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

Abstract

BackgroundPsychosocial 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.MethodsAdults 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).ResultsOf 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.ConclusionsResults 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.

Tryptophan metabolism, its relation to inflammation and stress markers and association with psychological and cognitive functioning: Tasmanian Chronic Kidney Disease pilot study

“…As this study was originally designed as a pilot to assess the feasibility of a larger cohort study, a formal power calculation was not performed. Another substantial limitation of the study design is the lack of healthy controls, dictated by the design of the Tasmanian CKD pilot study, as described in published work [39]. Results should therefore be treated as preliminary and interpreted with caution.…”

“…The protocol for the Tasmanian Chronic Kidney Disease study has been published previously [39]. Briefly, clinical data and serum samples were obtained from 27 patients who were recruited 2 years earlier (while with CKD stage 4) via the treating physician, to participate in a prospective cohort pilot study.…”

Exploring experiences of the quality of nursing care among patients, nurses, caregivers and physicians in a haemodialysis department

“…McKercher et al . () suggested that patients under dialysis lose their energy and general well‐being.…”

Brief cognitive behavioural intervention for depression and anxiety symptoms improves quality of life in chronic haemodialysis patients

“…The BDI and Beck Anxiety Inventory (BAI) are common measurements scales in studies with renal patients (Brekke et al ., ; Cukor et al ., ; Lin et al ., ; McKercher et al ., ; Turkmen et al ., ). They are both 21‐item scales that address cognitive and somatic depression or anxiety symptoms, respectively, and they are both widely used in general and clinical populations.…”