Relocating away from family and country for treatment, adjusting to life with a chronic condition and time lost to dialysis cause grief and sadness which have immense impact on quality of life and challenges treatment adherence. We describe the first randomised controlled trial to address both chronic disease and mental health in Indigenous people with ESKD, which is the first to test the effectiveness of a culturally adapted e-mental health intervention in this population. It builds on an existing program of mental health research with demonstrated efficacy – the Aboriginal and Islander Mental Health Initiative (AIMhi) – to test the newly developed electronic motivational care planning (MCP) therapy – the AIMhi Stay Strong App. Methods This is a 3-arm, waitlist, single-blind randomised controlled trial testing the efficacy of the Stay Strong App in improving psychological distress, depressive symptoms, quality of life and treatment adherence among Indigenous clients undergoing haemodialysis for ESKD in Alice Springs and Darwin with follow up over two periods of 3 months (total of 6 months observation). The study compares the efficacy of MCP using the AIMhi Stay Strong App with two control groups (control app intervention and treatment as usual) on participant-reported psychological distress (the primary outcome) using the Kessler Distress Scale (K10); depressive symptoms using the adapted Patient Health Questionnaire (PHQ-9); quality of life using the EuroQoL instrument (EQ5D) and adherence to dialysis treatment planning through file audit. Participants are randomised to receive MCP either at baseline (early treatment) or after 3 months (delayed treatment). The study also examines the cost effectiveness of this therapy in this setting through examination of health care service utilisation across groups during the first 3 months. Discussion This project will contribute much needed evidence on the efficacy of an electronic wellbeing intervention for Indigenous people with ESKD – a group in which distress is likely to be unacceptably high, yet relatively untreated. Trial registration Australian New Zealand Clinical Trial Registry; ACTRN12617000249358; Date registered: 17/02/2017.
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Affiliation(s)
- Kylie M Dingwall
- Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, PO Box 4066, Alice Springs, NT, 0870, Australia.
| | - Tricia Nagel
- Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, Darwin, NT, 0811, Australia
| | - Jaquelyne T Hughes
- Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, Darwin, NT, 0811, Australia.,Division of Medicine, Royal Darwin Hospital, Darwin, NT, 0811, Australia
| | - David J Kavanagh
- Centre for Children's Health Research, Institute of Health & Biomedical Innovation and School of Psychology & Counselling, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, 4101, Australia
| | - Alan Cass
- Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, Darwin, NT, 0811, Australia
| | - Kirsten Howard
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia
| | - Michelle Sweet
- Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, PO Box 4066, Alice Springs, NT, 0870, Australia
| | - Sarah Brown
- Western Desert Nganampa Walytija Palyantjaku Tjutaku, Alice Springs, NT, 0870, Australia
| | - Cherian Sajiv
- Central Australian Renal Services, Alice Springs Hospital, Northern Territory Department of Health, Alice Springs, NT, 0870, Australia.,Top End Renal Services, Royal Darwin Hospital, Northern Territory Department of Health, Darwin, NT, 0810, Australia.,Flinders University, Adelaide, SA, 5042, Australia
| | - Sandawana W Majoni
- Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, PO Box 4066, Alice Springs, NT, 0870, Australia.,Top End Renal Services, Royal Darwin Hospital, Northern Territory Department of Health, Darwin, NT, 0810, Australia.,Northern Territory Medical Program, Flinders University, Darwin, NT, 0815, Australia
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Erdley-Kass SD, Kass DS, Gellis ZD, Bogner HA, Berger A, Perkins RM. Using Problem-solving Therapy to Improve Problem-solving Orientation, Problem-solving Skills and Quality of Life in Older Hemodialysis Patients. Clin Gerontol 2018; 41:424-437. [PMID: 29185878 DOI: 10.1080/07317115.2017.1371819] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To determine the effectiveness of Problem-Solving Therapy (PST) in older hemodialysis (HD) patients by assessing changes in health-related quality of life and problem-solving skills. METHODS 33 HD patients in an outpatient hemodialysis center without active medical and psychiatric illness were enrolled. The intervention group (n = 15) received PST from a licensed social worker for 6 weeks, whereas the control group (n = 18) received usual care treatment. RESULTS In comparison to the control group, patients receiving PST intervention reported improved perceptions of mental health, were more likely to view their problems with a positive orientation and were more likely to use functional problem-solving methods. Furthermore, this group was also more likely to view their overall health, activity limits, social activities and ability to accomplish desired tasks with a more positive mindset. CONCLUSIONS The results demonstrate that PST may positively impact mental health components of quality of life and problem-solving coping among older HD patients. CLINICAL IMPLICATIONS PST is an effective, efficient, and easy to implement intervention that can benefit problem-solving abilities and mental health-related quality of life in older HD patients. In turn, this will help patients manage their daily living activities related to their medical condition and reduce daily stressors.
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Affiliation(s)
- Shiloh D Erdley-Kass
- a Department of Sociology, Social Work and Criminal Justice , Bloomsburg University , Bloomsburg , Pennsylvania , USA
| | - Darrin S Kass
- b College of Business , Bloomsburg University , Bloomsburg , Pennsylvania , USA
| | - Zvi D Gellis
- c School of Social Policy and Practice and Center for Mental Health and Aging , University of Pennsylvania , Philadelphia , Pennsylvania, USA
| | - Hillary A Bogner
- d Perleman School of Medicine , University of Pennsylvania , Philadelphia Pennsylvania , USA
| | - Andrea Berger
- e Geisinger Center for Health Research , Danville , Pennsylvania , USA
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Alradaydeh MF, Khalil AA. The association of spiritual well-being and depression among patients receiving hemodialysis. Perspect Psychiatr Care 2018; 54:341-347. [PMID: 29077991 DOI: 10.1111/ppc.12249] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 09/11/2017] [Accepted: 09/24/2017] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The purpose of this study was to identify the relationship between spiritual well-being (meaning/peace, and faith) and depression among Jordanian patients receiving hemodialysis. METHODS Cross-sectional descriptive correlation design was used to carry out on a nationally representative convenience sample of 158 patients receiving hemodialysis at five different hospitals in Jordan. RESULTS The mean total score of the depression was 17.8 of the 40. While the mean total score of the spiritual well-being was 36.9 of the 48. The Pearson's correlation coefficient test showed significant negative correlation between spiritual well-being and depression (r = -.64, p < .005). CONCLUSION Healthcare providers should consider spiritual well-being in their assessment and interventions by helping the patients to establish meaning, peace, and faith to reduce patients' depression.
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Affiliation(s)
| | - Amani Anwar Khalil
- Clinical Nursing Department, Faculty of Nursing, The University of Jordan, Amman, Jordan
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21
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Hettiarachchi R, Abeysena C. Association of Poor Social Support and Financial Insecurity with Psychological Distress of Chronic Kidney Disease Patients Attending National Nephrology Unit in Sri Lanka. Int J Nephrol 2018; 2018:5678781. [PMID: 29888004 PMCID: PMC5977053 DOI: 10.1155/2018/5678781] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 04/04/2018] [Accepted: 04/10/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is associated with high morbidity and mortality. Hence, CKD patients are often in chronic psychological distress. The objective of the study was to describe factors associated with psychological distress of CKD patients attending National Nephrology Unit. METHODS A descriptive cross-sectional study was conducted among 382 CKD patients above 18 years of age applying systematic sampling. The data was collected using self-administered questionnaires to assess the psychological distress (GHQ-12), social support (SSQ6), coping strategies (BRIEFCOPE), pain (0 to 10 numeric pain rating scale), and physical role limitation due to ill health (SF36QOL). Sociodemographic and disease-related data were collected using an interviewer administered questionnaire and a data extraction sheet. Multiple logistic regression was applied for determining the associated factors. The results were expressed as adjusted odds ratio (AOR) and 95% confidence intervals (95% CI). RESULTS Percentage of psychological distress was 55.2% (95% CI: 48.4% to 62%). Poor social support (AOR = 1.81, 95% CI: 1.14-2.88), low satisfaction with the social support received (AOR = 4.14, 95% CI: 1.59-10.78), stages IV and V of CKD (AOR = 2.67, 95% CI: 1.65-4.20), presence of comorbidities (AOR = 2.38, 95% CI: 1.21-4.67), within one year of diagnosis (AOR = 2.23, 95% CI: 1.36-3.67), low monthly income (AOR = 2.26, CI: 1.26-4.06), higher out-of-pocket expenditure per month (AOR = 1.75, 95% CI: 1.75-1.99), and being a female (AOR = 2.95, 95% CI: 1.79-4.9) were significantly associated with psychological distress. CONCLUSIONS More than half of the CKD patients were psychologically distressed. Factors such as financial and social support will be worth considering early because of their modifiability.
