Screening and psychiatric follow-up in pre-dialysis patients

Authors: DG Straatsburg, MD FRANZP; EA Hoekman; R Smulders; JG Lijmer, MD PhD

Organisation: OLVG Hospital, Amsterdam, The Netherlands

Introduction

Patients with end-stage renal failure disease (ESRD) are referred to our dialysis clinic for pre-dialysis work-up. In this retrospective study we examined the prevalence of psychiatric symptoms with the Hospital Anxiety Depression Scale (HADS 14 item questionnaire) and the added value of screening in this population by the number of changes in treatment plan.

Methods

Retrospective cohort study. Since 2011, all patients referred for pre-dialysis work-up were screened with the HADS. Protocol dictated that patients with a HADS score ≥  12 were referred for psychiatric evaluation. From 2011-2013 all patient files and HADS scores were retrieved, the results of the psychiatric evaluations and the number of changes in treatment plan were assessed.

Results:

102 patients, were referred for pre-dialysis work-up. 88 filled in the HADS and the mean score was 13 (SE 0.8). 46 patients scored  ≥ 12. 52 % (CI 36%-56%) and were offered a psychiatric assessment. 15 of the 46 patients had previous psychological problems.

19 patients were assessed. Of the 27 patients that weren’t seen, 5 were referred to another psychiatric practice, 9  preferred only follow-up by the social worker, 3 patients didn’t want to see the psychiatrist and 10 were lost to follow-up. After psychiatric assessment all 19 patients were diagnosed with a psychiatric disorder and a new treatment plan was formulated.

Of the 19 patients seen at our outpatient clinic, only 8 had  ≥ 5 treatment sessions. 5 patients had between 2-4 sessions and 6 discontinued after the intake. Main reasons for cessation were, too many hospital visits and fatigue.
Discussion:

We found a high prevalence of 52% of anxiety and depressive symptoms in patients referred for pre-dialysis work-up. In addition we found that with screening and psychiatric follow-up at least 24 (24%, CI 15%-34%) patients benefited from screening by a new treatment plan for their symptoms.. This research shows that with a standardised screening instrument and psychiatric follow-up this group can be detected. However many patients were not able to follow  treatment. More research is needed for treatments more accessible for pre-dialysis patients.

Research sup This study had no external funding

 

 

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