Psychosocial distress in chronic kidney disease: Benefits of kidney transplantation

Candice Richardson1, Dmitri Belenko1, Eszter C. Mucsi, 1 Nathaniel Edwards1, Dorothy Wong1, Marta Novak2, Madeline Li3, Istvan Mucsi1

1Multiorgan Transplant Program, University Health Network, Toronto, Ontario, Canada

2 Centre for Mental Health, University Health Network and Department of Psychiatry, University of Toronto, Toronto, Canada

3Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, Toronto, Ontario, Canada.

Purpose

We describe the frequency of psychosocial distress among Canadian patients with advanced chronic kidney disease (CKD), and compare distress between pre-dialysis, dialysis patients and kidney transplant recipients (KTRs).

Methods

We recruited a cross-sectional convenience sample of pre-dialysis and dialysis patients from two hospital-based clinics and dialysis units; as well as stable KTRs followed at our transplant center. We used the Distress Assessment and Response Tool (DART) to assess psychosocial distress, and collected demographic information using a tablet-based electronic data capture system. The DART includes the PHQ-9 for depression, GAD-7 for anxiety and the Social Difficulties Inventory. The presence of anxiety, depression, and social difficulties was defined as a score of ≥10 on the GAD-7, PHQ-9, and SDI, respectively; any distress as a score of ≥10 on at least one of the above scales.

Results

Out of 175 patients (82 KT recipients, 26 pre-dialysis 67 dialysis); mean(±SD) age 56(±15) years, 55% male, 37% (37/82) of KT recipients and 31%(8/26) of pre-dialysis patients reported any distress, compared to 60%(40/67) of dialysis patients (p=0.006). Compared to hemodialysis patients, KT recipients had lower rates of social difficulties (34%vs.51%, p=0.049) and any distress (37%vs.58%, p=0.013); the difference between rates of depression (26%vs.18%) was not statistically significant (p=0.298). Psychosocial distress was associated with non-Caucasian ethnicity (57%vs.35%, p=0.004) with highest rates among African- (73%) and Asian-Canadians (51%). In a multivariable adjusted (age, gender, ethnicity, education, comorbidity) logistic regression model KT remained significantly associated with less psychosocial distress compared to dialysis (OR=0.42, 95%CI=0.18–0.97; P=0.043).

Conclusion:

These preliminary results suggest that psychosocial distress is very frequent among those with CKD. KT is associated with lower odds of psychosocial distress  compared to patients on dialysis. A systematic approach to distress screening and management may improve psychosocial and medical outcomes for these patients.