Among hospitalized patients with end-stage renal disease (ESRD), patients who have a concomitant psychiatric diagnosis are more likely to die prematurely than those who do not, according to new research published in the Clinical Journal of the American Society of Nephrology.

According to Medicare data, 72% of adults older than 65 years, 66% of younger adults, and 64% of children had at least 1 hospitalization within the first year of progressing to ESRD. Of these, 2% of adults and 1% of children were hospitalized with a primary psychiatric diagnosis, most commonly depression/affective disorder in younger adults and children and organic disorders/dementias in seniors, Paul L. Kimmel, MD, of the National Institute of Diabetes and Digestive and Kidney Diseases in Bethesda, Maryland, and colleagues reported. In addition, 19% of seniors, 25% of younger adults, and 15% of children were hospitalized with a secondary psychiatric diagnosis. The prevalence of psychiatric diagnoses increased from 1996 to 2013 in all groups, likely driven by secondary diagnoses, according to the investigators.

Among adults and seniors receiving dialysis, the risk for all-cause death after discharge were 29% and 11% higher in those hospitalized with a primary or secondary psychiatric diagnosis, respectively, than in those hospitalized without a psychiatric diagnosis.

“This higher mortality in individuals hospitalized with psychiatric diagnoses is consistent with previous literature showing elevated mortality rates among dialysis patients with depression, and expands such associations to a broader set of psychologic conditions…” Dr Kimmel’s team explained. “The findings suggest clinicians who care for hospitalized dialysis patients should be aware of and prepared to manage psychiatric disorders and associated negative outcomes within these populations.”

Only inpatient diagnoses were examined in the study, so the true prevalence of psychiatric conditions in ESRD patients is likely higher, Michael J. Fischer, MD, and James P. Lash, MD, of the University of Illinois Hospital in Chicago, commented in an accompanying editorial.

The study findings “remind the nephrology community of the daunting task that confronts us, namely how to successfully manage psychiatric illness in patients with ESKD,” they wrote. “To achieve meaningful progress for this high-risk population, it will be necessary to improve the understanding of the causes of psychiatric illness, the engagement of health professionals with psychiatric expertise, and the implementation of effective treatment strategies that are acceptable to patients.”

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References

Kimmel PL, Fwu CW, Abbott KC, et al. Psychiatric Illness and Mortality in Hospitalized ESKD Dialysis Patients [published online August 22, 2019]. Clin J Am Soc Nephrol. doi:10.2215/CJN.14191218

Fischer MJ, Lash JP. Burden of Psychiatric Illness in Patients with ESKD [published online August 22, 2019]. Clin J Am Soc Nephrol. doi:10.2215/CJN.08190719