Pain and Depression Reduced Dialysis Success

Chronic dialysis patients with depression and pain risked worse treatment outcomes

(RxWiki News) Previous studies have shown that kidney failure patients on dialysis experience both emotional and physical symptoms. New research suggests that emotional symptoms may interfere with treatment and make physical symptoms worse.

A recent study found that chronic hemodialysis patients who experienced emotional symptoms and pain were more likely to miss treatments or cut them short, have emergency room visits and be hospitalized compared to those with no depressive symptoms or pain.

The researchers said methods to help treat these emotional and painful symptoms could help reduce the cost of treatment, as well as improve treatment outcomes.

"Tell your nephrologist if you are feeling depressed or having pain during dialysis."

This study was conducted by Steven D. Weisbord, MD, MSc, of the VA Pittsburgh Healthcare System, and colleagues

Hemodialysis is the most common treatment for advanced kidney failure. It uses a machine to filter waste, salts and fluid from the body.

The study included 286 people who received regular hemodialysis at 1 of 9 dialysis units in Western Pennsylvania. The patients were enrolled in the Symptom Management Involving End-Stage Renal Disease trial from 2009 to 2011. Their average age was 64.

Of the patients, 40 percent were black, 56 percent were male and 52 percent had diabetes.

The patients were given surveys each month that assessed their emotional symptoms and pain level. Each patient completed at least one of these surveys during the study period.

The study authors scored emotional symptoms from 0 to 27. A score of 10 or more indicated moderate to severe depression.

A survey that included 15 different symptoms assessed pain. The patients ranked each symptom on a scale of 0 to 3, with a 3 meaning severe pain.

The study authors gathered 4,452 emotional and 4,459 pain assessments. The results revealed that 788 (18 percent) of the depression surveys indicated moderate to severe depression. In addition, 3,537 (or 79 percent) of the pain surveys indicated chronic pain.

The researchers found that having depression increased the chance of missing a treatment by 21 percent and cutting a session short by 8 percent.

The patients who reported depression were 24 percent more likely to have emergency room visits and 19 percent more likely to be hospitalized than the participants who did not report these symptoms.

Patients with depressive symptoms had a 40 percent increased risk of death.

Dr. Weisbord and team discovered a 3 percent higher chance of cutting dialysis sessions short in patients who reported pain. These patients also had a 5 percent increased risk of being hospitalized.

The patients who consistently reported severe pain were 16 percent more likely to cut treatments short than participants who did not have severe pain. Severe pain also carried a 58 percent increased risk of going to the emergency room and 22 percent increased risk of being hospitalized.

However, pain of any degree did not indicate an increased risk of death.

"Patients receiving chronic hemodialysis experience a very high burden of physical and emotional symptoms," Dr. Weisbord said. "While not all symptoms are easily treated, there are effective therapies for depressive symptoms and pain. These findings underscore the need to determine whether the effective treatment of these symptoms, in addition to making patients feel better, can also reduce utilization of healthcare resources and costs and improve patient-centered outcomes."

The patients were part of a study centered on symptom management with dialysis, so symptoms may have been overrepresented, the study authors noted. The patients were all from one area of the country, so these findings may not apply to everyone. Also, some of the data was based on self-report.

Lastly, the associations between depressive symptoms and pain and treatment outcomes were simplified and presented as if the same associations were true in each assessment.

This study was published July 31 in the Clinical Journal of the American Society of Nephrology.

The US Department of Veteran Affairs Health Services provided funding.

Review Date: 
July 31, 2014