Depression and anxiety among patients undergoing dialysis and kidney transplantation: a cross-sectional study

Cognitive impairment in kidney transplanted patients

Chronic kidney disease affects almost all of the organs. Recently, more attention has been paid to the kidney and the central nervous system connections. In patients on kidney replacement therapy, including kidney transplantation, there is an increased prevalence of cognitive impairment, and depression and other neurological complications, such as cerebrovascular disorders and movement disorders. Kidney transplant recipients need an assessment for the risk factors and the pattern of cognitive impairment (memory, attention and executive function decline). This enables an accurate diagnosis to be made at an earlier stage. Partial post-transplant cognitive impairment recovery is also important. Finally, doctors and patients alike face numerous ethical concerns and challenges regarding the transplantation of kidneys and other solid organs. In this review, we examined some key issues regarding cognitive impairment in kidney transplant patients. We focused on the mechanism of cognitive impairment in kidney transplant recipients, patterns of cognitive impairment; evaluation of patients with cognitive impairment for kidney transplantation, the potential impact of cognitive impairment on waitlisted and transplanted patients on patient care, non-pharmacological interventions and unmet medical needs, psychological and ethical issues in kidney transplantation, and unmet needs. As cognitive impairment in kidney transplant recipients is an underestimated, underrecognized but clinically relevant problem, screening for cognitive function before and after kidney transplantation would be worth considering in standard routine practice.

Mediterranean-DASH Diet Intervention for Neurodegenerative Delay Diet and Psychological Problems in Maintenance Hemodialysis Patients by the Structural Equation Modeling Analysis of Malnutrition and Inflammation Markers Approach

OBJECTIVE

Although it is known that diet quality affects psychological problems in hemodialysis (HD) patients, there is need to explain the role of modifiable risk factors in this relationship. Therefore, the aim of this study was (1) to investigate the relationship between diet quality and modifiable risk factors to depression and anxiety in end-stage renal disease patients receiving maintenance HD; (2) to explore the mediating roles of modifiable factors in the relationship with diet quality to depression and anxiety.

METHODS

This cross-sectional study included 216 patients with end-stage renal disease receiving maintenance HD treatment. We assessed participants' dietary records for Mediterranean-DASH Diet Intervention for Neurodegenerative Delay (MIND) quality, Global Leadership Initiative on Malnutrition criteria for malnutrition and Hospital Anxiety and Depression Scale for psychological problems. Furthermore, biochemical findings and anthropometric measurements were performed to evaluate nutritional markers, metabolic risk factors and inflammation. We applied hierarchical regression analysis to estimate modifiable risk factors for depression and anxiety and structural-equation-modeling analysis to determine the mediating role of modifiable risk factors between diet quality and psychological problems.

RESULTS

Depression symptoms were observed in 59.2% (n = 128) of the participants, whilst the rate was 35.1% (n = 76) for anxiety. Depression and anxiety were found to be negatively correlated with MIND levels after covariate adjusting model, and the rates of explanation were found to be 16.2% and 12.2%, respectively. C-reactive protein (CRP), albumin levels and the presence of malnutrition were shown to be significant predictors of depression (ΔF = 14.761 and ΔR2: 0.071 for covariate-adjusted model). Albumin levels, CRP, HD duration, and malnutrition were found to be independent predictors of anxiety (ΔF = 16.174 and ΔR2: 0.077 for covariate-adjusted model). It was found that CRP and malnutrition partially mediated the association of MIND score with depression, and CRP mediated the association with anxiety.

CONCLUSION

It was concluded that adherence to the MIND diet is associated with a better nutritional profile and reduced inflammation, which in turn may be linked to fewer psychological problems.These further studies are needed to validate and expand upon our findings.

A survey on the association between patient activation and quality of life among patients with chronic kidney disease in Japan

BACKGROUND

Little is known about the association of health-related quality of life (HRQOL) with, and level of, patient activation among patients with chronic kidney disease (CKD) in Japan.

METHODS

We conducted a cross-sectional observational study using a questionnaire targeting patients with CKD across Japan from 2021 to 2023. The primary outcome was low HRQOL assessed using the short form 8 (SF-8). The risk of low HRQOL was evaluated by patient activation (using the Patient Activation Measure 13 (PAM-13)).

RESULTS

In total, 1427 patients with CKD were included in this study. Mean age was 61.9 (standard deviation (SD) 12.7) years and 891 (62.4%) were men. Among the participants, 948 (66.4%) were treated without dialysis or kidney transplantation, 304 (21.3%) underwent hemodialysis, 72 (5.1%) underwent peritoneal dialysis, and 103 (7.2%) underwent kidney transplantation. Regarding patient activation, those belonging to higher activation groups were less likely to have low physical HRQOL compared with those belonging to lower activation groups (adjusted odds ratio (OR) 0.73, 95% confidence interval (CI) 0.55-0.96 for medium; adjusted OR 0.53, 95% CI 0.41-0.70 for high; adjusted OR 0.42, 95% CI 0.29-0.61 for the highest activation group). When stratified by type of treatment for CKD, among participants with kidney transplantation the highest activation group tended to have more low mental HRQOL participants compared with the low activation group (adjusted OR 2.44, 95% CI 0.51-12.5).

CONCLUSION

Among Japanese patients with CKD, lower patient activation is associated with lower physical and mental HRQOL in a dose-dependent manner. However, the highest activation may be associated with low mental HRQOL among patients undergoing kidney transplantation.

Psychological wellbeing and treatment adherence among cardio-renal syndrome patients in Yemen: a cross section study

Background

Anxiety and depression are associated with adverse outcomes in cardiorenal syndrome patients undergoing hemodialysis, including decreased quality of life, poorer clinical parameters, and lower treatment adherence.

Objective

This study aimed to examine the level of psychological wellbeing and its relationship with treatment adherence among dialysis patients with cardiorenal syndrome.

Methods

This cross-sectional descriptive study was conducted between February and May 2021 on convenience sampling of 100 patients in two dialysis centers in Hadhramout, Yemen. Patients' depression and anxiety levels were assessed using the Hospital Anxiety and Depression Scale (HADS)-Arabic version, and patient treatment adherence was assessed using the Treatment Adherence Questionnaire (TAQ). Descriptive statistics, Pearson's correlation analysis, and multiple linear regression analyzes were performed to analyze data with a significance level set at p < 0.05.

Results

The mean age ± standard deviation of participants was 53.46 ± 14.24 years. Most (90%) of patients had moderate to high levels of anxiety and depression. Most of the patients (87%) had a low level of treatment adherence. The findings revealed that psychological wellbeing is significantly association with treatment adherence t = 2.577 (95% CI 0.029, 0.225), p = 0.011.

Conclusion

Anxiety and depression symptoms occurred more frequently among dialysis patients with cardiorenal syndrome, and there was a significant association between psychological wellbeing and treatment adherence. Our findings suggest that nurse managers should take into account that adding psychotherapies into the present cardiorenal syndrome treatment programs would improve patients' clinical and psychological parameters and, consequently, their clinical outcomes while taking patient heterogeneity and resource limitations into consideration.