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Affiliation(s)
- Ramya Hettiarachchi
- Community Medicine, Postgraduate Institute of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Chrishantha Abeysena
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Colombo, Sri Lanka
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22
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Golestaneh L. Decreasing hospitalizations in patients on hemodialysis: Time for a paradigm shift. Semin Dial 2018; 31:278-288. [DOI: 10.1111/sdi.12675] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Ladan Golestaneh
- Nephrology Division; Department of Medicine; Montefiore Medical Center; Albert Einstein College of Medicine; Bronx NY USA
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23
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Knowles SR, Ski CF, Langham R, O'Flaherty E, Thompson DR, Rossell SL, Moore G, Hsueh YSA, Castle DJ. Design and protocol for the Dialysis Optimal Health Program (DOHP) randomised controlled trial. Trials 2016; 17:447. [PMID: 27612446 PMCID: PMC5018180 DOI: 10.1186/s13063-016-1558-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 08/13/2016] [Indexed: 11/23/2022] Open
Abstract
Background Chronic kidney disease (CKD) and end-stage kidney disease (ESKD) are serious and growing health problems with enormous impact on psychological and social functioning. Despite high rates of comorbid depression and anxiety in these patient populations, and the adverse impact these have upon treatment adherence, quality of life, social connectedness and healthcare costs there has been little attention focused on the prevention or management of these problems. Thus, our aim was to evaluate the Dialysis Optimal Health Program (DOHP) that adopts a person-centred approach and engages collaborative therapy to educate and support those diagnosed with ESKD who are commencing dialysis. Methods The study design is a randomised controlled trial. Ninety-six adult patients initiating haemodialysis or peritoneal dialysis will be randomly allocated to either the intervention (DOHP) or usual care group. Participants receiving the intervention will receive nine (8 + 1 booster session) sequential sessions based on a structured information/workbook, psychosocial and educational supports and skills building. The primary outcome measures are depression and anxiety (assessed by the Hospital Anxiety and Depression Scale; HADS). Secondary outcomes include health-related quality of life (assessed by the Kidney Disease Quality of Life instrument; KDQOL), self-efficacy (assessed by General Self-Efficacy Scale) and clinical indices (e.g. albumin and haemoglobin levels). Cost-effectiveness analysis and process evaluation will also be performed to assess the economic value and efficacy of the DOHP. Primary and secondary measures will be collected at baseline and at 3-, 6-, and 12-month follow-up time points. Discussion We believe that this innovative trial will enhance knowledge of interventions aimed at supporting patients in the process of starting dialysis, and will broaden the focus from physical symptoms to include psychosocial factors such as depression, anxiety, self-efficacy, wellbeing and community support. The outcomes associated with this study are significant in terms of enhancing an at-risk population’s psychosocial health and reducing treatment-related costs and associated pressures on the healthcare system. Trial registration ANZCTR no. 12615000810516. Registered on 5 August 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1558-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Simon R Knowles
- Department of Psychology, Swinburne University, Melbourne, VIC, 3122, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, VIC, 3010, Australia.,Mental Health Service, St. Vincent's Hospital, Melbourne, VIC, 3065, Australia
| | - Chantal F Ski
- Department of Psychiatry, The University of Melbourne, Melbourne, VIC, 3010, Australia. .,Mental Health Service, St. Vincent's Hospital, Melbourne, VIC, 3065, Australia. .,Centre for the Heart and Mind, Australian Catholic University, Melbourne, VIC, 3000, Australia.
| | - Robyn Langham
- Department of Neurology, St. Vincent's Hospital, Melbourne, VIC, 3065, Australia
| | - Emmet O'Flaherty
- Department of Neurology, St. Vincent's Hospital, Melbourne, VIC, 3065, Australia
| | - David R Thompson
- Department of Psychiatry, The University of Melbourne, Melbourne, VIC, 3010, Australia.,Centre for the Heart and Mind, Australian Catholic University, Melbourne, VIC, 3000, Australia
| | - Susan L Rossell
- Department of Psychology, Swinburne University, Melbourne, VIC, 3122, Australia.,Mental Health Service, St. Vincent's Hospital, Melbourne, VIC, 3065, Australia
| | - Gaye Moore
- Department of Psychiatry, The University of Melbourne, Melbourne, VIC, 3010, Australia.,Mental Health Service, St. Vincent's Hospital, Melbourne, VIC, 3065, Australia
| | - Ya-Seng Arthur Hsueh
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, 3010, Australia
| | - David J Castle
- Department of Psychiatry, The University of Melbourne, Melbourne, VIC, 3010, Australia.,Mental Health Service, St. Vincent's Hospital, Melbourne, VIC, 3065, Australia.,Centre for the Heart and Mind, Australian Catholic University, Melbourne, VIC, 3000, Australia
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24
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Abstract
As medical advances are made in the care of persons with chronic illnesses including those with end-stage renal disease (ESRD), patients are not only experiencing increasing life expectancy but also bearing the burden of illness and treatment for a longer duration of time. With this in mind, it is increasingly important for health care providers to pay close attention to their individual patient's perceptions of their health, fitness, life satisfaction, and well-being. This assessment of Health-Related Quality of Life (HRQOL) also includes an evaluation of the patient's level of satisfaction with treatment, outcome, and health status, also taking into account their perspective on future prospects. In addition to improving patient-provider communication by helping in the identification and prioritization of problems, it is important to note that high HRQOL has been shown to be associated with better medical outcomes, including reduction in hospitalizations and death. In this review, we outline several validated tools that are used to quantitatively measure HRQOL in the ESRD population and incorporate these instruments in a review of specific, evidence-based measures by which we can measurably improve health-related quality of life in dialysis patients.
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Affiliation(s)
- Donald Mitema
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Bernard G Jaar
- Division of Nephrology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland.,Nephrology Center of Maryland, Baltimore, Maryland
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25
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Kopple JD, Kim JC, Shapiro BB, Zhang M, Li Y, Porszasz J, Bross R, Feroze U, Upreti R, Kalantar-Zadeh K. Factors affecting daily physical activity and physical performance in maintenance dialysis patients. J Ren Nutr 2015; 25:217-22. [PMID: 25701942 DOI: 10.1053/j.jrn.2014.10.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Accepted: 10/29/2014] [Indexed: 11/11/2022] Open
Abstract
Maintenance hemodialysis (MHD) patients display reduced daily physical activity (DPA) and physical performance (PP). Previous studies did not differentiate the effects of kidney failure and MHD treatments from comorbidities as causes for reduced DPA and PP. In relatively healthy MHD patients and normal adults, we evaluated DPA and PP and examined relationships between DPA and PP and possible associations between anxiety or depression and DPA and PP. DPA, 6-minute walk distance (6-MWD), sit-to-stand (STS), and stair-climbing tests were measured in 72 MHD patients (40% diabetics) with limited comorbidities and 39 normal adults of similar age and gender mix. Anxiety and depression were measured by the Beck anxiety and depression inventories. DPA, time-averaged over 7 days, and all 3 PP tests were impaired in MHD patients, to about 60% to 70% of normal values (P < .0001 for each measurement). MHD patients spent more time sleeping or physically inactive (P < .0001) and less time in ≥ moderate activity (P < .0001). Adjusted DPA correlated with 6-MWD but not STS or stair-climbing. Anxiety and depression were identified in 43% and 33% of MHD patients and 2.5% and 5.1% of normals (P < .0001 for each comparison). Most of the impairment in DPA and PP tests were also observed in MHD patients without anxiety or depression. However, MHD patients with both anxiety and depression generally had the most impaired DPA and PP. In MHD patients, higher adjusted anxiety scores were correlated with impaired 6-MWD and STS, whereas adjusted average DPA was negatively correlated with depression (r = -0.33, P = .006) but not anxiety. DPA on the hemodialysis day (P = .01), day after dialysis (P = .03), and day 2 after dialysis (P = .03) each correlated negatively with degree of depression but not with anxiety. MHD patients displayed negative-adjusted correlations between anxiety and 6-MWD (P = .03) and STS (P = .04). In relatively healthy MHD patients, DPA and PP are substantially impaired and correlated with each other, even in patients without evidence for anxiety or depression. Anxiety and depression are common in MHD patients and are associated with further impairment in DPA and PP.
