Depression and Anxiety in Dialysis Patients

Introduction Patients with chronic kidney disease are dependent on dialysis therapy; a chronic, intensive and time-consuming treatment with high physical and mental burden. Symptoms of depression and anxiety are common in dialysis patients and develop in a complex interaction between biological, psychological and social factors. These symptoms are associated with adverse outcomes such as decreased quality of life and increased risk of hospital admission and mortality. Despite the high burden and negative consequences, symptoms of depression and anxiety are often not identified or treated in dialysis patients. Screening We have assessed the concept of ‘general distress’ in dialysis patients by combining scores of depression and anxiety. Our findings show that the concept of general distress in dialysis patients is not suitable for screening. It is recommended to investigate depression and anxiety separately in dialysis patients. Screening tools for depression have been studied in dialysis patients, however, the few studies on screening tools for anxiety are indecisive. We assessed the accuracy of two widely used screening instruments for anxiety in dialysis patients by a diagnosis of anxiety disorder based on a psychiatric interview. Both instruments show good distinction between anxious and non-anxious patients and could be used in clinical or research practice for the detection of symptoms of anxiety in dialysis patients. Symptom dimensions We have examined symptom dimensions of anxiety and identified a ‘somatic’ and ‘subjective’ symptom dimension. Interestingly, only the somatic symptom dimension is related to hospital admissions and mortality while the subjective dimension is not. Both symptom dimensions are related to decreased quality of life. Furthermore, we assessed the relation between dialysis modality and symptom dimensions of depression and anxiety. Depression and anxiety and in particular their somatic symptoms dimensions are highly common in both peritoneal and hemodialysis patients. No differences are seen between these groups. Impact of COVID-19 In the general population, symptoms of depression, anxiety and stress are common reactions to the COVID-19 pandemic due. We examined symptoms of stress, depression, anxiety and quality of life before and during the COVID-19 pandemic in dialysis patients in the Netherlands. These symptoms do not increase during the pandemic. However, one third of dialysis patients report to experience COVID-19 related stress and have higher stress and depression levels and lower quality of life. Yet, de pandemic did not seem to have further increased their symptom severity compared to pre-pandemic levels. Treatment We have systematically searched and summarized all studies on treatment for depression and anxiety in dialysis patients. While there were few studies investigating this topic with methodological issues, we found promising evidence for psychotherapy as a treatment of depressive symptoms in dialysis patients. We have performed a large study in 18 dialysis centers in the Netherlands investigating the effect of an online self-help psychotherapy treatment on tablet-computers during hemodialysis sessions on symptoms of depression, supported online by a therapist. Depression scores improved in both the treatment and control group by 21%, but no indication was found for an additional positive effect of online self-help psychotherapy in dialysis patients compared to usual care. It could be possible that this intervention is more suitable for younger dialysis patients with adequate computer skills. Conclusion Despite the additional evidence on depression and anxiety in dialysis patients presented in this thesis, there are still gaps in the current literature that prevent successful implementation of screening for depression and anxiety in dialysis patients in the near future. Future research should try to fill in these gaps and examine how to best design the content and accessibility of an intervention for symptoms of depression and anxiety in hemodialysis patients.