Enhancing Digital Health Engagement in Chronic Disease: The Role of Doctor-Patient Communication and Media Use in Acceptance of Digital Health Care Among End-Stage Kidney Disease Patients

This study examines digital health challenges among end-stage kidney disease (ESKD) patients, a population characterized by older age, lower socioeconomic status, and limited access to modern technologies. Drawing from the Mere Exposure Effect, the Technology Acceptance Model, and insights from doctor-patient communication literature, our study implemented a month-long intervention across three distinct groups. The Digital Media Exposure Group watched doctor-recommended videos on YouTube using a tablet PC twice weekly for four weeks. The Digital Media Exposure with Doctor-Patient Communication Group engaged in physician-led discussions about the viewed content during their medical visits in addition to the activities in the first group. The Control Group received printed medical information that mirrored the content of the videos. Participants in this study, all of whom were diagnosed with ESKD, were recruited from a university hospital in South Korea (n = 88, Mage = 64.8). Their perceptions, attitudes, and behavioral intentions regarding digital health care were measured and compared between groups. The results unveiled significant group differences [Wilk's Λ = 0.829, F(8, 164) = 2.02, p = 0.047, partial η2 = 0.090], with variations in attitudes, perceived ease of use, and intentions among groups, and effect sizes ranging from 0.069 to 0.096.These findings underscore the importance of tailored interventions to address digital health disparities, particularly among underserved demographic groups. Strategies that prioritize user-friendly interfaces and clear communication between doctors and patients are advocated to promote digital health engagement, ensuring equitable access and improved outcomes for patients with chronic disease.

Depression and Quality of Life in Transplant Recipients During the COVID-19 Pandemic

INTRODUCTION

Depression prevention is crucial for maintaining both physical and mental health and enhancing individuals' quality of life (QOL) post-transplantation. Despite the heightened susceptibility of post-transplant patients to COVID-19 infection, the relationship between depression and QOL during the pandemic remains unclear. This study aimed to (1) identify depression and QOL during the pandemic in kidney and liver transplant patients, and (2) explore the relationship between QOL and depression.

DESIGN

This cross-sectional study involved patients aged 20 years or older who were at least 6 months post-transplantation. Depression and QOL were assessed using the Patient Health Questionnaire-9 and the 8-item Short-Form Health Survey, respectively. Logistic regression analysis was conducted to examine the relationship between QOL and depression. The study included 204 participants comprising 68 postkidney transplant and 136 postliver transplant patients.

RESULTS

Among all participants, depressive symptoms were present 30% of the time, with 8.3% experiencing moderate or severe depression. Logistic regression analysis revealed that depression (mental component summary; OR = 2.419, P < .001, 95% CI: 1.862-2.915) and postoperative period (physical component summary; OR = 1.397, P = .008, 95% CI: 1.094-1.733) significantly influenced QOL.

CONCLUSION

This study suggests that the prevention of depression in emerging infectious disease pandemics may contribute to maintaining the mental QOL of transplant recipients.

Prevalence and Management of Chronic Pain, Including Neuropathic Pain, in Dialysis Patients with End-Stage Renal Disease

BACKGROUND Chronic kidney disease (CKD) is a growing global health concern. Chronic pain, as a common symptom of CKD, particularly among patients with end-stage renal disease (ESRD), is influenced by complications, dialysis procedures, and comorbidities. We aimed to evaluate chronic pain and probable neuropathic pain in 96 dialysis patients with ESRD using the Douleur Neuropathique 4 (DN4) questionnaire. MATERIAL AND METHODS A total of 96 patients from a single dialysis center were enrolled for the purpose of this study. ESRD was caused by diseases causing kidney damage, such as diabetes. The average duration of maintenance dialysis was 4.6±5.67 years. Comorbidities, functional and mental assessment, and pharmacological treatment data were collected using a questionnaire. The satisfaction with life scale was also used. Chronic pain was defined as lasting more than 3 months. The DN4 was used to determine the neuropathic component of pain. RESULTS Chronic pain was observed in 63.5% of the study participants, with 47.5% of them reporting the presence of neuropathic pain accompanied by a neuropathic component. Significantly more patients with chronic pain reported mood disorders and reduced life satisfaction, but there was no difference in their activities of daily living-assessed functional status or duration of dialysis. Patients experiencing chronic pain received non-steroidal anti-inflammatory drugs, paracetamol, and opioids. CONCLUSIONS Chronic pain, especially with a neuropathic component, is highly prevalent in patients with CKD, and its treatment remains ineffective. Undiagnosed components of pain can contribute to underdiagnosis and inadequate therapy. Further studies and staff education are needed to address this important issue.

The Interplay of Anxiety, Depression, Sleep Quality, and Socioeconomic Factors in Somali Hemodialysis Patients

OBJECTIVE

This study aimed to assess anxiety, depression, and sleep quality in kidney failure patients receiving hemodialysis (HD) in Somalia and examine the relationship between anxiety, depression, and sleep quality.

METHODS

We conducted a study with 200 kidney failure patients on HD treatment for over 3 months. Participants completed sociodemographic questionnaires, the Patient Health Questionnaire-9 (PHQ-9), the Hospital Anxiety and Depression Scale (HADS), the Insomnia Severity Index (ISI), and the Pittsburgh Sleep Quality Index (PSQI).

RESULTS

Among the 200 participants (mean age = 52.3; SD = 14.13), 58.5% were men, 64% had CKD for 1-5 years, and 52.6% received HD for 1-5 years. Depressive symptoms were found in 61.5% (PHQ-9) and 37.5% (HADS depression subscale) of HD patients. Poor sleep quality (PSQI) was observed in 31.5% and significantly correlated with PHQ-9 (rs = 0.633), HADS anxiety (rs = 0.491), and HADS depression (rs = 0.529). The ISI score correlated significantly with PHQ-9 (rs = 0.611), HADS anxiety (rs = 0.494), and HADS depression (rs = 0.586). All PSQI components correlated with depression and anxiety, except sleep medication use. Hierarchical regression analysis revealed that HADS anxiety (β = 0.342) and HADS depression (β = 0.372) predicted ISI scores. HADS anxiety (β = 0.307) and HADS depression (β = 0.419) predicted PSQI scores.

CONCLUSIONS

Higher anxiety and depression levels negatively correlated with various dimensions of sleep quality in kidney failure patients. Early identification and appropriate management of these psychological disturbances are crucial for enhancing patients' overall quality of life.

Psychosocial Problems in Recipients of Kidney Transplant

OBJECTIVES

The purpose of kidney transplant is to improve the quality of life of recipients. Improving quality of life of transplant recipients is crucial for their treatment adherence and transplant success. However, it is known that psychosocial problems experienced by kidney transplant recipients after transplant can threaten quality of life and increase mortality and morbidity rates. Therefore, in this study, we examined up-to-date literature and recommendations on psychological problems experienced by recipients after kidney transplant.

MATERIALS AND METHODS

Studies were identified by searching PubMed, ScienceDirect, and Web of Science databases for the past 5 years. The search terms used included "depression, anxiety," "kidney transplant recipients," "kidney transplantation," psychosocial problems," and "psychosocial issues."

RESULTS

Our search of relevant databases resulted in 1663 articles imported into EndNote: 243 from PubMed, 1198 from ScienceDirect, and 222 from Web of Science. Twenty-one studies that met the inclusion criteria were included.

CONCLUSIONS

Recent studies have indicated that kidney transplant recipients experience depression, anxiety, and stress during the posttransplant period. Support is recommended for recipients after kidney transplant, and interventions aimed at reducing depression, anxiety, and stress are needed.

