Associations of depressive symptoms and pain with dialysis adherence, health resource utilization, and mortality in patients receiving chronic hemodialysis.

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Abstract

Depressive symptoms and pain are common in patients receiving chronic hemodialysis, yet their effect on dialysis adherence, health resource utilization, and mortality is not fully understood. This study sought to characterize the longitudinal associations of these symptoms with dialysis adherence, emergency department (ED) visits, hospitalizations, and mortality.

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Most cited references 25

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Prevalence, severity, and importance of physical and emotional symptoms in chronic hemodialysis patients.

Jayanth R Arnold, Linda F. Fried, Eli J. Fine … (2005)

The prevalence, severity, and clinical significance of physical and emotional symptoms in patients who are on maintenance hemodialysis remain incompletely characterized. This study sought to assess symptoms and their relationship to quality of life and depression. The recently developed Dialysis Symptom Index was used to assess the presence and the severity of 30 symptoms. The Illness Effects Questionnaire and Beck Depression Inventory were used to evaluate quality of life and depression, respectively. Correlations among symptom burden, symptom severity, quality of life, and depression were assessed using Spearman correlation coefficient. A total of 162 patients from three dialysis units were enrolled. Mean age was 62 y, 48% were black, 62% were men, and 48% had diabetes. The median number of symptoms was 9.0 (interquartile range 6 to 13). Dry skin, fatigue, itching, and bone/joint pain each were reported by > or =50% of patients. Seven additional symptoms were reported by >33% of patients. Sixteen individual symptoms were described as being more than "somewhat bothersome." Overall symptom burden and severity each were correlated directly with impaired quality of life and depression. In multivariable analyses adjusting for demographic and clinical variables including depression, associations between symptoms and quality of life remained robust. Physical and emotional symptoms are prevalent, can be severe, and are correlated directly with impaired quality of life and depression in maintenance hemodialysis patients. Incorporating a standard assessment of symptoms into the care provided to maintenance hemodialysis patients may provide a means to improve quality of life in this patient population.

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Psychosocial factors in dialysis patients.

Paul L Kimmel (2001)

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Depression is an important contributor to low medication adherence in hemodialyzed patients and transplant recipients.

Saurabh Jindal, D. Rosenthal, Paul L Kimmel … (2009)

End-stage renal disease (ESRD) is a growing public health concern and non-adherence to treatment has been associated with poorer health outcomes in this population. Depression, likely to be the most common psychopathology in such patients, is associated with increased morbidity and mortality. We compared psychological measures and self-reported medication adherence of 94 kidney transplant recipients to those of 65 patients receiving hemodialysis in a major medical center in Brooklyn, New York. Compared to the transplant group, the hemodialysis cohort was significantly more depressed as determined by the Beck Depression Inventory score. They also had a significantly lower adherence to medication as reported on the Medication Therapy Adherence Scale. Using hierarchical multiple regression analysis, the variance in depression was the only statistically significant predictor of medication adherence beyond gender and mode of treatment, accounting for an additional 12% of the variance. Our study strongly suggests that a depressive affect is an important contributor to low medication adherence in patients with ESRD on hemodialysis or kidney transplant recipients.

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Author and article information

Journal

Journal ID (iso-abbrev): Clin J Am Soc Nephrol

Title: Clinical journal of the American Society of Nephrology : CJASN

ISSN (Electronic): 1555-905X

ISSN (Print): 1555-9041

Publication date (Electronic): Sep 5 2014

Volume: 9

Issue: 9

Affiliations

[1 ] Renal Section, Medicine Service Line, and Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Renal-Electrolyte Division, Department of Medicine, and weisbordsd@upmc.edu.

[2 ] Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania;

[3 ] Department of Population Health, New York University School of Medicine, New York, New York; and.

[4 ] Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania;

[5 ] Renal Section, Medicine Service Line, and Renal-Electrolyte Division, Department of Medicine, and.

[6 ] Divisions of General Internal Medicine and Palliative Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania;

[7 ] Nephrology Department, Geisinger Medical Center, Danville, Pennsylvania.

[8 ] Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Divisions of General Internal Medicine and.