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.
Highlights
Psychosocial factors including depression, anxiety and lower social support are common in patients with chronic kidney disease (CKD)
Evidence from various chronic disease settings indicates that psychosocial factors including depression, anxiety and social isolation have a significant impact on quality of life, biological factors and disease progression [1,2,3]
Depression is associated with increased mortality and decreased quality of life in patients on dialysis [6,7,8], few studies have examined the influence of depression on disease progression and adverse outcomes in patients with CKD prior to the initiation of kidney replacement therapy (KRT) [9,10]
Summary
Psychosocial factors including depression, anxiety and lower social support are common in patients with chronic kidney disease (CKD). Depression is associated with increased mortality and decreased quality of life in patients on dialysis [6,7,8], few studies have examined the influence of depression on disease progression and adverse outcomes in patients with CKD prior to the initiation of kidney replacement therapy (KRT) (dialysis or transplantation) [9,10]. These studies indicate that clinical depression [9] and elevated depressive symptoms [10] are independent predictors of clinical outcomes, including initiation of dialysis, hospitalization or death in CKD patients. Kop and colleagues found that higher depressive symptoms were associated with subsequent acute kidney injury but not renal function decline, hospitalization or initiation of dialysis [11]
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