Quality of life and functional capacity in depressive patients on hemodialysis: a systematic review and meta-analysis

Depression is a common disorder in patients with chronic kidney disease (CKD), and some data support its relationship with functional capacity and quality of life. However, to date, this has not been evaluated systematically or through meta-analysis. We sought to investigate the relationship of quality of life and functional capacity with depressive disorder in patients with CKD on hemodialysis. This systematic review considered studies published up to 2021 and included cross-sectional and cohort studies. PubMed, Embase, SPORTDiscus, Web of Science, and Cochrane (CENTRAL) databases were used to search for studies. The New Castle-Ottawa Quality Assessment scale was used to measure the quality of the studies. A total of 4,626 studies were found and, after applying the selection criteria, 16 studies (2,175 patients) remained for qualitative analysis and 10 for meta-analysis (1,484 patients). The physical component summary (MD=-6.563; 95%CI: -9.702 to -3.424) and mental component summary (MD=-18.760; 95%CI: -28.641 to -8.879) were lower in depressive patients, as in all Short Form Health Survey 36 (SF-36) domains. Only one study provided data regarding functional capacity, but it was not evaluated by the defined outcome measure. Twelve studies were classified as "moderate quality" (5 to 6 stars) and four were classified as "low-quality" (0 to 4 stars). This meta-analysis with CKD patients on hemodialysis showed a negative relationship between depression and quality of life, with worsening in all physical and mental domains of the SF-36 in depressed patients.

Anxiety and depression in geriatric hemodialysis patients: factors that influence the border of diseases

INTRODUCTION

The two main psychological issues that people with end-stage renal disease (ESRD) experience are depression and anxiety. We conducted this study to determine both the prevalence of depression and anxiety, and the factors associated with them, among hemodialysis patients.

METHODS

Patients aged 18 years or older, who had received hemodialysis in a hemodialysis center in Elbasan, for at least 3 months were included in this study. Beck Anxiety Inventory and Beck Depression Inventory Instruments were used to assess hemodialysis patients levels of depression and anxiety.

RESULTS

Overall, 107 hemodialysis patients (men 65.4%) with a mean age of 57 ± 8.9 years were enrolled in the study. The prevalence of anxiety and depression resulted to be 85.98, and 84.11%, respectively. We found a significant difference in depression and anxiety scores in patients age groups of 61-70 years old (OR = 1.8; 95% CI [0.7-3.7]; p = 0.041), in non-smoking patients (OR 3.4; 95% CI [1.09-8.2]; p = 0.04), in diabetic patients (OR 3.4; 95% CI [1.09-8.2]; p = 0.04), and in patients with a time in dialysis of 6-10 years and >11 years, respectively, (OR 3.4; 95% [1.5-9.0]; p = 0.01), (OR1.3; 95% CI [0.4-3.6]; p = 0.04).

CONCLUSION

Our study shows that the prevalence of mental disorders (depression and anxiety) is high among patients with ESRD on maintenance hemodialysis. We recommend a routine screening and referral to psychological health specialists to evaluate the mental health disorders among hemodialysis patients with the primary aim of improving their quality of life.

Peer support interventions in patients with kidney failure: A systematic review

BACKGROUND

Peer support has been associated with improved health-related outcomes (e.g., psychological well-being and treatment adherence) among patients with serious, chronic conditions, including kidney disease. Yet, there is little existing research evaluating the effects of peer support programs on health outcomes among patients with kidney failure being treated with kidney replacement therapy.

METHODS

Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, we conducted a systematic review using five databases to assess the effects of peer support programs on health-related outcomes (e.g., physical symptoms, depression) among patients with kidney failure undergoing kidney replacement therapy.

RESULTS

Peer support in kidney failure was assessed across 12 studies (eight randomized controlled trials, one quasi-experimental controlled trial, and three single-arm trials) with 2893 patients. Three studies highlighted the links between peer support and improved patient engagement with care, while one found peer support did not significantly impact engagement. Three studies showed associations between peer support and improvements in psychological well-being. Four studies underscored the effects of peer support on self-efficacy and one on treatment adherence.

CONCLUSIONS

Despite preliminary evidence of the positive associations between peer support and health-related outcomes among patients with kidney failure, peer support programs for this patient population remain poorly understood and underutilized. Further rigorous prospective and randomized studies are needed to evaluate how peer support can be optimized and incorporated into clinical care for this vulnerable patient population.

ACLP Best Practice Guidance: Evaluation and Treatment of Depression in Solid Organ Transplant Recipients

We present Academy of Consultation Liaison Psychiatry best practice guidance on depression in solid organ transplant (SOT) recipients, which resulted from the collaboration of Academy of Consultation Liaison Psychiatry's transplant psychiatry special interest group and Guidelines and Evidence-Based Medicine Subcommittee. Depression (which in the transplant setting may designate depressive symptoms or depressive disorders) is a frequent problem among SOT recipients. Following a structured literature review and consensus process, the Academy of Consultation Liaison Psychiatry transplant psychiatry special interest group proposes recommendations for practice: all organ transplant recipients should be screened routinely for depression. When applicable, positive screening should prompt communication with the mental health treating provider or a clinical evaluation. If the evaluation leads to a diagnosis of depressive disorder, treatment should be recommended and offered. The recommendation for psychotherapy should consider the physical and cognitive ability of the patient to maximize benefit. The first-line antidepressants of choice are escitalopram, sertraline, and mirtazapine. Treating depressive disorders prior to transplantation is recommended to prevent posttransplant depression. Future research should address the mechanism by which transplant patients develop depressive disorders, the efficacy and feasibility of treatment interventions (both pharmacological and psychotherapeutic, in person and via telemedicine), and the resources available to transplant patients for mental health care.

Factors Related to Quality of Life of Hemodialysis Patients during the COVID-19 Pandemic

Taiwan had the second highest number globally of end-stage renal disease patients undergoing treatment in 2018. A meta-analysis of Chen et al. (2021) showed the incidence and mortality rates of COVID-19 were 7.7% and 22.4%, respectively. Few studies have explored the effects of patients' self-participation and perceptions of hemodialysis on their quality of life. This study aimed to explore the factors related to hemodialysis patients' quality of life during the COVID-19 pandemic. This study was a descriptive correlational study. Patients were recruited (n = 298) from the hemodialysis unit of a medical center in northern Taiwan. Variables included patients' sociodemographic, psychological, spiritual, and clinical characteristics (i.e., perceived health level, comorbidities, hemodialysis duration, weekly frequency, transportation, and accompaniment during hemodialysis), perceptions of hemodialysis, self-participation in hemodialysis, and health-related quality of life (KDQOL-36 scale). Data were analyzed using descriptive and bivariate and multivariate linear regression. Multivariate linear regression, after adjusting for covariates, showed that anxiety, self-perceived health status, two vs. four comorbidities, and self-participation in hemodialysis were significantly associated with quality of life. The overall model was significant and accounted for 52.2% (R² = 0.522) of the variance in quality of life during hemodialysis (adjusted R² = 0.480). In conclusion, the quality of life of hemodialysis patients with mild, moderate, or severe anxiety was poorer, whereas that of patients with fewer comorbidities, higher self-perceived health status, and higher self-participation in hemodialysis was better.

Sickness Symptoms in Kidney Transplant Recipients: A Scoping Review

Sickness symptoms (depressive symptoms, anxiety, and fatigue) are common among people with chronic illness, often presenting as a symptom cluster. Sickness symptoms persist in many patients with chronic kidney disease, even after kidney transplantation (KT); however, little is known about sickness symptom-induced burden in KT recipients. This scoping review synthesizes available evidence for sickness symptoms in KT recipients, including findings on symptom prevalence, predictors, outcomes, interrelationships, and clustering. Among 38 reviewed studies, none identified sickness symptoms as a cluster, but we observed interrelationships among the symptoms examined. Fatigue was the most prevalent sickness symptom, followed by anxiety and depressive symptoms. Predictors of these symptoms included demographic, clinical, and psychosocial factors, and health-related quality of life was the most researched outcome. Future research should use common data elements to phenotype sickness symptoms, include biological markers, and employ sophisticated statistical methods to identify potential clustering of sickness symptoms in KT recipients.

