ESKD

A recently published study found psychiatric illnesses, common among patients with ESKD hospitalized; within their first year of dialysis treatment, were associated with higher patient mortality after discharge. “The presence of depression or anxiety associated with lower quality; of life in adult and pediatric kidney disease patients,” Paul L. Kimmel, MD,of the National Institute of Diabetes and Digestive and Kidney Diseases, NIH, and colleagues wrote.

“Additionally, depression in adults with ESKD associated with lower treatment adherence; more frequent hospitalizations and increased mortality. In pediatric hemodialysis patients; anxiety associated with increased disease duration and hospitalizations. How common psychiatric illnesses are in the hospitalized ESKD hemodialysis population; and their associations with outcomes is unknown.”

Initiation for ESKD

However, to assess the prevalence of hospitalizations with psychiatric diagnoses; within 1 year of treatment initiation for ESKD, as well as to determine the associations between these factors and mortality after discharge; researchers used the United States Renal Data System to perform a retrospective cohort study of 214,225 patients who began treatment from 1996 to 2013. But patients were categorized into pediatric (0 to 21 years) adult (22 to 65 years) and elderly (65 years or more) groups.

But researchers found that, within the first year of treatment, 72% of elderly adults; 66% of adults and 64% of children had at least one hospitalization. But of hospitalized adults, 2% had a primary psychiatric diagnosis and 25% had a secondary psychiatric diagnosis. For children, 1% had a primary psychiatric diagnosis and 15% had a secondary diagnosis. However, the most common primary psychiatric diagnosis; in both hospitalized children and adults depression/affective disorders (4% and 3%, respectively).

Alcohol-related and drug disorders followed this as most common for adults (in 1%). Hospitalized elderly adults most commonly diagnosed with organic disorders/dementias (3%). However, regarding mortality after hospital discharge; researchers found the mortality rate was 237.4 deaths per 1,000 person-years in patients hospitalized without psychiatric diagnoses; 252.1 in patients with primary psychiatric diagnoses and 275.3 in patients with secondary psychiatric diagnoses.

Mange psychiatric disorders

In addition, hazard ratios of all-cause death were higher in all adults; hospitalized with either primary (HR = 1.29) or secondary (HR = 1.11) psychiatric diagnoses than those without these diagnoses. “ This study updates our understanding of the prevalence of and outcomes associated with hospitalizations with psychiatric diagnoses; in adult ESKD patients and expands that understanding to a large sample of pediatric patients for perhaps the first time; across a spectrum of psychiatric diagnoses,” the researchers wrote.

“Between 1996 and 2013, approximately 27% of adults; and 21% of elderly adults in the U.S. ESRD program had hospitalizations with psychiatric diagnoses. However, prevalence was slightly lower in pediatric patients at 16%. his represents a substantial increase from the 8.9% of patients hospitalized; with psychiatric diagnoses found in 1998. The findings suggest clinicians who care for hospitalized dialysis patients should aware of and prepared to mange psychiatric disorders; and associated negative outcomes within these populations.”

According to Michael J. Fischer, MD, MSPH, and James P. Lash, MD, providing the best quality of care for patients who have psychiatric conditions in addition to ESKD remains challenging. Although changes to the care model for maintenance dialysis have examined; and shown to associated with improvements in quality of life, ESKD patients continue to have fragmented and poorly coordinated care that hinders effective management of their complex multimorbidity including psychiatric illness.”