(HealthDay News) — Anxiety disorders are an important clinical problem in patients with end-stage renal disease (ESRD) treated with hemodialysis (HD), according to a review published online in the Clinical Journal of the American Society of Nephrology.

Scott D. Cohen, MD, MPH, from the George Washington University Medical Center in Washington, DC, and colleagues discuss anxiety in patients with ESRD treated with HD. To highlight the role of anxiety, they presented 3 clinical vignettes, which were composites of individual patients.

The authors note that anxiety disorders are under-recognized but pose an important clinical problem in ESRD patients. Links have been suggested for anxiety disorders with depression, lower perceived quality of life, and poorer behavioral adherence. Many seemingly irrational behaviors of patients may be an expression of underlying anxiety. ESRD HD patients should be evaluated for the presence of anxiety disorders as part of their psychosocial assessment; the assessment should go beyond asking patients about their moods or anxiety states. Screening strategies have not been developed, but are needed. In addition, there is a lack of evidence for the appropriate therapeutic approach; referral to mental health professionals is recommended, as well as treatment with psychotherapy and pharmacotherapy.

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“Randomized controlled trials to evaluate the impact and consequences of screening and treating anxiety disorders in the ESRD patient population are urgently needed,” the authors write.

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1. Cohen SD, Cukor D, and Kimmel PL. Anxiety in Patients Treated with Hemodialysis. Clin J Am Soc Nephrol. doi: 10.2215/​CJN.02590316.