Aim The current study evaluated the feasibility and preliminary efficacy of a psychosocial intervention, the Kidney Optimal Health Program, in reducing symptoms of depression and anxiety in individuals with advanced chronic kidney disease. Methods Patients with stage 4 or 5 chronic kidney disease were randomized to either a nine‐session psychosocial intervention programme or usual care. Feasibility was assessed through recruitment and retention rates and programme acceptability. Participants completed assessments of depression, anxiety and psychosocial health at baseline and at 3‐, 6‐ and 12‐month follow‐up. A repeated‐measures analysis of variance was used to compare groups on outcomes over time. Results One hundred and twenty‐eight patients were screened for eligibility; 84 consented to participant and were randomized to receive the intervention (N = 42) or usual care (N = 42). 27 (32.1%) participants withdrew prior to baseline assessment. Of those who completed the baseline assessment (N = 57), trial retention was high (75.4% at 3‐month, 80.7% at 6‐month and 70.2% at 12‐month follow‐up). Participants reported high levels of programme acceptability. The patients who completed the intervention (N = 17) demonstrated significantly decreased depression at 12‐month follow‐up compared to the usual care group (N = 13). Conclusion The results support the feasibility of the Kidney Optimal Health Program intervention in recruitment, retention and programme acceptability with an improved screening protocol. Preliminary support is provided for improvement in depressive symptoms in patients with advanced chronic kidney disease. Further investigation through a fully powered randomized controlled trial is warranted.

Diabetes and left internal jugular vein insertion site were significantly associated with increased risk of a catheter-related bloodstream infection from a tunneled hemodialysis catheter. Ex-smoker status was significantly associated with reduced risk.

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BackgroundChronic 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.MethodsThe 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.DiscussionWe 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 registrationANZCTR no. 12615000810516. Registered on 5 August 2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1558-z) contains supplementary material, which is available to authorized users.

BackgroundPatients with chronic kidney disease (CKD) experience a significant impact on psychological well-being and quality of life (QoL). To date, exploration of the potential mediators between individual disease perceptions and quality of life in CKD is limited. Underpinned by the Common Sense Model (CSM), this study evaluated the potential mediating role of selfefficacy, coping styles and psychological distress on the relationship between illness perceptions and QoL in patients living with CKD. MethodsParticipants were147 people (mean age 61.1 years (SD=12.0)) with Stage 3 CKD (n=5), Stage 4 CKD (n=57) or end-stage kidney disease (ESKD; Stage 5; n=85). Measures included kidney function (eGFR), illness perceptions (Brief Illness Perceptions Questionnaire; BIPQ), coping styles (Carver Brief COPE scale; COPE), psychological distress (Hospital Anxiety and Depression Scale; HADS), self-efficacy (General Self-Efficacy Scale; SE) and QoL (Kidney Disease Quality of Life Short Form; KDQoL-SF). Correlational analyses were preformed, followed by regression modelling.ResultsCorrelational analyses indicated that 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 by the final model was 65.7%. DiscussionThese findings provide partial validation of the CSM in a CKD cohort. Based on these results, we suggest that psychological interventions are likely to have a beneficial impact on QoL if they target the mediating psychological processes associated with illness perceptions and psychological distress.

patient, while 3 catheters were removed due to catheter thrombosis (3/9, 33.3%). Two patients were noted to have catheter dislodgement into the pleural cavity (2/9, 22.2%), both presented with shock and haemothorax. Poor blood flow was the most common complication during the use of transhepatic catheters. Catheter revision was required in 2 cases. The maximum blood flow rate achieved for each catheter ranged from 150ml/minute to 250ml/minute, with a mean rate of 186ml/minute. The maximum blood flow rate was below 200ml/ minute in 4 of the catheters (4/9,44.4%). Bleeding at the catheter site necessitating hospital admission occurred in 3 cases (3/9, 33.3%), catheter exit site infection occurred in 2 (2/9, 22.2%), but there were no catheter related sepsis. Conclusions: For patients who have exhausted access options for dialysis, transhepatic catheter placement is an alternative with potentially good long-term functionality. However, limitations in blood flow rate, and the high thrombosis rate with the need for high level of maintenance to preserve patency should be noted. Furthermore, physicians need to be cautious about potentially lifethreatening complications such as catheter dislodgement.

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