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Affiliation(s)
- Joel D Kopple
- Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California; David Geffen School of Medicine at UCLA, Los Angeles, California; UCLA Fielding School of Public Health, Los Angeles, California.
| | - Jun C Kim
- Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California; Division of Nephrology, CHA Gumi Medical Center, CHA University, South Korea
| | - Bryan B Shapiro
- Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Min Zhang
- Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California; Division of Nephrology, Tianjin Union Medical Center, Tianjin, People's Republic of China
| | - Yinan Li
- Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California; Department of Nephrology, the First Affiliated Hospital of Xiamen University, People's Republic of China
| | - Janos Porszasz
- Rehabilitation Clinical Trials Center, Division of Respiratory and Critical Care Physiology and Medicine Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Rachelle Bross
- UCLA Clinical and Translational Science Institute, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Usama Feroze
- Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California; VA Boston Health Care System/Harvard South Shore Psychiatry Residency Program, Brockton, Massachusetts
| | - Rajeev Upreti
- Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Kamyar Kalantar-Zadeh
- UCLA Fielding School of Public Health, Los Angeles, California; Division of Nephrology and Hypertension, University of California at Irvine, Irvine, California; Harold Simmons Center for Kidney Disease Research and Epidemiology, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
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26
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Hedayati SS, Daniel DM, Cohen S, Comstock B, Cukor D, Diaz-Linhart Y, Dember LM, Dubovsky A, Greene T, Grote N, Heagerty P, Katon W, Kimmel PL, Kutner N, Linke L, Quinn D, Rue T, Trivedi MH, Unruh M, Weisbord S, Young BA, Mehrotra R. Rationale and design of A Trial of Sertraline vs. Cognitive Behavioral Therapy for End-stage Renal Disease Patients with Depression (ASCEND). Contemp Clin Trials 2015; 47:1-11. [PMID: 26621218 DOI: 10.1016/j.cct.2015.11.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 11/21/2015] [Accepted: 11/23/2015] [Indexed: 11/18/2022]
Abstract
Major Depressive Disorder (MDD) is highly prevalent in patients with End Stage Renal Disease (ESRD) treated with maintenance hemodialysis (HD). Despite the high prevalence and robust data demonstrating an independent association between depression and poor clinical and patient-reported outcomes, MDD is under-treated when identified in such patients. This may in part be due to the paucity of evidence confirming the safety and efficacy of treatments for depression in this population. It is also unclear whether HD patients are interested in receiving treatment for depression. ASCEND (Clinical Trials Identifier Number NCT02358343), A Trial of Sertraline vs. Cognitive Behavioral Therapy (CBT) for End-stage Renal Disease Patients with Depression, was designed as a multi-center, 12-week, open-label, randomized, controlled trial of prevalent HD patients with comorbid MDD or dysthymia. It will compare (1) a single Engagement Interview vs. a control visit for the probability of initiating treatment for comorbid depression in up to 400 patients; and (2) individual chair-side CBT vs. flexible-dose treatment with a selective serotonin reuptake inhibitor, sertraline, for improvement of depressive symptoms in 180 of the up to 400 patients. The evolution of depressive symptoms will also be examined in a prospective longitudinal cohort of 90 HD patients who choose not to be treated for depression. We discuss the rationale and design of ASCEND, the first large-scale randomized controlled trial evaluating efficacy of non-pharmacologic vs. pharmacologic treatment of depression in HD patients for patient-centered outcomes.
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Affiliation(s)
- S Susan Hedayati
- Renal Section, VA North Texas Health Care System, United States; Division of Nephrology, University of Texas Southwestern Medical Center, United States.
| | - Divya M Daniel
- Kidney Research Institute, University of Washington, United States
| | - Scott Cohen
- Division of Nephrology, George Washington University, United States
| | - Bryan Comstock
- School of Public Health, University of Washington, United States
| | - Daniel Cukor
- Department of Psychiatry, SUNY Downstate Medical Center, United States
| | | | - Laura M Dember
- Division of Nephrology, University of Pennsylvania, United States
| | - Amelia Dubovsky
- Department of Psychiatry, University of Washington, United States
| | | | - Nancy Grote
- School of Social Work, University of Washington, United States
| | - Patrick Heagerty
- School of Public Health, University of Washington, United States
| | - Wayne Katon
- Department of Psychiatry, University of Washington, United States
| | - Paul L Kimmel
- National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, United States
| | | | - Lori Linke
- Kidney Research Institute, University of Washington, United States
| | - Davin Quinn
- Department of Psychiatry, University of New Mexico, United States
| | - Tessa Rue
- School of Public Health, University of Washington, United States
| | - Madhukar H Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center, United States
| | - Mark Unruh
- Division of Nephrology, University of New Mexico, United States
| | - Steven Weisbord
- Division of Nephrology, VA Pittsburgh Healthcare System and University of Pittsburgh School of Medicine, United States
| | - Bessie A Young
- Kidney Research Institute, University of Washington, United States
| | - Rajnish Mehrotra
- Kidney Research Institute, University of Washington, United States
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27
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Chen SF, Wang IJ, Lang HC. Risk of major depression in patients with chronic renal failure on different treatment modalities: A matched-cohort and population-based study in Taiwan. Hemodial Int 2015; 20:98-105. [PMID: 26179222 DOI: 10.1111/hdi.12334] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The influence of different treatment modalities on the risk of developing major depression in patients with chronic renal failure (CRF) is not well understood. We aimed to explore the incidence of major depression among patients with CRF who were on different dialysis modalities, who had received renal transplantation (RT), and those who had not yet received any of the aforementioned renal replacement therapies. We conducted a population-based retrospective cohort study using a national health insurance research database. This study investigated 89,336 study controls, 17,889 patients with chronic kidney disease on conservative treatment, 3823 patients on hemodialysis (HD), 351 patients on peritoneal dialysis (PD), and 322 patients who had RT. We followed all individuals until the occurrence of major depression or the date of loss to follow-up. The PD group had the highest risk (hazard ratio [HR] 2.43; 95% confidence interval [CI] 1.26-4.69), whereas the RT group had the lowest risk (HR 0.18; 95% CI 0.03-1.29) of developing major depression compared with the control group. Patients initiated on PD had a higher risk of developing major depression than patients initiated on HD (pairwise comparison: HR 2.20; 95% CI 1.09-4.46). Different treatment modalities are associated with different risks of developing major depression in patients with CRF. Among renal replacement therapies, patients who have had RT have the lowest risk of developing major depression. Patients who initiate renal therapy on PD may have a higher risk of major depression compared with patients who initiate renal therapy on HD.
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Affiliation(s)
- Shih-Feng Chen
- Nephrology Department, New Taipei City Hospital, New Taipei City, Taiwan.,Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - I-Jen Wang
- Psychiatry Department, Taipei City Hospital Jen-Ai Branch, Taipei, Taiwan
| | - Hui-Chu Lang
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
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28
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Grigoriou SS, Karatzaferi C, Sakkas GK. Pharmacological and Non-pharmacological Treatment Options for Depression and Depressive Symptoms in Hemodialysis Patients. Health Psychol Res 2015; 3:1811. [PMID: 26973957 PMCID: PMC4768541 DOI: 10.4081/hpr.2015.1811] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 12/01/2014] [Accepted: 12/01/2014] [Indexed: 12/04/2022] Open
Abstract
Depression is a mental disorder with a high prevalence among patients with end stage renal disease (ESRD). It is reported that depression afflicts approximately 20-30% of this patient population, being associated, amongst other, with high mortality rate, low adherence to medication and low perceived quality of life. There is a variety of medications known to be effective for the treatment of depression but due to poor adherence to treatment as well as due to the high need for medications addressing other ESRD comorbidities, depression often remains untreated. According to the literature, depression is under-diagnosed and undertreated in the majority of the patients with chronic kidney disease. In the current review the main pharmacological and non-pharmacological approaches and research outcomes for the management of depressive symptoms in hemodialysis patients are discussed.
