Caleb Weihao Huang1, Poh Hui Wee2, Lian Leng Low3, Ying Leng Agnes Koong4, Htay Htay5, Qiao Fan6, Wai Yin Marjorie Foo7, Jun Jie Benjamin Seng8. 1. Duke-NUS Medical School, Singapore, 8 College Road, 169857, Singapore. Electronic address: e0218098@u.duke.nus.edu. 2. Duke-NUS Medical School, Singapore, 8 College Road, 169857, Singapore. Electronic address: wee.pohhui@u.duke.nus.edu. 3. Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore, Outram Rd, 169608, Singapore; SingHealth Duke-NUS Family Medicine Academic Clinical Program, Outram Rd, 169608, Singapore; Outram Community Hospital, SingHealth Community Hospitals, 10 Hospital Boulevard, 168582, Singapore; SingHealth Regional Health System PULSES Centre, Singapore Health Services, Singapore, Outram Rd, 169608, Singapore. Electronic address: low.lian.leng@singhealth.com.sg. 4. Duke-NUS Medical School, Singapore, 8 College Road, 169857, Singapore; SingHealth Duke-NUS Family Medicine Academic Clinical Program, Outram Rd, 169608, Singapore; Marine Parade Polyclinics, SingHealth Polyclinics, 80 Marine Parade Central, 440080, Singapore. Electronic address: agnes.koong@singhealth.com.sg. 5. Department of Renal Medicine, Singapore General Hospital, Outram Rd, 169608, Singapore. Electronic address: htay.htay@singhealth.com.sg. 6. Center for Quantitative Medicine, Duke-NUS Medical School, 8 College Road, 169857, Singapore. Electronic address: qiao.fan@duke-nus.edu.sg. 7. Department of Renal Medicine, Singapore General Hospital, Outram Rd, 169608, Singapore. Electronic address: marjorie.foo.w.y@singhealth.com.sg. 8. Duke-NUS Medical School, Singapore, 8 College Road, 169857, Singapore; SingHealth Regional Health System PULSES Centre, Singapore Health Services, Singapore, Outram Rd, 169608, Singapore. Electronic address: benjamin.seng@u.duke.nus.edu.
Abstract
BACKGROUND: Anxiety is associated with poor health outcomes among chronic kidney disease (CKD) patients. This review summarizes the prevalence and risk factors associated with elevated anxiety symptoms and disorders among CKD patients. METHODS: Articles evaluating the prevalence and risk factors associated with elevated anxiety symptoms and disorders among CKD patients, as diagnosed via DSM 4th or 5th edition criteria, clinical interviews or validated questionnaires, were searched in Medline®, Embase®, PsychINFO® and CINAHL®. Using random-effects meta-analyses, the prevalence of elevated anxiety symptoms and disorders were estimated. A narrative review on the risk factors associated with elevated anxiety symptoms and disorders was presented. RESULTS: From 4941 articles, 61 studies were included. The pooled prevalence of anxiety disorders (9 studies, n = 1071) among CKD patients across studies was 19% while that of elevated anxiety symptoms (52 studies, n = 10,739) was 43%. Across continents, prevalence of elevated anxiety symptoms was highest in Europe and Asia. Between pre-dialysis and dialysis patients, the prevalence of elevated anxiety symptoms was not statistically different at 31% and 42% respectively. Common risk factors associated with elevated anxiety symptoms included concomitant depression, lower parathyroid hormone levels, increased comorbidities, increased duration of hospitalization, reduced perceived quality of life, and decreased vitality levels. CONCLUSION: Given the high prevalence of anxiety disorders and elevated anxiety symptoms, more studies are required to assess the role and outcomes of anxiety screening among CKD patients. This could facilitate early identification of at-risk patients and potentially improve their clinical outcomes.
BACKGROUND: Anxiety is associated with poor health outcomes among chronic kidney disease (CKD) patients. This review summarizes the prevalence and risk factors associated with elevated anxiety symptoms and disorders among CKD patients. METHODS: Articles evaluating the prevalence and risk factors associated with elevated anxiety symptoms and disorders among CKD patients, as diagnosed via DSM 4th or 5th edition criteria, clinical interviews or validated questionnaires, were searched in Medline®, Embase®, PsychINFO® and CINAHL®. Using random-effects meta-analyses, the prevalence of elevated anxiety symptoms and disorders were estimated. A narrative review on the risk factors associated with elevated anxiety symptoms and disorders was presented. RESULTS: From 4941 articles, 61 studies were included. The pooled prevalence of anxiety disorders (9 studies, n = 1071) among CKD patients across studies was 19% while that of elevated anxiety symptoms (52 studies, n = 10,739) was 43%. Across continents, prevalence of elevated anxiety symptoms was highest in Europe and Asia. Between pre-dialysis and dialysis patients, the prevalence of elevated anxiety symptoms was not statistically different at 31% and 42% respectively. Common risk factors associated with elevated anxiety symptoms included concomitant depression, lower parathyroid hormone levels, increased comorbidities, increased duration of hospitalization, reduced perceived quality of life, and decreased vitality levels. CONCLUSION: Given the high prevalence of anxiety disorders and elevated anxiety symptoms, more studies are required to assess the role and outcomes of anxiety screening among CKD patients. This could facilitate early identification of at-risk patients and potentially improve their clinical outcomes.
Authors: Kirsten S Dorans; Julie A Wright Nunes; Douglas E Schaubel; Daohang Sha; Sarah J Schrauben; Robert G Nelson; Panduranga S Rao; Debbie L Cohen; Lawrence J Appel; James P Lash; Mahboob Rahman; Harold I Feldman Journal: Kidney360 Date: 2022-05-24
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