Quality of life and physical activity level in patients with chronic kidney disease during COVID-19 pandemic

The COVID-19 pandemic process may affect the physical and psychosocial health in patients with chronic kidney disease (CKD). The aim of this study was to compare the quality of life, physical activity, fear of COVID-19 and mental health in CKD patients and healthy individualsand compare the aforementioned parameters in end-stage renal disease (ESRD) and renal transplantation (RTx) patients during the pandemic. Eighty-two patients (33 ESRD, 49 RTx) and age-gender matched 108 healthy individuals were included. Quality of life (Short Form 36 Health Survey Questionnaire-SF-36), physical activity (short form of the International Physical Activity Questionnaire -IPAQ-SF), fear of COVID-19 (Fear of COVID-19 Scale-FCV-19S) and mental health (Hospital Anxiety and Depression Scale-HADS) were evaluated. Physical activity levels and all SF-36 scores except mental health in CKD patients were significantly lower than healthy individuals (p < 0.05). FCV-19S and HADS scores were similar between the groups (p > 0.05). ESRD patients' pain and general health perceptions scores of SF-36 were lower than RTx patients' (p < 0.05). Quality of life and physical activity levels were worse in CKD patients compared to healthy individuals during the pandemic. The participants had fear of COVID-19, poor mental health and low physical activity. For these reasons, psychosocial and physical activity interventions for the both groups may be beneficial for the affected outcomes during COVID-19 pandemic.

Factors Affecting Anxiety of Kidney Transplant Recipients According to Donor Type: A Descriptive Study

PURPOSE

High anxiety among kidney transplant recipients has negative psychosocial consequences for health quality. This study aims to determine the risk factors that affect levels of anxiety in recipients of kidney transplants according to living and deceased donor types.

DESIGN

The study was conducted using a descriptive correlational research method.

METHODS

The study conducted research with 330 kidney transplant recipients (from 261 live and 69 cadaver donors) who agreed to participate between February and July 2019. Participants completed the State-Trait Anxiety Inventory, which assesses state and trait anxiety.

FINDINGS

Participants had low state anxiety and moderate trait anxiety scores. A statistically significant, positive, moderate correlation was found between state anxiety scale and trait anxiety scale mean scores of recipients of kidney transplants from both living and deceased donors. According to a regression analysis of trait anxiety scores of transplant recipients from living donors, positive independent risk factors for anxiety include kidney transplant recipients with a low income, receiving kidneys from male donors, drug noncompliance, sleep disorders, and mental problems.

CONCLUSIONS

Both kidney transplant recipients from living and deceased donors had low state anxiety and moderate trait anxiety. Nurses should develop effective intervention strategies that continue throughout life to reduce the anxiety of kidney transplant recipients.

Depression and anxiety symptoms among patients receiving maintenance hemodialysis: a single center cross-sectional study

BACKGROUND

To investigate depression and anxiety and related factors among patients receiving maintenance hemodialysis (MHD).

METHODS

This cross-sectional study included patients underwent MHD in 3/2022 at Jinshan Hospital affiliated to Fudan University. Depression and anxiety levels of patients were assessed using Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI), respectively. SF-36 was used to assess patients' quality of life. Multiple linear regression analysis was used to determine the variables associated with the scores of BDI/BAI.

RESULTS

A total of 103 patients were included, 71 cases (68.93%) and 38 cases (36.89%) with depression and anxiety, respectively. The scores of almost all domains of the SF-36 showed a declining trend with increasing depression or anxiety among patients on MHD. Higher Charlson Comorbidity Index (CCI) (β =0.066, 95%CI: 0.016-0.116, P = 0.010), lower educational status (β = - 0.139, 95%CI: - 0.243- -0.036, P = 0.009), and number of oral medications (β =0.177, 95%CI: 0.031-0.324, P = 0.018) were significantly associated with higher BDI scores. Longer dialysis duration (β =0.098, 95%CI: 0.003-0.193, P = 0.044) and number of oral medications (β =4.714, 95%CI: 1.837-7.590, P = 0.002) were significantly associated with higher BAI scores.

CONCLUSIONS

Depression and anxiety may be likely to occur among patients undergoing MHD and impact their quality of life. Higher CCI, lower educational status and usage of multiple oral medications may be associated with depression, whereas longer dialysis duration and multiple oral medications may be associated with anxiety in MHD patients.

Depression in transplantation

PURPOSE OF REVIEW

To review and summarize the literature published between 1 January 2020 and 30 June 2022, on the prevalence, risk factors and impact of depression in transplant population.

RECENT FINDINGS

Depression is common in transplantation candidates and recipients, with a prevalence up to 85.8% in kidney recipients. Multiple studies have indicated after transplantation depression correlates with increased mortality and with higher healthcare utilization. Social risk factors for posttransplant depression include financial difficulties and unemployment, while less is understood about the biological substrate of depression in this population. There is evidence that dynamic psychotherapy is effective for depression in organ transplant recipients, while cognitive behavioral therapy or supportive therapy did not lead to improvement of depression in transplant recipients. For living organ donors, the rates of depression are similar to the general population, with financial factors and the clinical status of the recipient playing a significant role.

SUMMARY

Depression is a common finding in transplant population. More research is needed to understand the biological substrate and risk factors and to develop effective treatment interventions.

Association of Levothyroxine Treatment and Thyroid Peroxidase Antibodies with Antidepressant Use: A Danish Population-Based Longitudinal Study

Background: Subjects receiving levothyroxine (LT4) treatment have increased prevalence of depression, anxiety, and antidepressant use, but whether the underlying mechanism relates to thyroid autoimmunity is still unclarified. Methods: This is a population-based longitudinal study. Baseline biochemical and questionnaire data from the Danish General Suburban Population Study (GESUS) in 2010-2013 were linked with individual-level longitudinal data in national health registries. The aim was to investigate the associations between thyroid peroxidase antibodies (TPOAbs) and LT4 treatment, separately and through interaction, and at least one redeemed prescription for antidepressants. Logistic and Cox regression were used to evaluate initiation of antidepressant use before and after the baseline examination in GESUS, respectively. All exposures and covariates were fixed at the date of baseline examination. Thyroid autoimmunity was defined as serum TPOAbs >60 U/mL. Adjustments included sex, age, education, income, Charlson comorbidity index, smoking, and alcohol. Sensitivity analyses were performed for missing variables, exclusion of lithium use, exclusion of thyroid surgery, and conservative definitions for LT4 treatment and antidepressant use requiring at least two prescriptions. Results: We included 12,894 individuals, of whom 2353 (18%) had "past or current" antidepressant use at baseline, leaving 10,541 individuals at risk for incident antidepressant use after baseline. The median follow-up was 7.8 years during which 783 individuals (7.4% of 10,541 individuals) had incident antidepressant use. TPOAb positivity was not associated with "past or current" (odds ratio [OR] 0.90 [confidence interval, CI 0.78-1.03], p = 0.13) nor incident antidepressant use (hazard ratio [HR] 1.02 [CI 0.83-1.25], p = 0.88). LT4 treatment was associated with increased "past or current" antidepressant use (OR 1.33 [CI 1.10-1.62], p = 0.004) and increased incident antidepressant use (HR 1.38 [CI 1.03-1.85], p = 0.03). There were no interactions between the effects of TPOAb positivity and LT4 treatment on the use of antidepressants in logistic (p = 0.87) or Cox regression models (p = 0.82). Sensitivity analyses were robust, except that incident use of at least two redeemed antidepressant prescriptions was not statistically significant. Conclusions: LT4 treatment, but not TPOAb positivity, was associated with increased prevalent or incident antidepressant use with at least one prescription. Our findings do not support that thyroid autoimmunity is an important factor for antidepressant use in patients receiving LT4 treatment.