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Affiliation(s)
- Stefania S Grigoriou
- Department of Physical Education and Sport Science, University of Thessaly, Trikala; Institute of Research and Technology Thessaly, Centre for Research and Technology-Hellas , Trikala, Greece
| | - Christina Karatzaferi
- Department of Physical Education and Sport Science, University of Thessaly, Trikala; Institute of Research and Technology Thessaly, Centre for Research and Technology-Hellas , Trikala, Greece
| | - Giorgos K Sakkas
- Department of Physical Education and Sport Science, University of Thessaly, Trikala; Institute of Research and Technology Thessaly, Centre for Research and Technology-Hellas , Trikala, Greece
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29
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Exploring the relationships between health status, illness perceptions, coping strategies and psychological morbidity in a chronic kidney disease cohort. Am J Med Sci 2015; 348:271-6. [PMID: 24751421 DOI: 10.1097/maj.0000000000000242] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Using the common sense model of illness adjustment, this study aimed to explore the impact of chronic kidney disease (CKD) on individual illness perceptions, coping styles and psychological well-being. METHODS Eighty individuals (50 men and 30 women) with an average age of 62.66 years (standard deviation, 11.98) were included in the study. All participants were under the care of the Renal Unit of a metropolitan tertiary referral hospital. Twenty-nine patients (36%) had CKD stage 3b-4, and 51 (64%) had CKD stage 5 (or end stage kidney disease [ESKD]). Disease severity was evaluated using the health perceptions questionnaire, coping styles assessed with the Carver brief COPE scale, illness perceptions explored with the brief illness perceptions questionnaire and anxiety and depression measured using the hospital anxiety and depression scale. RESULTS The hospital anxiety and depression scale assessment revealed 13 patients (16.3%) with moderate or severe anxiety and 6 (7.5%) with moderate depression. Consistent with the common sense model, disease activity had a significant direct influence on illness perceptions, while, in turn, illness perceptions had a significant direct influence on depression and anxiety. Adaptive and maladaptive coping were found to mediate the relationship between illness perceptions, and anxiety and depression. CONCLUSIONS The results provide evidence that it is the perception of an illness rather than the actual symptoms themselves that best account for adaption to CKD. These findings suggest that intervention strategies aimed at increasing psychological well-being need to focus on changing illness perceptions rather than improving symptoms of CKD or coping mechanisms.
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30
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Depression in patients with chronic kidney disease on dialysis in Saudi Arabia. Int Urol Nephrol 2014; 46:2393-402. [PMID: 25164589 DOI: 10.1007/s11255-014-0802-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 07/24/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Patients with chronic kidney disease on hemodialysis experience considerable psychological stress due to physical and social changes brought on by illness, increasing the risk of depressive disorder (DD). We examined the prevalence of DD and depressive symptoms, identified treatments for depression, and determined baseline demographic, social/behavioral, physical, and psychological correlates. METHODS A convenience sample of 310 dialysis patients in Jeddah, Saudi Arabia, was screened for DD using the Structured Clinical Interview for Depression and for depressive symptoms using the Hamilton Depression Rating Scale (HDRS). Established measures of psychosocial and physical health characteristics were administered, along with questions about current and past treatments. Bivariate and multivariate analyses identified independent correlates of DD and symptoms. RESULTS The prevalence of DD was 6.8 % (major depression 3.2 %, minor depression 3.6 %), and significant depressive symptoms were present in 24.2 % (HDRS 8 or higher). No patients with DD were being treated with antidepressant medication, whereas 28.6 % (6 of 21) were receiving counseling. Being a Saudi national, married, in counseling, or having a history of antidepressant were associated with DD in bivariate analyses. Correlates of depressive symptoms HDRS in multivariate analyses were Saudi nationality, marital status, stressful life events, poor physical functioning, cognitive impairment, overall severity of medical illness, and history of family psychiatric problems. CONCLUSIONS The prevalence of DD and depressive symptoms is lower in Saudi dialysis patients than in the rest of the world, largely untreated, and is associated with a distinct set of demographic, psychosocial, and physical health characteristics.
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31
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Zhang M, Kim JC, Li Y, Shapiro BB, Porszasz J, Bross R, Feroze U, Upreti R, Martin D, Kalantar-Zadeh K, Kopple JD. Relation between anxiety, depression, and physical activity and performance in maintenance hemodialysis patients. J Ren Nutr 2014; 24:252-60. [PMID: 24788308 DOI: 10.1053/j.jrn.2014.03.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Revised: 03/04/2014] [Accepted: 03/04/2014] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Maintenance hemodialysis (MHD) patients have a high prevalence of anxiety and depression and decreased daily physical activity (DPA) and exercise capacity. Because affective disorders may affect DPA and physical performance, we investigated possible relationships between anxiety or depression and DPA and physical performance in relatively healthy MHD patients. DESIGN AND METHODS This cross-sectional study included 72 relatively healthy MHD patients and 39 normal adults. DPA was measured for 7 days with an Actigraph Activity Monitor®. Physical performance was assessed using the 6-minute walk (6-MWT), sit-to-stand (STS), and stair-climbing tests. Subjects completed the Beck Anxiety Inventory (BAI), the Beck Depression Inventory-II (BDI), and the Hospital Anxiety and Depression Scale (HADS). Main outcome measures were physical activity counts (expressed as vector magnitude), in the 6-MWT, STS, stair-climbing test, BAI, BDI, and HADS scores. RESULTS Anxiety and depression by BAI and BDI were identified in 43% and 33% of MHD patients and 2.5% and 5% of normals, respectively (P < .0001 for each comparison). MHD patients without anxiety or depression had decreased DPA and physical performance compared with normals, indicating that these disorders were also independent of anxiety or depression. MHD patients with anxiety and depression generally had the most impaired DPA and physical performance. Higher BAI and BDI scores were each associated with impaired physical performance. In fully adjusted analyses, DPA in MHD patients was negatively correlated with the BDI (r = -0.33, P = .01) but not with the BAI. DPA on the day of hemodialysis (P = .01), and day 1 (P = .03) and day 2 (P = .03) after dialysis each correlated negatively with degree of depression by BDI. In MHD patients, BAI was negatively correlated with 6-MWT (P = .03) and STS (P = .04). CONCLUSIONS In relatively healthy adult MHD patients, anxiety and depression are common and are associated with impaired physical performance. There was a trend toward stronger negative associations between BDI scores and DPA than between BAI scores and DPA.
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Affiliation(s)
- Min Zhang
- Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California; Division of Nephrology, Tianjin Union Medical Center, Tianjin, People's Republic of China
| | - Jun Chul Kim
- Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California; Division of Nephrology, CHA Gumi Medical Center, CHA University, Daegu, South Korea
| | - Yinan Li
- Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California; Department of Nephrology, the First Affiliated Hospital of Xiamen University, People's Republic of China
| | - Bryan B Shapiro
- Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
| | - Janos Porszasz
- Rehabilitation Clinical Trials Center, Division of Respiratory and Critical Care Physiology and Medicine Los Angeles Biomedical Research Institute at Harbor- University of California-Los Angeles Medical Center, Torrance, California
| | - Rachelle Bross
- University of California-Los Angeles Clinical and Translational Science Institute, Los Angeles Biomedical Research Institute at Harbor-University of California-Los Angeles Medical Center, Torrance, California; Harold Simmons Center for Kidney Disease Research and Epidemiology, Los Angeles Biomedical Research Institute at Harbor-University of California-Los Angeles Medical Center, Torrance, California
| | - Usama Feroze
- Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California; VA Boston Health Care system/Harvard South Shore Psychiatry Residency Program, Brockton, Massachusetts
| | - Rajeev Upreti
- Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California
| | - David Martin
- Division of Psychology, Department of Psychiatry, Harbor-University of California-Los Angeles Medical Center, Torrance, California
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Los Angeles Biomedical Research Institute at Harbor-University of California-Los Angeles Medical Center, Torrance, California; Division of Nephrology and Hypertension, University of California at Irvine, Orange, California; University of California Los Angeles Fielding School of Public Health, Los Angeles, California
| | - Joel D Kopple
- Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California; University of California Los Angeles Fielding School of Public Health, Los Angeles, California; David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California.
