Abstract
BackgroundOlder patients with advanced chronic kidney disease are at increased risk for a severe course of the coronavirus disease-2019 (COVID-19) and vulnerable to mental health problems. We aimed to investigate prevalence and associated patient (demographic and clinical) characteristics of mental wellbeing (health-related quality of life [HRQoL] and symptoms of depression and anxiety) before and during the COVID-19 pandemic in older patients with advanced chronic kidney disease.MethodsAn ongoing Dutch multicentre prospective cohort study enrols patients of ≥70 years with an eGFR < 20 mL/min/1.73m2 from October 2018 onward. With additional questionnaires during the pandemic (May–June 2020), disease-related concerns about COVID-19 and general anxiety symptoms were assessed cross-sectionally, and depressive symptoms, HRQoL, and emotional symptoms longitudinally.ResultsThe 82 included patients had a median age of 77.5 years (interquartile range 73.9–82.1), 77% were male and none had tested positive for COVID-19. Cross-sectionally, 67% of the patients reported to be more anxious about COVID-19 because of their kidney disease, and 43% of the patients stated that their quality of life was reduced due to the COVID-19 pandemic. Compared to pre-COVID-19, the presence of depressive symptoms had increased (11 to 22%; p = .022) and physical HRQoL declined (M = 40.4, SD = 10.1 to M = 36.1, SD = 10.4; p < .001), particularly in males. Mental HRQoL (M = 50.3, SD = 9.6 to M = 50.4, SD = 9.9; p = .913) and emotional symptoms remained similar.ConclusionsOlder patients with advanced chronic kidney disease suffered from disease-related anxiety about COVID-19, increased depressive symptoms and reduced physical HRQoL during the COVID-19 pandemic. The impact of the pandemic on this vulnerable patient group extends beyond increased mortality risk, and awareness of mental wellbeing is important.Trial registrationThe study is registered at the Netherlands Trial Register (NTR), trial number NL7104. Date of registration: 06-06-2018.
Highlights
Older persons are highly vulnerable during the coronavirus 2019 (COVID-19) pandemic: previous research showed a twenty-fold increased mortality in people aged 80 years or above compared to 50–59 year olds [1]
This date was chosen to ensure that at least one assessment was completed before the World Health Organisation declared the COVID-19 outbreak a pandemic (11th of March) and the Netherlands went into lockdown (15th of March), which involved the closing of restaurants, educational institutions, sporting and cultural facilities, working from home and obliged social distancing
This study investigated mental wellbeing in older patients with advanced chronic kidney disease (CKD) during the COVID-19 pandemic
Summary
Older persons are highly vulnerable during the coronavirus 2019 (COVID-19) pandemic: previous research showed a twenty-fold increased mortality in people aged 80 years or above compared to 50–59 year olds [1]. Patients with advanced chronic kidney disease (CKD) have shown to be more vulnerable to mental health problems, such as anxiety and depression [10] In this population, emotional symptoms, like symptoms of anxiety and depression, worrying, sleep disorders, perceived lack of social support, and reduced social interactions, affect health-related quality of life (HRQoL) [11,12,13,14], but have been associated with adverse clinical outcomes and increased mortality risk [15, 16]. We aimed to investigate prevalence and associated patient (demographic and clinical) characteristics of mental wellbeing (health-related quality of life [HRQoL] and symptoms of depression and anxiety) before and during the COVID-19 pandemic in older patients with advanced chronic kidney disease
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