Anxiety and depression linked to physical impairments in dialysis patients

With the rate of chronic kidney disease on the rise among older Americans, researchers seeking to improve patients’ quality of life studied a group of adults undergoing hemodialysis and found their higher rates of depression andanxiety could be associated with their impaired physical exercise capability and reduced daily physical activity, according a new study published online by the Journal of Renal Nutrition.

The researchers studied 72 relatively healthy maintenance hemodialysis patients and compared them to 39 healthy adults who were not on dialysis. They found significantly higher rates of anxiety and depression among the dialysis patients, than among the adults who were not on dialysis. They also found the dialysis patients suffering from depression and anxiety had the greatest impairments in physical exercise performance and daily physical activity.

“Adults undergoing dialysis often have less daily physical activities than other adults, but little was known about what, if any, effect this reduced activity had on their mental state,” said Joel D. Kopple, MD, Los Angeles Biomedical Research Institute (LA BioMed) lead researcher. “Our study found an association between reduced daily physical activities and depression and anxiety. Also, the capacity to perform physical exercise was diminished in these patients. These findings provide a strong rationale for studying whether increased daily physical activity can reduce depression and anxiety among adults undergoing dialysis.”

Each person enrolled in the study took walks, climbed stairs and engaged in other physical activities so that researchers could determine their physical abilities. The researchers gauged their depression and anxiety using standardized tests and found 43% of the dialysis patients had anxiety and 33% suffered from depression. In comparison, only 2.5% of the adults who were not on dialysis had anxiety and only 5% of them suffered from depression.

Approximately one in 10 Americans has some form of chronic kidney disease, and the incidence of chronic kidney disease among people ages 65 and older more than doubled between 2000 and 2008, according to the Centers for Disease Control and Prevention.

Hemodialysis is a life-preserving treatment for hundreds of thousands of Americans with kidney failure. It is a medical procedure to remove fluid and waste products from the blood and to correct electrolyte imbalances. This is accomplished using a machine and a dialyzer, which is sometimes described as an “artificial kidney.”

“Research is important to improve the quality of life of patients undergoing dialysis,” said Dr. Kopple. “With the growing population of people undergoing dialysis, this research is growing in importance.”

http://www.medicalnewstoday.com/releases/277460.php

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More physician visits could help prevent re-hospitalization of dialysis patients

 

More frequent face-to-face physician visits in the month following hospital discharge may help reduce a kidney failure patient’s chances of needing to be sent back to the hospital, according to a study appearing in an upcoming issue of theJournal of the American Society of Nephrology (JASN). The study also found that closer outpatient monitoring of kidney failure patients following hospital discharge could cut health care costs significantly.

Kevin Erickson, MD, from Stanford University, and his colleagues looked to see if more outpatient physician visits to patients might cut down on readmissions among kidney failure patients.

Highlights of the study

• In 26,613 patients who were on dialysis between 2004 and 2009, one additional provider visit in the month following hospital discharge was estimated to reduce the probability of 30-day hospital readmission by 3.5%.
• The reduction in 30-day hospital readmission ranged from 0.5% to 4.9% in an additional four groups of patients tested, depending on population density around facilities, facility profit status, and patient Medicaid eligibility.
• At current Medicare reimbursement rates, the effort to see patients one additional time in the month following hospital discharge could lead to 31,370 fewer hospitalizations per year, and $240 million per year saved.

“This research is important by highlighting the role that outpatient nephrology providers have in preventing hospital readmissions for patients receiving hemodialysis,” said. Erickson.

 

In an accompanying editorial, Raymond Hakim, MD, from Vanderbilt University, and Allan Collins, MD, FACP, from the University of Minnesota, Minneapolis, noted that the study’s findings should be considered in any plan to reduce rehospitalizations in the dialysis population. They also noted several other interventions and services by the health care team that can lead to reduced rehospitalization. “Reducing the high rates of rehospitalization in [kidney failure] patients is clearly in the best interests of patients and in the financial interests of dialysis facilities providing maintenance dialysis services, as well as the hospitals to which patients are occasionally admitted to receive acute services,” they wrote.

Study co-authors include Jay Bhattacharya, MD, PhD, Wolfgang Winkelmayer, MD, ScD, and Glenn Chertow, MD, MPH.

The article, entitled “Physician Visits and 30-Day Hospital Readmissions in Patients Receiving Hemodialysis,” appears online at http://jasn.asnjournals.org/

http://www.nephrologynews.com/articles/110222-more-physician-visits-could-help-prevent-re-hospitalization-of-dialysis-patients

 

Picture courtesy to http://jasn.asnjournals.org/