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Giannaki CD, Sakkas GK, Karatzaferi C, Hadjigeorgiou GM, Lavdas E, Kyriakides T, Koutedakis Y, Stefanidis I. Effect of exercise training and dopamine agonists in patients with uremic restless legs syndrome: a six-month randomized, partially double-blind, placebo-controlled comparative study. BMC Nephrol 2013; 14:194. [PMID: 24024727 PMCID: PMC3847208 DOI: 10.1186/1471-2369-14-194] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 07/12/2013] [Indexed: 12/17/2022] Open
Abstract
Background Restless Legs Syndrome is very common in hemodialysis patients however there are no comparative studies assessing the effectiveness of a non-pharmacological treatment to a classical treatment on parameters related to syndromes’ severity and quality of life. Methods In this randomized, partially double blind, placebo controlled trial, thirty two hemodialysis patients with restless legs syndrome were randomly assigned into three groups: 1) the exercise training group (N = 16), 2) the dopamine agonists group (ropinirole 0.25 mg/d) (N = 8) and 3) the placebo group (N = 8). The intervention programs lasted 6 months. Restless Legs Syndrome severity was assessed using the international severity scale, physical performance by a battery of tests, muscle size and composition by computed tomography, body composition by Dual Energy X Ray Absorptiometry, while depression score, sleep quality, daily sleepiness and quality of life were assessed through questionnaires. Results Exercise training and dopamine agonists were effective in reducing syndrome’s symptoms by 46% (P = 0.009) and 54% (P = 0.001) respectively. Within group changes revealed that both approaches significantly improved quality of life (P < 0.05), however, only the dopamine agonists significantly improved sleep quality (P = 0.009). Within group changes showed a tendency for lean body mass improvements with dopamine agonists, this reached statistical significance only with the exercise training (P = 0.014), which also reduced fat infiltration in muscles (P = 0.044) and improved physical performance (P > 0.05) in various tests. Between group changes detect significant improvements with both exercise and dopamine agonists in depression score (P = 0.003), while only the dopamine agonist treatment was able to significantly improve sleep quality, compared to exercise and placebo (P = 0.016). Conclusions A 6-month exercise training regime was as effective as a 6-month low dosage dopamine agonist treatment in reducing restless legs syndrome symptoms and improving depression score in uremic patients. Further research is needed in order to show whether a combination treatment could be more beneficial for the amelioration of RLS. Trial registration NCT00942253
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Al Wakeel J, Mitwalli AH, Alsuwaida A, Al Ghonaim M, Usama S, Hayat A, Shah IH. Recommendations for fasting in Ramadan for patients on peritoneal dialysis. Perit Dial Int 2013; 33:86-91. [PMID: 23349195 DOI: 10.3747/pdi.2010.00095] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION The month of Ramadan holds great religious and social significance for Muslims all over the world. The aim of the present study was to provide a modified dialysis schedule for peritoneal dialysis (PD) patients that allows for fasting and that minimizes the effect on the patient's general health and volume status. METHODS We observed 31 patients under treatment at the PD unit of King Khalid University Hospital, King Saud University, Riyadh. During the 3 - 4 weeks before the start of Ramadan, all patients were counseled individually and in detail about the possibility of fasting. They were also provided with clear instructions about fluid intake (up to 1 L daily) and avoiding a high-potassium diet. Of the 31 patients, 18 (10 women, 8 men) elected to fast during the month of Ramadan. The mean duration of fast in the study year (2009) in Riyadh, Saudi Arabia, was about 14 hours: from 0415 h (before sunrise) to 1800 h (after sunset). Depending on membrane type and patient preference, the fasting group was shifted to one of two regimens: Modified continuous ambulatory PD (8 patients): 3 exchanges during the night (1.36% or 2.27%), and icodextrin for a long dwell during the day. The first dialysis exchange was performed immediately after breaking the fast (1900 h), and the next at 2300 h. The final exchange was performed in the early morning before sunrise (0300 h), when the icodextrin was infused. Modified continuous cycling PD (10 patients): exchanges (1.36% or 2.27%) were performed over 6 - 7 hours, and icodextrin was infused for a long dwell during the day. The patient connected to the cycler at 2000 h or 2100 h, and therapy finished at nearly 0300 h, with icodextrin as the last fill. RESULTS Of the study patients, 2 were admitted because of peritonitis (1 in each modality group), and the modified therapy was discontinued. In the modified CCPD group, 1 patient (on PD for 1 month before Ramadan) developed PD-related pleural effusion (proved by pleural fluid analysis), and PD was consequently discontinued. Hypotension developed in 2 patients of the CAPD group and 1 of the CCPD group during the first 2 weeks. In the CCPD group, 1 patient presented with lower limb edema and mild fluid overload. Overall, PD patients that opted to fast during Ramadan did not experience any serious morbidity or deterioration in renal function during their period of observance. No biochemical parameters or clearance studies showed a statistically significant p value. CONCLUSIONS In view of the study findings, we conclude that most stable patients on PD can fast, provided that they strictly adhere to their medications and dialysis therapy in addition to the dietary restrictions. These patients should be followed closely to detect any complications and to ensure that adequate fluid and electrolyte balance are maintained.
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Affiliation(s)
- Jamal Al Wakeel
- Department of Medicine, King Saud University, Riyadh, Saudi Arabia.
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Cukor D, Fruchter Y, Ver Halen N, Naidoo S, Patel A, Saggi SJ. A preliminary investigation of depression and kidney functioning in patients with chronic kidney disease. Nephron Clin Pract 2013; 122:139-45. [PMID: 23736810 DOI: 10.1159/000349940] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Accepted: 02/12/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The incidence and prevalence of Chronic Kidney Disease (CKD) is growing rapidly. Understanding the factors associated with declining renal function is of clinical significance. The current study's main goal was to identify variables that could predict decline in glomerular filtration rate (GFR) over time in outpatients with varying stages of CKD. METHODS Seventy CKD patients completed psychological questionnaires and medical variables were extracted from the medical charts. Follow-up GFR was collected 6 months later. CKD patients with elevated depression scores were compared to patients with subclinical depression on medical and psychological variables. RESULTS Average Beck Depression Inventory (BDI) score was 10.0 ± 7.8, placing the mean below the cut-off for clinical elevation. GFR was significantly different for the two groups (nondepressed, 40.0 ± 11.3 vs. depressed 29.6 ± 8.9; p < 0.05). Similarly, patients with elevated depression scores reported lower quality of life (Short Form 36 Health Survey; p < 0.05) inferior social support (Interpersonal Support Evaluation List; p < 0.05), and worse community integration (Community Integration Questionnaire; p < 0.05). Utilizing a regression, with a model correcting for baseline GFR, the BDI explained 19% of the variance in GFR score (t = -2.0, p < 0.05) for subjects with decreased GFR. CONCLUSIONS Increased levels of preexisting depression were associated with inferior quality of life, social support and kidney functioning. Depression scores explained a significant amount of variance in GFR scores at 6 months even when corrected for baseline variability. Elevated depression scores are prevalent in CKD populations and further research on the impact of depression interventions is warranted.
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Affiliation(s)
- Daniel Cukor
- Department of Psychiatry and Behavioral Science, SUNY Downstate Medical Center, New York, NY 11203, USA.
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Kimmel PL. The weather and quality of life in ESRD patients: everybody talks about it, but does anybody do anything about it? Semin Dial 2013; 26:260-2. [PMID: 23406381 DOI: 10.1111/sdi.12063] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Paul L Kimmel
- Division of Kidney Urologic and Hematologic Diseases, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892, USA.
