MON-155 COMPARITIVE ASSESSMENT OF PSYCHOSOCIAL NEEDS OF DIALYSIS PATIENTS WITH CHRONIC KIDNEY DISEASE AND PREDIALYSIS PATIENTS - A SINGLE CENTRE STUDY

Abstract

As chronic disease sufferers, dialysis and late-stage chronic kidney disease patients are at a high risk of psychological as well as physical co-morbidities of their illness. Mental illnesses such as depression and anxiety are a significant burden in end-stage renal disease patients and are associated with poorer outcomes in physical health. Furthermore, poor physical health impacts ability to carry out activities of daily living. This has a negative impact on quality of life for many patients and few centres offer specific social or psychological support for this group. This cross-sectional survey-based study seeks to evaluate objective and subjective indicators of health-related quality of life, and to identify predictors of poor physical and mental health in a population of severe end stage renal disease patients at a single centre without such support available. Following a pilot in dialysis patients only, 108 dialysis, 47 pre-dialysis (CKD5) and 55 chronic kidney disease stage 4 (CKD4) patients aged 18+ were surveyed when attending the unit for dialysis or an appointment, and by post if dialysing at home. The self-administered questionnaire reviewed the patient experience of dialysis/treatment, a self-assessment of ‘coping’ (scored out of 10) and need for additional support. Health-related quality of life (HR-QuOL) was assessed with the 12-Item Short Form Survey (SF-12) and scored using items 1-12 of the UCLA Kidney Disease Quality of Life v1.3 template to obtain scores of mental (MCS-12) and physical (PCS-12) health. Demographic associations with MCS-12 and PCS-12 were assessed by ANOVA with Bonferroni post-hoc correction and stepwise regression analysis. PCS-12 deteriorated with disease stage such that CKD4 patients had significantly greater scores than dialysis patients (p=.004); within the dialysis subgroup, PCS-12 was greater in PD than HD patients, but there was no significant difference between those treated at home and in the unit. Gender was found to be a predictor of MCS-12, where males generally exhibited better scores (p=.022). Self-assessed mental coping was lower in younger dialysis patients; however, there was no difference in HR-QuOL scores between age groups. Both MCS-12 and PCS-12 were most strongly predicted by the patient’s self-assessment ‘coping’ score /10 for their mental and physical health respectively Subjective patient reporting of their physical and mental health via a score from 1-10 gives a very strong indication of formal HR-QuOL score and may be a useful tool in practice to easily identify patients in need of support. Physical health score is best predicted by stage in disease process and, in dialysis groups, method of dialysis; mental health is best predicted by gender and to a lesser extent, age. By being aware of at-risk groups, identified in this cohort as the young, females, and patients with more advanced disease, specific services can be offered to improve quality of life through emotional and practical support. The authors hope to use the results of this study along with further analysis of patient-evaluated need to establish a renal-specific counselling service for those service users identified as in need of psychological and practical support.