Are cultural or psychosocial factors associated with patient-reported outcomes at the conclusion of kidney transplant evaluation?

BACKGROUND

Kidney transplant evaluation (KTE) is a period marked by many stressors for patients, which may lead to poorer patient-reported outcomes (PROs). Research on the association of cultural and psychosocial factors with PROs during KTE is lacking, even though cultural and psychosocial variables may mitigate the relationship between acceptance status and PROs.

METHODS

Using a prospective cohort study of 955 adults referred for KTE, we examined whether cultural factors and psychosocial characteristics, assessed at the initiation of KTE, are associated with PROs at KTE completion, controlling for demographics and medical factors. Also, we analyzed whether these factors moderate the relationship between transplant acceptance status and PROs.

RESULTS

In multivariable regression models, a stronger sense of mastery was associated with higher physical and mental QOL. A stronger sense of self-esteem was associated with higher kidney-specific QOL. Depression was associated with a lower mental QOL, but only in those who were accepted for transplant. Having low levels of external locus of control was associated with better mental QOL in those who were not accepted for transplant. Higher anxiety was associated with poorer kidney-specific QOL among those who were not accepted for KT, but trust in physician was only associated with greater satisfaction in transplant clinic service for those who were accepted for KT.

CONCLUSIONS

Targeting interventions to increase patient mastery and external locus of control, and reduce depression and anxiety in patients undergoing kidney transplant evaluation may be useful approaches to improve their experience during this stressful period.

Classification Algorithms for Brain Magnetic Resonance Imaging Images of Patients with End-Stage Renal Disease and Depression

This study was aimed to explore the relationship between depression and brain function in patients with end-stage renal disease (ESRD) complicated with depression based on brain magnetic resonance imaging (MRI) image classification algorithms. 30 people in the healthy control group and 70 people in the observation group were selected as the research objects. First, the preprocessing algorithms were applied on MRI images. With the depression classification algorithm based on deep learning, the features were extracted from the capsule network to construct a classification network, and the network structure was compared to obtain the difference in the distribution of brain lesions. Different classifiers and degree centrality, functional connection, low-frequency amplitude ratio, and low-frequency amplitude were selected to analyze the effectiveness of features. In the deep learning method, the neural network model was constructed, and feature extraction and classification network were carried out. The classification layer was based on the capsule network. The results showed that the correct rate of the deep learning feature extraction network structure combined with the capsule network classification was 82.47%, the recall rate was 83.69%, and the accuracy was 88.79%, showing that the capsule network can improve the heterogeneity of depression. The combination of fractional amplitude of low-frequency fluctuation (fALFF), DC, and amplitude of low-frequency fluctuation (ALFF) can achieve the accuracy of 100%. In summary, MRI images showed that patients with depression may have neurological abnormalities in the white matter area. In this study, the classification algorithm based on brain MRI images can effectively improve the classification performance.

Anxiety and Depression among Patients with Chronic Kidney Disease Undergoing Haemodialysis in a Tertiary Care Centre: A Descriptive Cross-sectional Study

Introduction

Chronic kidney disease is a global public health problem with psychological issues and other adverse issues like renal failure, cardiovascular disease, and premature deaths. This study aimed to find out the prevalence of anxiety and depression among patients with chronic kidney disease undergoing haemodialysis in a tertiary care centre.

Methods

A descriptive cross-sectional study was done among patients with chronic kidney disease undergoing haemodialysis in the Department of Medicine, Nephrology unit of a tertiary care centre from December 2020 to June 2021. Ethical approval was taken from the Institutional Review Committee (Reference number: 1712202003). The whole sampling method was used. The diagnosis of anxiety and depression was made using the Nepali version of the Hospital Anxiety and Depression Scale with a cut-off of ≥8 scores.

Results

Among 96 patients, the prevalence of anxiety was 66 (68.75%) and that of depression was 74 (77.08%) patients.

Conclusions

The prevalence of anxiety and depression was similar to other studies done in similar settings.

Keywords

anxiety; chronic kidney disease; depression; hemodialysis.

The Associations of Suspected COVID-19 Symptoms with Anxiety and Depression as Modified by Hemodialysis Dietary Knowledge: A Multi-Dialysis Center Study

During the COVID-19 pandemic, it is essential to evaluate hemodialysis patients’ dietary knowledge, especially among those with COVID-19 related symptoms, in order to identify appropriate strategies in managing their mental health. The study’s purposes were to test the psychometric properties of the hemodialysis dietary knowledge (HDK) scale, and to investigate the modifying impact of HDK on the associations of suspected COVID-19 symptoms (S-COVID-19-S) with anxiety and depression among hemodialysis patients. A cross-sectional study was conducted from July 2020 to March 2021 at eight hospitals across Vietnam. Data of 875 hemodialysis patients were analyzed, including socio-demographic, anxiety (the generalized anxiety disorder scale, GAD-7), depression (the patient health questionnaire, PHQ-9), S-COVID-19-S, HDK, health literacy, and digital healthy diet literacy. Confirmatory factor analysis (CFA) and logistic regression models were used to analyze the data. The HDK scale demonstrates the satisfactory construct validity with good model fit (Goodness of Fit Index, GFI = 0.96; Adjusted Goodness of Fit Index, AGFI = 0.90; Standardized Root Mean Square Residual, SRMR = 0.05; Root Mean Square Error of Approximation, RMSEA = 0.09; Normed Fit Index, NFI = 0.96; Comparative Fit Index, CFI = 0.96, and Parsimony goodness of Fit Index, PGFI = 0.43), criterion validity (as correlated with HL (r = 0.22, p < 0.01) and DDL (r = 0.19, p < 0.01), and reliability (Cronbach alpha = 0.70)). In the multivariate analysis, S-COVID-19-S was associated with a higher likelihood of anxiety (odds ratio, OR, 20.76; 95% confidence interval, 95%CI, 8.85, 48.70; p < 0.001) and depression (OR, 12.95; 95%CI, 6.67, 25.14, p < 0.001). A higher HDK score was associated with a lower likelihood of anxiety (OR, 0.70; 95%CI, 0.64, 0.77; p < 0.001) and depression (OR, 0.72; 95%CI, 0.66, 0.79; p < 0.001). In the interaction analysis, the negative impacts of S-COVID-19-S on anxiety and depression were mitigated by higher HDK scores (p < 0.001). In conclusion, HDK is a valid and reliable tool to measure dietary knowledge in hemodialysis patients. Higher HDK scores potentially protect patients with S-COVID-19-S from anxiety and depression during the pandemic.

The effects of psychosocial and economic factors on the quality of life of patients with end-stage renal disease and their caregivers in Klang Valley, Malaysia: protocol for a mixed-methods study

INTRODUCTION

The number of patients in Malaysia requiring dialysis is expected to rise substantially in the future due to the ageing population and increasing prevalence of diabetes mellitus and hypertension. Hence, more individuals will be expected to adopt the role of caregivers in the future. The upward trend of end-stage renal disease (ESRD) and caregiving for dialysis patients has detrimental consequences for both patients and caregivers in terms of their psychological well-being and quality of life. Despite the current circumstances, there are very few studies in Malaysia that have explored the psychosocial factors, specifically on the economic impact of the management of ESRD.

