Psychosocial factors in adults with chronic kidney disease: characteristics of pilot participants in the Tasmanian Chronic Kidney Disease study

BMC Nephrology

Matthew D Jose²  Jennifer L Scott¹  Michael A Ashby⁴  Andrew J Palmer³  Mark R Nelson³  Leigh Blizzard³  Alison J Venn³  Charlotte M McKercher³ 

[1] School of Psychology, Faculty of Health Sciences, University of Tasmania, Hobart, Tasmania, Australia;School of Medicine, University of Tasmania, Hobart, Tasmania, Australia;Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia;Royal Hobart Hospital, Hobart, Tasmania, Australia

关键词: Social support;    Health-related quality of life;    Depression;    Cohort;    Chronic kidney disease;    Anxiety;   

Others  :  1082955
DOI  :  10.1186/1471-2369-14-83

 received in 2012-10-12, accepted in 2013-04-09,  发布年份 2013

【 摘 要 】

Background

Psychosocial factors including depression, anxiety and lower social support are common in patients with chronic kidney disease (CKD). However the influence of these potentially modifiable risk factors on morbidity and mortality in this renal population is unknown. The Tasmanian Chronic Kidney Disease study is a prospective cohort study which aims to examine the influence of both biomedical and psychosocial factors on disease progression, decision making and length and quality of life in adults with severe CKD, prior to kidney replacement therapy (KRT). This paper describes the recruitment, baseline characteristics and initial follow-up of pilot participants.

Methods

Adults aged > 18 years with stage 4 CKD (eGFR 15–29 mls/min/1.73 m²) and not receiving dialysis were recruited via treating physicians. Measures included depression (9-item Patient Health Questionnaire), anxiety (Beck Anxiety Inventory) and social support (Multidimensional Scale of Perceived Social Support). Primary outcomes were kidney disease progression, use of KRT and health-related quality of life (Kidney Disease and Quality of Life Short Form and the EQ-5D).

Results

Of those invited (n = 105), 49 provided consent and completed baseline assessment. There were no significant differences between responders and non-responders in age, gender and socio-economic status (all p > 0.05). Participants were predominantly male (63.3%) with a mean age of 72.6 ± 10.2 years. Mean serum creatinine was 241 ± 62 μmol/L with mean eGFR 22 ± 5 mls/min/1.73 m². Prevalence of major depression and moderate to severe anxiety was 10% and 9% respectively. Less severe depression and fewer anxiety symptoms were associated with higher health-related quality of life. Follow-up at 10-months showed CKD progression in 34% of participants (use of KRT in 16%, stage 5 CKD without KRT in 18%), one death, with the remainder stable at CKD stage 3 or 4.

Conclusions

Results indicate that a larger prospective study is feasible and has the capacity to examine the influence of biomedical and psychosocial factors on kidney disease progression, use of dialysis and transplantation, and salient personal and economic outcomes. Findings have the potential to provide an evidence base for revising healthcare provision in order to optimize the care of patients with CKD.

