Depression symptoms and pain among people with kidney disease receiving chronic dialysis treatment may be relieved with wider use of antidepressant and analgesic therapies, a new study suggests.
Steven Weisbord, who led the research at the VA Pittsburgh Healthcare System, called for more investigation after following a group of patients for as many as 24 months between 2009 and 2011. Among 286 patients on dialysis who answered monthly questionnaires, 18 percent reported severe depressive symptoms while 79 percent reported experiencing pain. Worsening health outcomes, patients with depression were far more likely — 21 percent — to miss dialysis treatments, and nearly a quarter more likely to visit the emergency room. Patients with depression were also hospitalized 19 percent more of the time, with a chance of dying 40 percent greater than others.
Severe pain symptoms, too, was associated with missed dialysis appointments in the study, with such patients 16 percent more likely to undergo abbreviated dialysis treatments. They were also 58 percent more likely to visit the emergency room, with a 22 percent higher chance of hospitalization than others.
"Patients receiving chronic hemodialysis experience a very high burden of physical and emotional symptoms,” Weisbord said in a press statement. “While not all symptoms are easily treated, there are effective therapies for depressive symptoms and pain. These findings underscore the need to determine whether the effective treatment of these symptoms, in addition to making patients feel better, can also reduce utilization of healthcare resources and costs and improve patient-centered outcomes.”
Published on Thursday in the Clinical Journal of the American Society of Nephrology, the study suggests investigators should assess the potential of antidepressant and analgesic therapies to not only improve patient survivability and health but to reduce medical costs.
In a word, dialysis is ‘overwhelming’ — that’s my best description of it,” wrote Devon Osborne in Renal Business Today. “Dialysis and depression seem to go together all too well. As dialysis patients, we are but one decision away from death. It’s a reality we deal with everyday whether consciously or not.”
The prevalence of chronic kidney disease for patients such Osborne over the age of 60 has been rising, according to statistics from the National Institutes of Health. Whereas the 1988-1994 National Health and Nutrition Examination Survey found a prevalence of 18.8 percent, the 2003-2006 NHANES study found nearly a quarter of older Americans adults had the disease.
Source: Mor M, Sevick MA, Shields AM, et al. Associations of Depressive Symptoms and Pain with Dialysis Adherence, Health Resource Utilization, and Mortality in Patients Receiving Chronic Hemodialysis. Clinical Journal of the American Society of Nephrology. 2014.