METHODS AND ANALYSIS

This two-phase sequential explanatory mixed-methods design, incorporating a quantitative design (phase I) and a qualitative study (phase II), is to be conducted in 4 government hospitals and 10 other non-governmental organisations or private dialysis centres within Klang Valley, Malaysia. A cross-sectional survey (phase I) will include 236 patient-caregiver dyads, while focus group discussions (phase II) will include 30 participants. The participants for both phases will be recruited purposively. Descriptive statistics, independent sample t-tests and multiple regression analysis will be used for analyses in phase I, and thematic analysis will be used in phase II.

ETHICS AND DISSEMINATION

Approval for the study has been obtained from the National Medical Research and Ethics Committee (MREC) (NMRR-21-1012-59714) and the Research Ethics Committee of Hospital Canselor Tuanku Muhriz UKM (UKM PPI/111/8/JEP-2021-078) and University of Malaya Medical Centre (MREC ID NO: 2 02 178-10346). Informed consent of the participants will be obtained beforehand, and no personal identifiers will be obtained from the participants to protect their anonymity. The findings will be published in peer-reviewed scientific journals and presented at national or international conferences with minimal anonymised data.

Anxiety Presentations and Treatments in Populations With Kidney Disease

Anxiety is common in patients with chronic kidney disease, but in its extreme expressions, anxiety can also be a complicating comorbid psychiatric illness. There is only a small literature base on anxiety disorders in patients with renal disease, and many of the studies are not sufficiently specific about which anxiety disorders are being studied. Larger epidemiological studies are required to delineate the incidence, prevalence, and outcomes associated with the varied anxiety disorders. In addition, the impact of the co-occurrence of anxiety with other chronic psychiatric or medical problems, needs further study. Anxiety is a clinical condition that warrants treatment, primarily due to its association with mortality in end-stage renal disease patients, and its negative impact on perceived quality of life. Therapeutic options for patients with anxiety and kidney disease include both pharmacologic and nonpharmacologic approaches. Current treatment strategies for anxiety specific to patients with renal disease are provided.

Impact of COVID-19 Pandemic on Elevated Anxiety Symptoms of Maintenance Hemodialysis Patients in China: A One-Year Follow-Up Study

Recent studies have shown that coronavirus disease 2019 (COVID-19) aggravates anxiety in patients with maintenance hemodialysis (MHD), but it is still unclear how long this adverse effect will last. This study aims to investigate the impact of COVID-19 on the elevated anxiety symptoms of MHD patients 1 year after the outbreak. Assessment of elevated anxiety symptoms was performed on patients with MHD during early COVID-19 (February 17-February 29, 2020) and 1-year follow-up (March 1-March 13, 2021), and a total of 100 patients had completed face-to-face questionnaires at the first and 1-year follow-up. At the beginning of the outbreak, 40% of the patients with MHD had anxiety symptoms [self-rating anxiety scale (SAS) score ≥ 50], and 11% (SAS score: 60-69) and 2% (SAS score ≥ 70) of the patients had moderate and severe anxiety symptoms, respectively. Multivariate analysis shows that possibility of unaccompanied transfer, possibility of family members or themselves being infected in a hospital, added body temperature monitoring during dialysis, and increased medical procedures are the risk factors in elevated anxiety symptoms during early COVID-19. At the 1-year follow-up, the incidence of anxiety symptoms in the same group of patients declined to 28%, and all the patients had mild anxiety symptoms (SAS score: 50-59), which is significantly lower than that of the early COVID-19 pandemic with statistically significant difference (p = 0.003). Increased protective measures taken by the medical staves were the only risk factor in elevated anxiety symptoms during the 1-year follow-up. This study shows that COVID-19 has a direct impact on the deterioration of anxiety symptoms in patients with MHD. With the changes of the requirements for COVID-19 prevention and control, as well as the enhancement of propaganda and education of the pandemic and psychological care, the severity and risk factors of anxiety symptoms in the patients with MHD are changing. Thus, targeted interventions are suggested to improve the psychological endurance of the patients with MHD.

Metabolic Syndrome and Psychological Effects of Exercise in Hemodialysis Patients

Metabolic syndrome (MS) and anxiety disorders are common problems among hemodialysis patients (HD). However, there have been no studies defining the role of physical activity in reducing anxiety in HD patients with MS. This study was aimed to determine the effects on the severity of anxiety of a four-week rehabilitation program for HD patients, with or without metabolic syndrome (MS), planned and adapted to their abilities. The study was single-center, interventional, non-randomized, and prospective. Fifty-eight individuals completed the project (28 HD patients and 30 controls (C) with normal kidney function). Each group was divided into two subgroups with respect to MS. The mean age of the subjects in the HD and C groups was 56.9 ± 13.3 years (x¯ ± SD) and 61.5 ± 8.3 years (x¯ ± SD), respectively. Planned and adapted to the patient's abilities, the rehabilitation program based on physiotherapy was provided to each subject for 4 weeks. Baseline and post-intervention determined anxiety levels using the State-Trait Anxiety Inventory (STAI). The X1 scale tests state anxiety, and the X2 scale tests trait anxiety. Post-intervention, there was no significant difference in the intensity of state anxiety observed in HD patients compared to C with normal renal function, as observed before the program. After four weeks of regular physical activity planned and adapted to the patient's abilities in an inpatient ward, the level of state anxiety (X1) and trait anxiety (X2) lowered considerably in all HD patients (respectively: 35.1 ± 8.0 vs. 29.2 ± 5.0, p = 0.001 for X1 and 41.8 ± 9.1 vs. 38.1 ± 5.9, p = 0.008 for X2). The rehabilitation program significantly reduced the intensity of state anxiety (X1) in HD patients with MS (35.8 ± 7.9 vs. 29.2 ± 5.1; p = 0.01). The rehabilitation program helped to significantly reduce the intensity of trait anxiety (X2) in HD patients without MS (41.9 ± 10.7 vs. 36.9 ± 5.9; p = 0.04). Four-week physical activity planned and adapted to the patient's abilities reduces the intensity of anxiety in HD patients and controls with normal renal function. HD patients with MS benefit more in terms of reducing perceived state anxiety, and HD patients without MS in terms of reducing trait anxiety.

Depression in dialysis

PURPOSE OF REVIEW

The aim of this study was to examine updated prevalence rates, risk factors and the prognosis, diagnosis and treatments for depression among dialysis patients.

RECENT FINDINGS

Depression influences prognosis, complications, quality of life (QOL), treatment and costs for dialysis patients worldwide. Reported prevalence of depression is 13.1-76.3%; it is higher for dialysis than transplant and higher post than predialysis. Reported depression rates with peritoneal dialysis (PD) compared with in-centre haemodialysis (HD) are inconsistent. Related medical factors are known, but suspected associated patient characteristics including gender and race remain unexplored. Associations between depression in dialysis and QOL, mortality, pathophysiological mechanisms of increased mortality, infection and pathways of inflammation-mediated and psychosocial factors require clarification. Several depression screening instruments are validated for dialysis patients - the Structured Clinical Interview for DSM disorders (SCID) remains the gold standard - but authors suggest the diagnostic standard should be higher than for the general population. Short-term studies indicate nonpharmacological therapy achieves clinical effects for depression in dialysis patients, but research on long-term effects is needed.