【 授权许可】

   
2013 McKercher et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Katon W, Lin E, Korff M, Ciechanowski P, Ludman E, Young B, Peterson D, Rutter C, McGregor M, McCulloch D: Collaborative care for patients with depression and chronic illnesses. New Engl J Med 2010, 363:2611-2620.
• [2]Sareen J, Jacobi F, Cox B, Belik S, Clara I, Stein M: Disability and poor quality of life associated with comorbid anxiety disorders and physical conditions. Arch Intern Med 2006, 166:2109-2116.
• [3]House J, Landis K, Umberson D: Social relationships and health. Science 1988, 241:540-545.
• [4]Fekete E, Antoni M, Schneiderman N: Psychosocial and behavioral interventions for chronic medical conditions. Curr Opin Psychiatry 2007, 20:152-157.
• [5]Australian Institute of Health and Welfare (AIHW): Chronic Kidney Disease in Australia. Canberra: AIHW; 2005.
• [6]Lopes A, Bragg J, Young E, Goodkin D, Mapes D, Combe C, Piera L, Held P, Gillespie B, Port F: Depression as a predictor of mortality and hospitalization among hemodialysis patients in the United States and Europe. Kidney Int 2002, 62:199-207.
• [7]Hedayati SS, Bosworth HB, Briley LP, Sloane RJ, Pieper CF, Kimmel PL, Szczech LA: Death or hospitalization of patients on chronic hemodialysis is associated with a physician-based diagnosis of depression. Kidney Int 2008, 74:930-936.
• [8]Kimmel PL, Peterson RA, Weihs KL, Simmens SJ, Alleyne S, Cruz I, Veis JH: Multiple measurements of depression predict mortality in a longitudinal study of chronic hemodialysis outpatients. Kidney Int 2000, 57:2093-2098.
• [9]Hedayati S, Minhajuddin A, Afshar M, Toto R, Trivedi M, Rush A: Association between major depressive episodes in patients with chronic kidney disease and initiation of dialysis, hospitalization, or death. JAMA 2010, 303:1946-1953.
• [10]Tsai Y-C, Chiu Y-W, Hung C-C, Hwang S-J, Tsai J-C, Wang S-L, Lin M-Y, Chen H-C: Association of symptoms of depression with progression of CKD. Am J Kidney Dis 2012, 60:54-61.
• [11]Kop WJ, Seliger SL, Fink JC, Katz R, Odden MC, Fried LF, Rifkin DE, Sarnak MJ, Gottdiener JS: Longitudinal association of depressive symptoms with rapid kidney function decline and adverse clinical renal disease outcomes. CJASN 2011, 6:834-844.
• [12]Cukor D, Coplan J, Brown C, Friedman S, Newville H, Safier M, Spielman LA, Peterson RA, Kimmel PL: Anxiety disorders in adults treated by hemodialysis: a single-center study. Am J Kidney Dis 2008, 52:128-136.
• [13]Kimmel PL, Peterson RA, Weihs KL, Simmens SJ, Alleyne S, Cruz I, Veis JH: Psychosocial factors, behavioral compliance and survival in urban hemodialysis patients. Kidney Int 1998, 54:245-254.
• [14]Untas A, Thumma J, Rascle N, Rayner H, Mapes D, Lopes AA, Fukuhara S, Akizawa T, Morgenstern H, Robinson BM, Pisoni RL, Combe C: The associations of social support and other psychosocial factors with mortality and quality of life in the Dialysis Outcomes and Practice Patterns Study. CJASN 2011, 6:142-152.
• [15]Thong MS, Kaptein AA, Krediet RT, Boeschoten EW, Dekker FW: Social support predicts survival in dialysis patients. Nephrol Dial Transplant 2007, 22:845-850.
• [16]Jose MD, Otahal P, Kirkland G, Blizzard L: Chronic kidney disease in Tasmania. Nephrology 2009, 14:743-749.
• [17]Clinical Audit Tool (CAT)[http://www.clinicalaudit.com.au/ webcite]
• [18]Kroenke K, Spitzer R, Williams J: The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001, 16:606-613.
• [19]Beck A, Epstein N, Brown G, Steer R: An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol 1988, 56:893-897.
• [20]Zimet GD, Dahlem NW, Zimet SG, Farley GK: The Multidimensional Scale of Perceived Social Support. J Pers Assess 1988, 52:30-41.
• [21]Watnick S, Wang P, Demadura T, Ganzini L: Validation of 2 depression screening tools in dialysis patients. Am J Kidney Dis 2005, 46:919-924.
• [22]Beck A, Steer R: Beck Anxiety Inventory manual. 2nd edition. San Antonio, TX: Psychological Corporation; 1993.
• [23]Wetherell J, Areán P: Psychometric evaluation of the Beck Anxiety Inventory with older medical patients. Psychol Assess 1997, 9:136-144.
• [24]Spinale J, Cohen S, Khetpal P, Peterson R, Clougherty B, Puchalski C, Patel S, Kimmel P: Spirituality, social support, and survival in hemodialysis patients. CJASN 2008, 3:1620-1627.
• [25]Australian Bureau of Statistics (ABS): Census of population and housing: socio-economic indexes for areas (SEIFA). Canberra: ABS; 2001.
• [26]Liu J, Huang Z, Gilbertson DT, Foley RN, Collins AJ: An improved comorbidity index for outcome analyses among dialysis patients. Kidney Int 2009, 77:141-151.
