Multiple measurements of depression predict mortality in a longitudinal study of chronic hemodialysis outpatients

https://repositorio.ufba.br/ri/bitstream/ri/5034/1/4493090a.pdf

Depression as a predictor of mortality and hospitalization among hemodialysis patients in the United States and Europe

Psychosocial factors in dialysis patients

Psychosocial issues are an understudied yet important concern in the overall health of hemodialysis (HD) patients. Stress is a concomitant of chronic illness and its treatment, and may have meaningful influences on psychological and medical outcomes. This article reviews the influences of psychopathology, social support, family issues, dialysis unit culture, and socioeconomic status on patients treated with center HD. Depressive affect and decreased perception of social support have been linked with mortality in several studies of ESRD patients. Decreased marital satisfaction, disturbances in family dynamics, and lower socioeconomic status (SES) have been associated with poorer health outcomes and can affect patients' perception of social support and depressive affect. Chronically ill ESRD patients who undergo treatment with constant interaction and observation by medical staff are potentially an ideal group for evaluation of the effects of stress and psychosocial factors on outcomes in those with chronic disease, as well as an excellent patient population for intervention to reduce morbidity and mortality. These interactions between potentially modifiable psychosocial risk factors for disease and medical aspects of illness form a paradigm for the study of interventions related to adjustment to chronic illness in the ESRD population.

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Psychosocial Aspects of Chronic Disease: ESRD as a Paradigmatic Illness

Depression in patients with chronic renal disease: what we know and what we need to know.

The authors examine the relationship between psychosocial factors and factors and survival of patients with chronic renal failure, while considering simultaneously the influence of parameters of physiologic functioning. Psychosocial and physiologic variables selected for discriminant analysis were extracted from data on 285 home-dialysis patients in Ontario, Canada. This analytical procedure defined which variables best discriminated between the survivor and nonsurvivor groups. The findings suggest that demographic and psychosocial factors may be more important than physiologic variables in determination of survival on home dialysis. The severity and type of depression is of particular importance to outcome.

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The relationship of depression to survival in chronic renal failure.

The role of support in influencing outcome of end-stage renal disease

Social support as a mediator of psychological dysfunctioning and a determinant of renal failure outcomes.

For the past 25 years, dialysis has been advocated as an artificial replacement therapy for the functional loss of kidneys. Thousands of patients with chronic renal failure have been kept alive who otherwise would-have died. At present, in excess of 80 000 persons in the United States are on dialysis, a dramatic increase from the 2398 of 15 years ago [1]. This increase, in large measure, is due to the technological and treatment advances in renal replacement therapy. However, technologies such as automated dialysis systems [2, 3], bacteriologically safe catheters [4], and modified peritoneal dialysis procedures such as CAPD [5] or its automated nocturnal form, ‘prolonged dwell’ peritoneal dialysis [6], do more than sustain life. They enhance patients’ physical status and tolerance for home treatment [7] and free them from the constraints of extracorporeal hemodialysis [8], thus contributing to overall improvement in patients’ cognitive acuity and psychosocial functioning [9–12].

Quality of Life in Peritoneal Dialysis Patients: Instruments and Application

In recent years the increasing use of peritoneal dialysis, particularly continuous ambulatory peritoneal dialysis (CAPD), has been an important factor in the management of patients with end-stage renal disease (ESRD) outside the hospital environment. While the efficiency of this innovative peritoneal technique is well documented with numerous publications describing physiological and procedural advantages, little attention has been given to the influence of psychological and social factors upon the rehabilitation and quality of life that the CAPD patient experiences.

Stephen A. Kline

Papers

The relationship of depression to survival in chronic renal failure.

The role of support in influencing outcome of end-stage renal disease

Social support as a mediator of psychological dysfunctioning and a determinant of renal failure outcomes.

Quality of Life in Peritoneal Dialysis Patients: Instruments and Application

Quality of life and psychosocial aspects of chronic peritoneal dialysis