SUMMARY

Depression management through early screening and continuous care models emphasizing dynamic relationships between healthcare teams, patients and families should be encouraged. Large-scale studies of short-term and long-term benefits of pharmacological and nonpharmacological depression management are warranted.

Relationship Between Depression and Its Severity with Dialysis Adequacy in Hemodialysis Patients in Ahvaz Teaching Hospitals

Background: Depression is a prevalent psychological disorder among hemodialysis patients and is associated with a variety of adverse outcomes. Dialysis adequacy also affects hemodialysis patients' survival rates. Objectives: This study aimed to investigate the prevalence of depression in hemodialysis patients and its association with dialysis adequacy. Methods: In this cross-sectional study, 205 individuals undergoing hemodialysis at Ahvaz teaching hospitals in 2019 were included. The depression level was determined using the Beck Depression Inventory (BDI-II) for the participants aged below 65 years and Geriatric Depression Scale (GDS) for the patients aged above 65 years. Dialysis adequacy measures, including the Kt/V and urea reduction rate (URR), were calculated using standard formulas. Results: In this study, 60.5% of the participants suffered from depression, and the overall prevalence of depression was 54.6% in individuals aged below 65 and 67% in those aged above 65 years. Among the patients with age below 65 years, 19 persons (17.6%) were suffering from mild depression, 22 individuals (20.4%) were suffering from moderate depression, and 18 individuals (16.7%) had severe depression. Among the patients aged above 65 years, moderate depression was found to affect 45 persons (46.4%), and 20 individuals (20.6%) had severe depression. The mean values of Kt/V and URR were not significantly correlated with depression scores (P > 0.05). Conclusions: Depression is a common disorder among hemodialysis patients in Iran; however, it is not significantly associated with dialysis adequacy. However, the results of studies on the relationship between depression and dialysis adequacy cannot be analyzed simply.

Association between Financial Hardship and Symptom Burden in Patients Receiving Maintenance Dialysis: A Systematic Review

BACKGROUND

Many patients on maintenance dialysis experience financial hardship. Existing studies are mainly cost analyses that quantify financial hardship in monetary terms, but an evaluation of its impact is also warranted. This review aims to explore the definition of financial hardship and its relationship with symptom burden among patients on dialysis.

METHODS

A literature search was conducted in November 2020, using six electronic databases. Studies published in English that examined the associations between financial hardship and symptom burden were selected. Two reviewers independently extracted data and appraised the studies by using the JBI Critical Appraisal Checklists.

RESULTS

Fifty cross-sectional and seven longitudinal studies were identified. Studies used income level, employment status, healthcare funding, and financial status to evaluate financial hardship. While relationships between decreased income, unemployment, and overall symptom burden were identified, evidence suggested that several symptoms, including depression, fatigue, pain, and sexual dysfunction, were more likely to be associated with changes in financial status.

CONCLUSION

Our findings suggest that poor financial status may have a negative effect on physical and psychological well-being. However, a clear definition of financial hardship is warranted. Improving this assessment among patients on dialysis may prompt early interventions and minimize the negative impact of financial hardship.

Efficacy of Benson's Relaxation Technique on Anxiety and Depression among Patients Undergoing Hemodialysis: A Systematic Review

This study aimed to evaluate the efficacy of Benson's relaxation technique on anxiety and depression among patients undergoing hemodialysis. A systematic review of randomized controlled trials was conducted. Searching databases included EBSCO Host, PubMed, ProQuest, Science Direct, Sage Journals, Ovid, and Google Scholar from January 2000 to September 2020. Five randomized controlled trials were identified. Findings revealed a statistically significant decrease in anxiety score. Concerning depression; one RCT showed a statistically significant decrease and two RCTs revealed a non-significant difference in depression level. The overall quality of the RCTs was not high. Despite that the RCTs showed benefits of BRT in managing anxiety. However, this is not the same for depression. The lack of high-quality scientific evidence supporting its retinue use indicates that additional well designed randomized controlled trials in multiple countries are warranted to support the efficacy of Benson's relaxation technique on anxiety and depression among patients undergoing hemodialysis.

Multifaceted Sexual Dysfunction in Dialyzing Men and Women: Pathophysiology, Diagnostics, and Therapeutics

Patient survival continues to increase with the growing quality of dialysis and management of chronic kidney disease (CKD). As such, chronic therapy must include considerations of quality of life (QOL), and this includes the disproportionate prevalence of sexual dysfunction (SD) in this patient population. This review aims to describe the pathophysiological and the psychosocial causes of SD with regard to renal replacement therapy, particularly hemo- and peritoneal dialysis. The differences in its manifestation in men and women are compared, including hormonal imbalances—and therefore fertility, libido, and sexual satisfaction—the experience of depression and anxiety, and QOL. The impact of comorbidities and the iatrogenic causes of SD are described. This review also presents validated scales for screening and diagnosis of SD in CKD patients and outlines novel therapies and strategies for the effective management of SD. Increased prevalence of CKD invariably increases the number of patients with SD, and it is crucial for health care professional teams to become familiar with the clinical tools used to manage this sensitive and under-quantified field. As a known predictor of QOL, sexual function should become a point of focus in the pursuit of patient-centered care, particularly as we seek to achieve as “normal” a life as possible for individuals who receive dialysis.

Prevalence and risk factors for elevated anxiety symptoms and anxiety disorders in chronic kidney disease: A systematic review and meta-analysis

BACKGROUND

Anxiety is associated with poor health outcomes among chronic kidney disease (CKD) patients. This review summarizes the prevalence and risk factors associated with elevated anxiety symptoms and disorders among CKD patients.

METHODS

Articles evaluating the prevalence and risk factors associated with elevated anxiety symptoms and disorders among CKD patients, as diagnosed via DSM 4th or 5th edition criteria, clinical interviews or validated questionnaires, were searched in Medline®, Embase®, PsychINFO® and CINAHL®. Using random-effects meta-analyses, the prevalence of elevated anxiety symptoms and disorders were estimated. A narrative review on the risk factors associated with elevated anxiety symptoms and disorders was presented.

RESULTS

From 4941 articles, 61 studies were included. The pooled prevalence of anxiety disorders (9 studies, n = 1071) among CKD patients across studies was 19% while that of elevated anxiety symptoms (52 studies, n = 10,739) was 43%. Across continents, prevalence of elevated anxiety symptoms was highest in Europe and Asia. Between pre-dialysis and dialysis patients, the prevalence of elevated anxiety symptoms was not statistically different at 31% and 42% respectively. Common risk factors associated with elevated anxiety symptoms included concomitant depression, lower parathyroid hormone levels, increased comorbidities, increased duration of hospitalization, reduced perceived quality of life, and decreased vitality levels.

CONCLUSION

Given the high prevalence of anxiety disorders and elevated anxiety symptoms, more studies are required to assess the role and outcomes of anxiety screening among CKD patients. This could facilitate early identification of at-risk patients and potentially improve their clinical outcomes.