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Jung O, Haack HS, Buettner M, Betz C, Stephan C, Gruetzmacher P, Amann K, Bickel M. Renal AA-amyloidosis in intravenous drug users--a role for HIV-infection? BMC Nephrol 2012; 13:151. [PMID: 23171281 PMCID: PMC3519698 DOI: 10.1186/1471-2369-13-151] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 11/18/2012] [Indexed: 11/12/2022] Open
Abstract
Background Chronic renal disease is a serious complication of long-term intravenous drug use (IVDU). Recent reports have postulated a changing pattern of underlying nephropathy over the last decades. Methods Retrospective investigation including all patients with prior or present IVDU that underwent renal biopsy because of chronic kidney disease between 01.04.2002 and 31.03.2012 in the city of Frankfurt/Main, Germany. Results Twenty four patients with IVDU underwent renal biopsy because of progressive chronic kidney disease or proteinuria. Renal AA-amyloidosis was the predominant cause of renal failure in 50% of patients. Membranoproliferative glomerulonephritis (GN) was the second most common cause found in 21%. Patients with AA-amyloidosis were more likely to be HIV infected (67 vs.17%; p=0.036) and tended to have a higher rate of repeated systemic infections (92 vs. 50%; p=0.069). Patients with AA-amyloidosis presented with progressive renal disease and nephrotic-range proteinuria but most patients had no peripheral edema or systemic hypertension. Development of proteinuria preceded the decline of GFR for approximately 1–2 years. Conclusions AA-amyloidosis was the predominant cause of progressive renal disease in the last 10 years in patients with IVDU. The highest rate of AA-amyloidosis observed was seen in HIV infected patients with IVDU. We speculate that chronic HIV-infection as well as the associated immunosuppression might promote development of AA-amyloidosis by increasing frequency and duration of infections acquired by IVDU.
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Affiliation(s)
- Oliver Jung
- Department of Infectious Disease, Goethe University, Frankfurt/Main, Germany
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Oyekçin DG, Gülpek D, Sahin EM, Mete L. Depression, anxiety, body image, sexual functioning, and dyadic adjustment associated with dialysis type in chronic renal failure. Int J Psychiatry Med 2012; 43:227-41. [PMID: 22978081 DOI: 10.2190/pm.43.3.c] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Depression is the most widely studied complication in dialysis patients. In patients with chronic renal failure, changes in body image are considered to be associated with invasive treatment interventions. In addition, sexual problems are common in dialysis patients. In this study, hemodialysis and peritoneal dialysis patients are investigated for depression, anxiety, body image, sexual satisfaction, and dyadic adjustment. METHODS Hemodialysis patients (n = 36), peritoneal dialysis patients (n = 54), and healthy controls (n = 30) were included in the study. All the subjects were assessed with Structured Clinical Interview for DSM-IV, Body Image Scale, Beck Depression Inventory, Beck Anxiety Scale, Golombok-Rust Inventory for Sexual Satisfaction, and Dyadic Adjustment Scale. RESULTS Depression (20.64 +/- 15.20) and anxiety levels (14.72 +/- 12.36) were significantly higher in hemodialysis group compared to peritoneal dialysis (13.54 +/- 12.51; 12.74 +/- 11.21) and control groups (7.17 +/- 5.58; 9.86 +/- 9.19). In peritoneal dialysis group, as depression and anxiety levels increased, body image was disturbed and sexual satisfaction decreased. In peritoneal dialysis group, body image (86.98 +/- 23.63) was better than hemodialysis group (101.58 +/- 26.51) and was not different from the control group (83.67 +/- 22.11). In hemodialysis group, as depression and anxiety levels increased, body image was disturbed. In both groups, long-term dialysis disturbed body image. CONCLUSION Patients should be informed about the impacts of dialysis. Clinicians may wish to monitor dialysis-users for anxiety, depression, dyadic adjustment, and body image difficulties at follow-up appointments. Interventions that target intimate partner interventions, appearance-related beliefs, and anxiety depression may be of benefit to this population.
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Serum S100B protein is associated with depressive symptoms in patients with end-stage renal disease. Clin Biochem 2012; 45:1573-7. [PMID: 22935566 DOI: 10.1016/j.clinbiochem.2012.08.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 08/14/2012] [Accepted: 08/14/2012] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Depression is associated with a poorer prognosis in patients with end-stage renal disease (ESRD). Increasing evidence indicates that glial pathology and blood-brain-barrier (BBB) dysfunction are involved in the pathophysiology of depression. S100B, a protein expressed in astro- and oligodendroglia in the human brain is considered a biomarker of depression. Our objective was to investigate the relationship between S100B and depressive symptoms in patients undergoing hemodialysis (HD). DESIGN AND METHODS Seventy-eight Korean patients undergoing chronic HD without significant neurological issues participated in a cross-sectional observation study. Depressive symptoms were assessed with the Beck Depression Inventory-II (BDI-II), and serum S100B levels were measured using blood samples obtained prior to a mid-week HD session. RESULTS The mean age of patients was 59.0 years, and the mean dialysis duration was 51.7 months. About 45% of patients undergoing HD met criteria for depression (BDI-II≥20). Serum S100B levels were significantly higher in patients with depression compared with patients without depression (115.1±45.4 vs. 66.1±35.3 pg/mL, p<0.001). S100B (r=0.556, p<0.001) and high-sensitivity C-reactive protein (hs-CRP; r=0.422, p<0.001) and β2-microglobulin (r=0.391, p<0.001) levels were positively correlated with BDI-II scores. A multivariate regression analysis showed that both S100B and hs-CRP were significantly associated with BDI-II scores. CONCLUSIONS The results showed a close association between S100B and depressive symptoms in patients undergoing HD. However, the mechanisms underlying this relationship are currently unknown and warrant further investigation.
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Libório AB, Santos JPL, Minete NFA, Diógenes CDA, Soares AP, Queiroz AL, Barreto DMS. Proteinuria is associated with quality of life and depression in adults with primary glomerulopathy and preserved renal function. PLoS One 2012; 7:e37763. [PMID: 22662214 PMCID: PMC3360627 DOI: 10.1371/journal.pone.0037763] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 04/24/2012] [Indexed: 11/19/2022] Open
Abstract
Background There is no information about HRQoL, depression and associated factors in adult with nephrotic syndrome-associated glomerulopathy. Methodology/Principal Findings Patients with primary glomerulopathy where compared with age and sex-matched hemodialysis patients and healthy subjects. Laboratory data, medical history, comorbid conditions were collected to evaluate factors associated with HRQoL (SF-36) and Depression (Hamilton Depression Rating Scale - HAMD). Glomerulopathy patients had low HRQoL in all eight SF-36 domains and two composite scores (physical and mental) in comparison with healthy subjects. HAMD score also was elevated and there was high depression prevalence. Overall, these data were comparable between glomerulopathy and hemodialysis patients. Using multiple regression analysis, factors associated with low HRQoL physical composite score were: last 24 h-urine protein excretion (−0.183, 95%CI −0.223 to −0.710 for each gram of proteinuria, p = 0.01) and cyclosporine use (−15.315, 95%CI −25.913 to −2.717, p = 0.03). Low HRQoL mental composite score was associated with last 24 h-urine protein excretion (−0.157, 95%CI −0.278 to −0.310 for each gram of proteinuria, p = 0.03) and HMAD score was independently associated with age (0.155, 95%CI 0.318 to 0.988 for each year, p = 0.04), female sex (4.788, 95%CI 1.005 to 8.620, 0 = 0.03), disease duration (0.074, 95%CI 0.021 to 0.128 for each month, p = 0.01) and last 24 h-urine protein excretion (0.050, 95%CI 0.018 to 0.085 for each gram of proteinuria, p = 0.02). Conclusions/Significance Nephrotic-syndrome associated glomerulopathy patients have low HRQoL and high prevalence of depression symptoms, comparable with those of hemodialysis patients. Last 24 h-protein excretion rate is independently associated with physical and mental HRQoL domains in addition to depression.
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Bornivelli C, Aperis G, Giannikouris I, Paliouras C, Alivanis P. RELATIONSHIP BETWEEN DEPRESSION, CLINICAL AND BIOCHEMICAL PARAMETERS IN PATIENTS UNDERGOING HAEMODIALYSIS. J Ren Care 2012; 38:93-7. [DOI: 10.1111/j.1755-6686.2012.00259.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Halen NV, Cukor D, Constantiner M, Kimmel PL. Depression and mortality in end-stage renal disease. Curr Psychiatry Rep 2012; 14:36-44. [PMID: 22105534 DOI: 10.1007/s11920-011-0248-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
End-stage renal disease is growing in prevalence and incidence. With technical advancements, patients are living longer on hemodialysis. Depression is the most prevalent comorbid psychiatric condition, estimated at about 25% of end-stage renal disease samples. The identification and assessment of depression are confounded by the overlap between depression symptomatology and uremia. Several recent studies have employed time-varying models and identified a significant association between depression and mortality. Due to the high prevalence of depression and the potential impact on survival, well-constructed investigations are warranted.