• [27]National Heart Lung and Blood Institute: Clinical Guidelines for the Identification, Evaluation and Treatment of Overweight and Obesity in Adults: The Evidence Report. Bethesda, MD: National Heart, Lung, and Blood Institute; 1998.
• [28]Teng E, Chui H: The Modified Mini-Mental State (MMS) examination. J Clin Psychiatry 1987, 48:314-318.
• [29]Hays R, Kallich J, Mapes D, Coons S, Carter W: Development of the Kidney Disease Quality of Life (KDQOL) Instrument. Qual Life Res 1994, 3:329-338.
• [30]Karnofsky D, Burchenal J: The clinical evaluation of chemotherapeutic agents in cancer. In Evaluation of Chemotherapeutic Agents in Cancer. Edited by McLeod C. New York: Columbia University Press; 1949:191-205.
• [31]Katz S, Ford A, Moskowitz R, Jackson B, Jaffe M: Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. JAMA 1963, 185:914-919.
• [32]Lawton M, Brody E: Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969, 9:179-186.
• [33]Ende J, Kazis L, Ash A, Moskowitz M: Measuring patients’ desire for autonomy: decision making and information-seeking preferences among medical patients. J Gen Intern Med 1989, 4:23-30.
• [34]Krantz D, Baum A, Wideman M: Assessment of preferences for self-treatment and information in health care. J Pers Soc Psychol 1980, 39:977-990.
• [35]Kurella M, Luan J, Yaffe K, Chertow GM: Validation of the Kidney Disease Quality of Life (KDQOL) Cognitive Function subscale. Kidney Int 2004, 66:2361-2367.
• [36]McClellan WM, Anson C, Birkeli K, Tuttle E: Functional status and quality of life: predictors of early mortality among patients entering treatment for end stage renal disease. J Clin Epidemiol 1991, 44:83-89.
• [37]Levey A: K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002, 39:266.
• [38]Levey A, Coresh J, Greene T, Stevens L, Zhang Y, Hendriksen S, Kusek J, Van Lente F: Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med 2006, 145:247-254.
• [39]Cleemput I, Kesteloot K, Moons P, Vanrenterghem Y, Van Hooff JP, Squifflet J-P, De Geest S: The construct and concurrent validity of the EQ-5D in a renal transplant population. Value in Health 2004, 7:499-509.
• [40]Liem Y, Bosch J, Myriam Hunink M: Preference-based quality of life of patients on renal replacement therapy: a systematic review and meta-analysis. Value in Health 2008, 11:733-741.
• [41]Wyld M, Morton RL, Hayen A, Howard K, Webster AC: A systematic review and meta-analysis of utility-based quality of life in chronic kidney disease treatments. PLoS Med 2012, 9:e1001307.
• [42]Australian Bureau of Statistics: National Survey of Mental Health and Wellbeing: summary of results 2007. Canberra: ABS; 2008.
• [43]Porter A, Fischer M, Brooks D, Bruce M, Charleston J, Cleveland W, Dowie D, Faulkner M, Gassman J, Greene T, Hiremath L, Kendrick C, Kusek J, Thornley-Brown D, Wang X, Norris K, Unruh M, Lash J: Quality of life and psychosocial factors in African Americans with hypertensive chronic kidney disease. Translational Research 2012, 159:4-11.
• [44]Nutt D, Stein D: Understanding the neurobiology of comorbidity in anxiety disorders. CNS Spectrums 2006, 11:13-20.
• [45]Kazarian SS, McCabe SB: Dimensions of social support in the MSPSS: factorial structure, reliability, and theoretical implications. J Community Psychol 1991, 19:150-160.
• [46]Australian Bureau of Statistics: National Health Survey: SF36 population norms, Australia. Canberra: ABS; 1995.
• [47]Cohen S, Patel S, Khetpal P, Peterson R, Kimmel P: Pain, sleep disturbance, and quality of life in patients with chronic kidney disease. CJASN 2007, 2:919-925.
• [48]Leyfer O, Ruberg J, Woodruff-Borden J: Examination of the utility of the Beck Anxiety Inventory and its factors as a screener for anxiety disorders. J Anxiety Disord 2006, 20:444-458.
• [49]Schröder FH, Denis LJ, Kirkels W, De Koning HJ, Standaert B: European randomized study of screening for prostate cancer. Progress report of Antwerp and Rotterdam Pilot studies. Cancer 1995, 76:129-134.
• [50]Galea S, Tracy M: Participation rates in epidemiologic studies. Ann Epidemiol 2007, 17:643-653.
• [51]Cass A, Chadban S, Craig J, Howard H, McDonald S, Salkeld G, White S: The economic impact of end-stage kidney disease in Australia: Projections to 2020. Melbourne: Kidney Health Australia; 2010.
• [52]Australian Institute of Health and Welfare (AIHW): End-stage kidney disease in Australia: total incidence, 2003–2007. Canberra: AIHW; 2011.
• [53]Chan HW, Clayton PA, McDonald SP, Agar JW, Jose MD: Risk factors for dialysis withdrawal: an analysis of the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, 1999–2008. CJASN 2012, 7:775-781.