Development and preliminary validation of a self-rating anxiety inventory for maintenance haemodialysis patients

This study aimed to develop a self-rating anxiety inventory for maintenance haemodialysis patients (AI-MHD) and perform preliminary validation to provide a simple, effective, and highly specific practical tool for effective anxiety disorder screening in haemodialysis patients. Based on existing general anxiety disorder screening scales and common symptoms of MHD patients as a reference and after expert discussions and preliminary validation at a single dialysis centre, a self-rating AI-MHD containing 12 items was developed. Subsequently, the AI-MHD was applied in 4 dialysis centres and compared with GAD-7 and HADS-A. Further multicentre validation showed that Cronbach's alpha for the scale was 0.918; the AI-MHD score not only significantly differed between the anxiety disorders group and the non-anxiety disorders group (p<0.001) but also correlated with GAD-7 and HADS-A scores (p<0.001). In addition, the Kaiser-Meyer-Olkin (KMO) score was 0.847, and Bartlett's test of sphericity was significant (x²=849.45, p<0.001). The anxiety disorder detection rate was 93%, and the specificity was 90%, which were significantly better than the screening results using the GAD-7 and HADS-A scales in the same groups. Although there were limitations, such as the sample size and regionality, the AI-MHD showed good efficacy and reliability in rating anxiety in MHD patients.

Health-related quality of life associated with risk of death in Brazilian dialysis patients: an eight-year cohort

PURPOSE

Despite the advancements in renal replacement therapy, patients with end-stage renal disease face several limitations, with significant impacts on health-related quality of life (HRQoL) and mortality. This study aims to examine associations between quality of life and risk of death in Brazilian patients who underwent dialysis therapy between 2007 and 2015.

METHODS

Observational, prospective, non-concurrent cohort study of patients who underwent dialysis therapy at the Brazilian Public Health System (SUS) and were followed up for 8 years. Semi-structured questionnaires interrogating socioeconomic and demographic characteristics, as well as HRQoL measures (36 Item Short-Form Health Survey, SF-36), were employed. The Cox proportional risk model was used to investigate associations between HRQoL and risk of death.

RESULTS

Our sample comprised 1162 patients; of these, 884 were on hemodialysis (HD) and 278 on peritoneal dialysis (PD). Among the HD patients, death was associated with the physical (HR: 0.993; 95% CI: 0.989-0.997) and physical summary component (HR: 0.994; 95% CI: 0.989-0.999) domains of HRQoL. Regarding the PD patients, death was associated with the bodily pain (HR: 0.994; 95% CI: 0.990-0.998), mental health (HR: 0.094; 95% CI: 0.990-0.998), emotional problems (HR: 0.993; 95% CI: 0.987-0.998), social functioning (HR: 1.012; 95% CI: 1.002-1.023), physical problems (HR: 0.992; 95% CI: 0.986-0.998) and mental summary component (HR: 0.989; 95% CI: 0.981-0.997) domains of HRQoL.

CONCLUSIONS

Our data suggest that early and timely intervention measures aiming to enhance the HRQoL of dialysis patients are an essential component of professional practice and may contribute to improving the management of factors associated with dialysis patients' mortality.

Does Depression and Anxiety Mediate the Relation between Limited Health Literacy and Diet Non-Adherence?

Limited health literacy (HL), depression and anxiety are common in dialyzed patients and affect health outcomes and self-management. We explored whether depression and anxiety mediate the association of HL with diet non-adherence (DN-A) in dialyzed patients. We performed a cross-sectional study in 20 dialysis clinics in Slovakia (n = 452; mean age: 63.6 years; males: 60.7%). Hierarchical cluster analysis was performed to create three HL groups. Logistic regression adjusted for age, gender and education was used to explore whether depression and anxiety mediate the association of HL with DN-A. Patients in the moderate HL group were more likely to be non-adherent to diet (OR (Odds Ratio)/95% CI: 2.19/1.21-3.99) than patients in the high HL group. Patients in the low HL and moderate HL group more likely reported depression or anxiety. Patients reporting depression (OR/95% CI: 1.94/1.26-2.98) or anxiety (OR/95% CI: 1.81/1.22-2.69) were more likely to be non-adherent with diet. Adjustment for depression reduced the association between moderate HL and DN-A by 19.5%. Adjustment for anxiety reduced the association between moderate HL and DN-A by 11.8%. Anxiety and depression partly mediated the association of HL with DN-A. More attention should be paid to treating patients' psychological distress to ensure adequate adherence with recommended diet.

Comparison of a home-based (multi) systemic intervention to promoting Medication AdheRence and Self-management among kidney transplant recipients with care-as-usual: the MARS randomized controlled trial protocol

Background

After kidney transplantation non-adherence and inadequate self-management undermine clinical outcomes and quality of life. Both have been demonstrated to be substantial in all age groups. However, interventions promoting adherence and self-management among kidney transplant recipients that have proven to be effective are scarce. In this study we aim to develop and test an intervention to optimize adherence and self-management. In this article we describe the background and design of the trial entitled ‘promoting Medication AdheRence and Self-management among kidney transplant recipients’ (MARS-trial)’.

Methods/design

This is a single-center, parallel arm randomized controlled trial. Nonadherent kidney transplant recipients aged 12 years or older are eligible for inclusion. Patients will be randomly assigned to either the experimental or a control group. The control group will receive care-as-usual. The experimental group will receive care-as-usual plus the MARS-intervention. The MARS-intervention is an outreaching intervention, based on the principles of (multi) systemic therapy which means involving the social network. A standardized intervention protocol is used for consistency but we will tailor the behavior change techniques used to the specific needs and determinants of each patient. The primary outcome of medication adherence will be measured using electronic monitoring. Secondary outcome measures regarding medication adherence and self-management are also assessed. Data is collected at baseline (T0), after a run-in period (T1), at six months post-baseline/end of treatment (T2) and after a six month follow-up period (T3).

Discussion

We combined elements of (multi) systemic therapy and evidence-based behavior change techniques to create an outreaching and highly individualized intervention. In this trial we will investigate the impact on medication adherence and self-management after kidney transplantation.

Trial registration

Netherlands Trial Register,trial number NTR7462. Registered 7th September 2018, https://www.trialregister.nl/trial/7264

Comparison of mental health, quality of sleep and life among patients with different stages of chronic kidney disease and undergoing different renal replacement therapies

BACKGROUND

The present study aimed to investigate and compare mental health, health-related quality of life, and sleep levels of patients with various stages of chronic kidney disease (CKD) and undergoing different renal replacement therapies and analyze the factors affecting these parameters.

METHODS

Overall, 140 patients with a mean age of 43 ± 14 years were recruited into this study. Study groups [controls and patients with CKD undergoing predialysis, hemodialysis (HD), peritoneal dialysis, kidney transplantation (KT)] were evaluated using Short Form Health Survey-36 (SF-36), Kidney Disease Quality of Life-36 (KDQoL-36), Pittsburgh Sleep Quality Index (PSQI), and General Health Questionnaire-12 (GHQ-12).

RESULTS

The KT group had the highest scores in physical and mental components of the subscales of SF-36 and KDQoL-36 but the lowest scores in PSQI and GHQ-12, indicating the best results in terms of mental health and quality of life, and sleep. Serum albumin and hemoglobin levels were positively correlated with several subscales of quality of life. Significant negative correlations were observed among PSQI, GHQ-12, and subscale scores of SF-36 and KDQoL-36. The HD group showed significantly lower scores in the subscales of symptoms and burden of kidney disease of KDQoL-36.

CONCLUSION

KDQoL was worse in the HD group and better in the KT group than in other groups. Serum albumin and hemoglobin levels, and Kt/V (dialyzer clearance of urea multiplied by dialysis time and normalized for urea distribution volume ) values of patients with CKD exerted a linear and significant effect on the quality of life, which showed a significant positive correlation with the quality of sleep and mental health. In contrast, serum calcium x phosphorus levels showed an inverse correlation with the subscale scores of KDQoL. HIPPOKRATIA 2020, 24(2): 51-58.