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Affiliation(s)
- Nisha Ver Halen
- SUNY Downstate Medical Center, 450 Clarkson Avenue, Box 1203, Brooklyn, NY 11203, USA.
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Chan R, Steel Z, Brooks R, Heung T, Erlich J, Chow J, Suranyi M. Psychosocial risk and protective factors for depression in the dialysis population: a systematic review and meta-regression analysis. J Psychosom Res 2011; 71:300-10. [PMID: 21999973 DOI: 10.1016/j.jpsychores.2011.05.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 05/05/2011] [Accepted: 05/05/2011] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Research into the association between psychosocial factors and depression in End-Stage Renal Disease (ESRD) has expanded considerably in recent years identifying a range of factors that may act as important risk and protective factors of depression for this population. The present study provides the first systematic review and meta-analysis of this body of research. METHODS Published studies reporting associations between any psychosocial factor and depression were identified and retrieved from Medline, Embase, and PsycINFO, by applying optimised search strategies. Mean effect sizes were calculated for the associations across five psychosocial constructs (social support, personality attributes, cognitive appraisal, coping process, stress/stressor). Multiple hierarchical meta-regression analysis was applied to examine the moderating effects of methodological and substantive factors on the strength of the observed associations. RESULTS 57 studies covering 58 independent samples with 5956 participants were identified, resulting in 246 effect sizes of the association between a range of psychosocial factors and depression. The overall mean effect size (Pearsons correlation coefficient) of the association between psychosocial factor and depression was 0.36. The effect sizes between the five psychosocial constructs and depression ranged from medium (0.27) to large levels (0.46) with personality attributes (0.46) and cognitive appraisal (0.46) having the largest effect sizes. In the meta-regression analyses, identified demographic (gender, age, location of study) and treatment (type of dialysis) characteristics moderated the strength of the associations with depression. CONCLUSION The current analysis documents a moderate to large association between the presence of psychosocial risk factors and depression in ESRD.
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Affiliation(s)
- Ramony Chan
- Consultation Liaison Psychiatry, Liverpool Hospital, Sydney, Australia.
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Giannaki CD, Sakkas GK, Karatzaferi C, Hadjigeorgiou GM, Lavdas E, Liakopoulos V, Tsianas N, Koukoulis GN, Koutedakis Y, Stefanidis I. Evidence of increased muscle atrophy and impaired quality of life parameters in patients with uremic restless legs syndrome. PLoS One 2011; 6:e25180. [PMID: 21984901 PMCID: PMC3184961 DOI: 10.1371/journal.pone.0025180] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 08/26/2011] [Indexed: 12/05/2022] Open
Abstract
Background Restless Legs Syndrome is a very common disorder in hemodialysis patients. Restless Legs Syndrome negatively affects quality of life; however it is not clear whether this is due to mental or physical parameters and whether an association exists between the syndrome and parameters affecting survival. Methodοlogy/Principal Findings Using the Restless Legs Syndrome criteria and the presence of Periodic Limb Movements in Sleep (PLMS/h >15), 70 clinically stable hemodialysis patients were assessed and divided into the RLS (n = 30) and non-RLS (n = 40) groups. Physical performance was evaluated by a battery of tests: body composition by dual energy X ray absorptiometry, muscle size and composition by computer tomography, while depression symptoms, perception of sleep quality and quality of life were assessed through validated questionnaires. In this cross sectional analysis, the RLS group showed evidence of thigh muscle atrophy compared to the non-RLS group. Sleep quality and depression score were found to be significantly impaired in the RLS group. The mental component of the quality of life questionnaire appeared significantly diminished in the RLS group, reducing thus the overall quality of life score. In contrast, there were no significant differences between groups in any of the physical performance tests, body and muscle composition. Conclusions The low level of quality of life reported by the HD patients with Restless Legs Syndrome seems to be due mainly to mental health and sleep related aspects. Increased evidence of muscle atrophy is also observed in the RLS group and possibly can be attributed to the lack of restorative sleep.
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Kohli S, Batra P, Aggarwal HK. Anxiety, locus of control, and coping strategies among end-stage renal disease patients undergoing maintenance hemodialysis. Indian J Nephrol 2011; 21:177-81. [PMID: 21886977 PMCID: PMC3161435 DOI: 10.4103/0971-4065.83729] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
End-stage kidney disease (ESKD) patients on maintenance hemodialysis (MHD) have a lot of anxiety. Anxiety and coping are associated with the locus of control; the present investigation aimed to study the state and trait anxiety, locus of control, and active and passive coping among patients on MHD. Thirty MHD patients and 30 controls were administered State-Trait Anxiety Inventory, Rotter's Locus of Control Scale, and Coping Responses Inventory. There were significantly higher scores on state and trait anxiety, respectively (67.53 ± 10.89 vs. 59.40 ± 6.97, P < 0.01, and 62.97 ± 8.45 vs. 58.07 ± 7.06, P < 0.05), and locus of control (11.27 ± 3.55 vs. 9.04 ± 1.86, P < 0.01) in patients as compared to controls. On coping responses, patients and controls differed on positive reappraisal (54.33 ± 4.67 vs. 51.17 ± 3.12, P < 0.01), seeking guidance and support (58.07 ± 5.51 vs. 53.27 ± 4.22, P < 0.01), problem solving (51.03 ± 4.70 vs. 47.57 ± 4.73, P < 0.01), cognitive avoidance (60.27 ± 6.76 vs. 56.80 ± 4.08, P < 0.05), acceptance or resignation (61.67 ± 6.30 vs. 58.83 ± 4.23, P < 0.01), emotional discharge (68.07 ± 6.78 vs. 64.30 ± 4.50, P < 0.05), approach coping (205.57 ± 10.55 vs. 189.70 ± 11.37, P < 0.01), and avoidance coping (255.30 ± 16.45 vs. 241.10 ± 10.50, P < 0.01). A higher prevalence of anxiety trait could be the cause of anxiety in MHD patients besides the medical problems. The locus of control among patients though a mixed one was significantly more toward externalism. Thus, there is a need to identify this group well in advance and prepared not only medically but also psychologically for MHD.
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Affiliation(s)
- S. Kohli
- Department of Psychology, MD University, Rohtak, Haryana, India
| | - P. Batra
- Department of Psychology, MD University, Rohtak, Haryana, India
| | - H. K. Aggarwal
- Department of Medicine, Division of Nephrology, PGIMS, Rohtak, Haryana, India
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Hung KC, Wu CC, Chen HS, Ma WY, Tseng CF, Yang LK, Hsieh HL, Lu KC. Serum IL-6, albumin and co-morbidities are closely correlated with symptoms of depression in patients on maintenance haemodialysis. Nephrol Dial Transplant 2010; 26:658-64. [PMID: 20631406 DOI: 10.1093/ndt/gfq411] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Depression may be associated with activation of pro-inflammatory cytokines and increased long-term mortality in patients on maintenance haemodialysis (MHD). There are numerous reports regarding the association of depression with inflammatory status, co-morbidities and nutritional condition, but few of these studies have explored the possible correlations between depression, age and economic status. The study explores the possible correlations between depression and demographic, socio-economic, clinical and laboratory variables. METHODS One hundred and forty-six MHD patients (65 males and 81 females, mean age: 63.8±15.2 years) were enrolled in this cross-sectional study. Demographic and socio-economic status as well as clinical and laboratory variables including co-morbidities were obtained. The self-administered Beck Depression Inventory (BDI) was used to determine the presence or absence of depression symptoms. Biochemical parameters (serum albumin, triglyceride, cholesterol, etc.) and dialysis dosage delivery (Kt/V and urea reduction rate or URR) were examined. All the patients were on high-flux biocompatible dialysers for MHD. The presence of an inflammatory state was assessed by determinations of plasma interleukin-6 (IL-6) levels. RESULTS The prevalence of depression (BDI≥14) was 45.9%. In patients found to have symptoms of depression, no statistically significant difference was shown with respect to age, gender, smoking habits or clinical characteristics. However, these patients were more likely to have a number of co-morbidities. They also had higher levels of serum IL-6 and total cholesterol as well as lower serum albumin and Kt/V values. The BDI correlated significantly with Kt/V values (r=-0.19; P<0.05), levels of serum albumin (r=-0.28; P<0.005) and serum IL-6 (r=0.47; P<0.001). Multivariate stepwise forward logistic regression analysis showed a direct correlation between BDI and IL-6 levels (P=0.001; OR=1.537) and between BDI and co-morbidities (P=0.037; OR=3.584). There was an inverse correlation between BDI and serum albumin levels (P=0.006; OR=0.145) and between BDI and age (P=0.007; OR=0.96). The rate of depression was significantly lower for the elderly patients (age≥75 years) compared with those below 64 years of age. The percentage of personal monthly disposable income at or above Taiwan dollar (TWD)>10,000 was similar in patients aged≥75 and those below 64 years old. CONCLUSIONS Maintenance haemodialysis patients with symptoms of depression may have higher serum IL-6 and lower serum albumin levels. The prevalence of depression was lower in elderly patients at or above 75 years old, and no correlation was found with socio-economic status. Factors including co-morbid conditions, serum IL-6, albumin and age may help predict which patients may be predisposed to develop symptoms of depression.
