Psychiatric illnesses are common in children and adults with kidney failure, and hospitalizations for such illnesses are linked to a greater risk of early death in adults, according to a new study published in CJASN, the journal of the American Society of Nephrology.
The researchers suggest that clinicians who care for hospitalized patients with kidney failure should be aware of and prepared to manage psychiatric disorders.
To investigate, Paul Kimmel, M.D. (National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health) and his team examined hospitalizations with psychiatric diagnoses. The researchers analyzed inpatient claims from the first year of kidney failure in U.S. adults and children who initiated dialysis treatment from 1996-2013.
“We wished to extend observations made more than 20 years ago regarding the prevalence of psychiatric disorders to the present, and expand our evaluations to assess the links between psychiatric illness and subsequent morbidity and mortality in patients with kidney failure,” Kimmel said.
Between 1996 and 2013, approximately 27% of adults (ages 22 to 64) and 21% of elderly adults (ages 65 and up) were hospitalized with psychiatric diagnoses in the first year of kidney failure. The prevalence was slightly lower in children, at 16%.
Approximately 2% of adults and 1% of children were hospitalized with a primary psychiatric diagnosis. The most common primary psychiatric diagnoses were depression/affective disorder in adults and children, and organic mental disorders/dementias in elderly adults.
The prevalence of hospitalizations with psychiatric diagnoses increased over time across age groups. The rate of hospitalizations with psychiatric diagnoses increased from 9% in 1996 – 1998 to 26% in 2011-2013 for children, from 19% to 40% for adults, and from 17% to 39% in elderly adults.
The increases in prevalence rates were mostly from secondary diagnoses. A total of 19% of elderly adults, 25% of adults, and 15% of children were hospitalized with a secondary psychiatric diagnosis.
Compared with hospitalizations without psychiatric diagnoses, hospitalizations with primary or secondary psychiatric diagnoses were associated with 29% and 11% greater risk of death, respectively, during the study period for adults.
“Clinicians need to be aware of these findings and be prepared to address the needs of their patients. Hopefully, attention to the psychosocial needs of dialysis patients will result in improved outcomes, but such notions need to be tested in well-designed randomized controlled trials,” said Kimmel.
“This is also an important study because it assessed the prevalence and some implications of psychiatric illness in the pediatric kidney failure population in a large comprehensive registry — something that has not been evaluated before.”
Source: American Society of Nephrology