Tuesday, 13 July 2010 09:54
A new Australian research report* has identified and validated a scoring system that uncovers depression in dialysis patients.
In Australia, in 2008, 15% of all patients on dialysis died from various causes. Of those who died 37% were coded as dying of social causes and almost half of these decided to withdraw from dialysis due to psycho-social reasons.
Anne Wilson, CEO and Managing Director of Kidney Health Australia said, "it is quite clear the mental health system in Australia needs to include a special approach to address the needs of the 10,000 patients who are currently on regular dialysis. Many patients have no or restricted access to psychiatric or psychological support services.
"Patients with failed kidneys on haemodialysis are tied to a machine three times a week up to five hours at a time placing considerable pressure on the patients and their families through dramatic changes in their lifestyle, work capacity and medical condition."
Dr Tim Mathew, Medical Director of Kidney Health Australia said, "the presence of "loss" and depression has often gone unrecognised by health professionals involved the care of dialysis patients. This lack of recognition has in part been due to the complexity of the problems and difficulty in assessing the severity of the reactions.
"Importantly this new research establishes that a simple scoring system (based on questionnaires) designed to assess the consequences of the loss is clinically valid and applicable to people on dialysis and also to those expecting to start dialysis in the near future.
"Loss manifesting as grief and often leading to depression is usually studied in relation to death.
"However, many of the same features are seen in patients facing severe loss of kidney function that has caused or is soon to cause dependency on dialysis treatment to sustain life."
Dr Mathew said, "the use of this assessment tool should lead to an improved clinical focus on the major issue of depression and grief in people with end stage kidney failure. Hopefully this will lead to earlier recognition of significant depression and ultimately to an improved survival on dialysis programs."
The Size of the Problem
With only 6.5% of the 10,000 people on dialysis lucky enough to receive a kidney transplant each year, most will never have that opportunity. In fact, the number of people on dialysis is projected to double to 20,000 by the year 2020. Every day 50 people die with kidney failure.
Patient Survey on Feelings of Patients by the National Consumer Council of Kidney Health Australia*
Living with advanced kidney disease has a serious negative impact on people's quality of life. We want you to understand the world of kidney patients with advanced disease, particularly those on dialysis, and their families. Kidney patients often feel:
·Fatigue which is overwhelming and limits their ability to work, participate in family and social activities, exercise and enjoy hobbies.
·Unwell and complain of poor concentration, memory lapses, physical pain, nausea and vomiting.
·Surprised and confused about the complexity and cause of the disease.
·Scared about the treatment and their future.
·Uncertain about how quickly their health will deteriorate.
·Anxious about the impact on their work, financial implications and social life. Many need to reduce work hours, change to lower level jobs, or give up work and interests totally in order to cope.
· Guilty about the financial and emotional pressures on their family and loved ones.
·Isolated and alone when dialysing.
· Powerless about their lack of control of the path ahead especially with the treatment choices they face.
·Worried about the lack of support for their loved ones and carers.
· Trapped by the lack of dialysis places locally and interstate limiting contact with friends and family.
*Measuring Kidney Disease-Related Loss in Samples of Predialysis and Dialysis Patients: Validating the Kidney Disease Loss Scale 2010 Ramony Chan,*Josephine Chow, Robert Brooks, Martin Gallagher, and Michael Suranyi*Consultation Liaison Psychiatry, Renal Unit, and Jonathan Erlich, Paul Snelling.
Centre for Population Mental Health Research, Liverpool Hospital, and Department of Nephrology, Prince of Wales Hospital, Sydney, New South Wales, Australia; Department of Renal Medicine, Concord Repatriation and General Hospital, Sydney, New South Wales, Australia; Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; School of Psychiatry and **Faculty of Medicine, University of New South Wales, Sydney, Australia; Faculty of Nursing, University of Sydney, Sydney, Australia; and §University of Tasmania, Tasmania, Australia