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Affiliation(s)
- Kuo-Chin Hung
- Department of Medicine, Cardinal Tien Hospital, School of Medicine, Fu Jen Catholic University, Taipei, Taiwan, Republic of China
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Østhus TBH, Dammen T, Sandvik L, Bruun CM, Nordhus IH, Os I. Health-related quality of life and depression in dialysis patients: associations with current smoking. ACTA ACUST UNITED AC 2010; 44:46-55. [PMID: 20030569 DOI: 10.3109/00365590903449324] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The study explored health-related quality of life (HRQoL) and depression in a culturally homogeneous dialysis patient population. Furthermore, the associations between HRQoL and depression with current smoking were elaborated. MATERIAL AND METHODS In a cross-sectional study of 301 dialysis patients from 10 dialysis centres in Norway, HRQoL was evaluated with the Kidney Disease and Quality of Life Short Form, version 1.3. Physical component summary scores (PCS) and mental component summary scores (MCS) were computed. Depression was assessed using the Beck Depression Inventory (BDI), and Cognitive Depression Index (CDI) was calculated. Depression was defined as a BDI score greater than 14. RESULTS HRQoL was poorer in dialysis patients compared with population norms. Depression was prevalent (33.2%), and differed significantly between smokers and non-smokers (52.8 vs 26.4%, p < 0.001). MCS was significantly reduced in smokers compared with non-smokers (44.1 +/- 12.2 vs 48.7 +/- 10.3, p < 0.001), but there was no difference in PCS (35.7 +/- 10.2 vs 37.1 +/- 10.4, not significant). Current smoking was independently associated with higher BDI score (p = 0.039), as well as with higher CDI score (p = 0.005) and worse score on MCS (p = 0.002), after adjustments for multiple covariates. CONCLUSIONS HRQoL is lower in Norwegian dialysis patients than in the general population, and depression is prevalent. The study suggests that poor perceived mental aspects of HRQoL and depression are associated with current smoking in dialysis patients, but a causal relationship remains to be shown.
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Bossola M, Ciciarelli C, Di Stasio E, Conte GL, Vulpio C, Luciani G, Tazza L. Correlates of symptoms of depression and anxiety in chronic hemodialysis patients. Gen Hosp Psychiatry 2010; 32:125-31. [PMID: 20302985 DOI: 10.1016/j.genhosppsych.2009.10.009] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Revised: 10/29/2009] [Accepted: 10/30/2009] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Little is known about the demographic, clinical and laboratory variables which may be correlated with symptoms of depression and anxiety in hemodialysis (HD) patients. The present study aimed at evaluating such correlation in HD patients treated at a single HD center in a Mediterranean country. METHODS Eighty HD patients were assessed for depression and anxiety with the Beck Depression Inventory (BDI) and the Hamilton Anxiety Rating Scale (HARS). The scores of BDI and HARS were correlated with demographic, clinical and laboratory variables. RESULTS Based on the Beck Depression Inventory, 38 patients had no symptoms of depression and 42 had symptoms of depression. Based on the HARS, three patients had no symptoms of anxiety and 38 had mild symptoms of anxiety, whereas moderate or severe symptoms of anxiety were present in 39 patients. In univariate analysis, BDI score correlated significantly with age, the Charlson Comorbidity Index, SF-36 Vitality Subscale, Mini-Mental Status Examination, creatinine, albumin, plasma 25-hydroxy vitamin D and interleukin-6 (IL-6) levels. HARS score correlated significantly with age, Charlson Comorbidity Index, SF-36 Vitality Subscale and parathyroid hormone (PTH) levels. In the multivariate analysis, a direct and an inverse correlation between BDI and IL-6 [P=.042, OR=1.31 (95% CI=1.01-1.71)] and creatinine [P=.050, OR=0.73 (95% CI=0.54-1.00)] was observed. With regard to HARS, only a direct correlation with Charlson Comorbidity Index [P<.001, OR=1.55 (95% CI=1.22-1.96)] was found. CONCLUSION Although numerous demographic, clinical and laboratory variables correlated with BDI and HARS in univariate analysis, the multivariate regression analysis showed only a direct correlation between BDI and IL-6 [P=.042, OR=1.31 (95% CI=1.01-1.71)] and an inverse correlation between BDI and creatinine [P=.050, OR=0.73 (95% CI=0.54-1.00)] and a direct correlation between HARS and the Charlson Comorbidity Index [P<.001, OR=1.55 (95% CI=1.22-1.96)].
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Affiliation(s)
- Maurizio Bossola
- Servizio Emodialisi, Istituto di Clinica Chirurgica, Università Cattolica del Sacro Cuore, 8-00168 Rome, Italy.
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Weiner S, Kutner NG, Bowles T, Johnstone S. Improving psychosocial health in hemodialysis patients after a disaster. SOCIAL WORK IN HEALTH CARE 2010; 49:513-525. [PMID: 20640964 DOI: 10.1080/00981380903212107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Twenty-two social workers implemented a cognitive-behavioral intervention with 69 patients in 22 dialysis units in Louisiana to improve psychosocial health following Hurricanes Katrina and Rita. Pre- and post-intervention questionnaires measured psychosocial status domains (general health status, social functioning, burden of kidney disease, depressed mood, anxiety, and mastery). Participants rated their general health status (p < .05) and social functioning (p < .05) significantly higher after the intervention. Participants who listened to the class Managing stress through communication and problem solving and discussed it with their social worker, had significant improvement in depressed mood score (p < .05) after completing the program, compared to participants who did not discuss this material with their social worker. Sixty-five percent had scores indicating depressed mood before the program, compared with 56% following. The more positive participants' program evaluation, the higher their quality of life (lower perceived burden of kidney disease [p = .05]).
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Affiliation(s)
- Sheila Weiner
- National Kidney Foundation, New York, New York, USA.
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Cognitive-behavioral group therapy is an effective treatment for major depression in hemodialysis patients. Kidney Int 2009; 76:414-21. [PMID: 19455196 DOI: 10.1038/ki.2009.156] [Citation(s) in RCA: 165] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Depression is an important target of psychological assessment in patients with end-stage renal disease because it predicts their morbidity, mortality, and quality of life. We assessed the effectiveness of cognitive-behavioral therapy in chronic hemodialysis patients diagnosed with major depression by the Mini International Neuropsychiatric Interview (MINI). In a randomized trial conducted in Brazil, an intervention group of 41 patients was given 12 weekly sessions of cognitive-behavioral group therapy led by a trained psychologist over 3 months while a control group of 44 patients received the usual treatment offered in the dialysis unit. In both groups, the Beck Depression Inventory, the MINI, and the Kidney Disease and Quality of Life-Short Form questionnaires were administered at baseline, after 3 months of intervention or usual treatment, and after 9 months of follow-up. The intervention group had significant improvements, compared to the control group, in the average scores of the Beck Depression Inventory overall scale, MINI scores, and in quality-of-life dimensions that included the burden of renal disease, sleep, quality of social interaction, overall health, and the mental component summary. We conclude that cognitive-behavioral group therapy is an effective treatment of depression in chronic hemodialysis patients.
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