Anxiety symptoms, mortality, and hospitalization in patients receiving maintenance dialysis: a cohort study

Robbert W. Schouten, Gertrud L. Haverkamp, Wim L. Loosman, Prataap K. Chandie Shaw, Frans J. van Ittersum, Yves F. C. Smets, Louis-Jean Vleming, Friedo W. Dekker, Adriaan Honig, Carl E. H. Siegert

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Rationale & Objective: Anxiety symptoms are common in dialysis patients and have a large impact on quality of life. The association of anxiety symptoms with adverse clinical outcomes in dialysis patients is largely unknown. This study examined the association of anxiety symptoms with hospitalization and mortality in patients receiving maintenance dialysis. Study Design: Prospective cohort study. Setting & Participants: Maintenance dialysis patients treated at 10 dialysis centers in the Netherlands between 2012 and 2016. Exposures: Time-varying symptoms of anxiety and depression using the Beck Anxiety Inventory and Beck Depression Inventory. Outcomes: All-cause mortality, 1-year hospitalization rate, and hospital length of stay. Analytical Approach: Cox proportional hazards and Poisson regression models adjusted for sociodemographic and clinical variables. Sensitivity analyses included multiple imputation of missing data and restriction to incident patients only. Results: 687 patients were included, composed of 433 prevalent and 242 incident dialysis patients. Median follow-up time was 3.1 (IQR, 3.0-3.5) years, during which 172 deaths occurred. 22% of patients had anxiety symptoms and 42% had depressive symptoms. Anxiety symptoms were associated with all-cause mortality and 1-year hospitalization rate and length of stay in all multivariable models. Anxiety symptoms showed a clear dose-response relationship with mortality. Limitations: Depression and anxiety often coexist and share symptoms. The observational design of this study limits inferences about causal mechanisms between anxiety and clinical outcomes. Conclusions: Anxiety symptoms are independently associated with increased risk for mortality and 1-year hospitalization. Anxiety symptoms are a clinically relevant risk factor for morbidity and mortality in dialysis patients and warrant further research on effective treatment.
Original languageEnglish
Pages (from-to)158-166
Number of pages9
JournalAmerican Journal of Kidney Diseases
Volume74
Issue number2
DOIs
Publication statusPublished - 1 Aug 2019

Cite this

Schouten, Robbert W. ; Haverkamp, Gertrud L. ; Loosman, Wim L. ; Chandie Shaw, Prataap K. ; van Ittersum, Frans J. ; Smets, Yves F. C. ; Vleming, Louis-Jean ; Dekker, Friedo W. ; Honig, Adriaan ; Siegert, Carl E. H. / Anxiety symptoms, mortality, and hospitalization in patients receiving maintenance dialysis: a cohort study. In: American Journal of Kidney Diseases. 2019 ; Vol. 74, No. 2. pp. 158-166.
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abstract = "Rationale & Objective: Anxiety symptoms are common in dialysis patients and have a large impact on quality of life. The association of anxiety symptoms with adverse clinical outcomes in dialysis patients is largely unknown. This study examined the association of anxiety symptoms with hospitalization and mortality in patients receiving maintenance dialysis. Study Design: Prospective cohort study. Setting & Participants: Maintenance dialysis patients treated at 10 dialysis centers in the Netherlands between 2012 and 2016. Exposures: Time-varying symptoms of anxiety and depression using the Beck Anxiety Inventory and Beck Depression Inventory. Outcomes: All-cause mortality, 1-year hospitalization rate, and hospital length of stay. Analytical Approach: Cox proportional hazards and Poisson regression models adjusted for sociodemographic and clinical variables. Sensitivity analyses included multiple imputation of missing data and restriction to incident patients only. Results: 687 patients were included, composed of 433 prevalent and 242 incident dialysis patients. Median follow-up time was 3.1 (IQR, 3.0-3.5) years, during which 172 deaths occurred. 22{\%} of patients had anxiety symptoms and 42{\%} had depressive symptoms. Anxiety symptoms were associated with all-cause mortality and 1-year hospitalization rate and length of stay in all multivariable models. Anxiety symptoms showed a clear dose-response relationship with mortality. Limitations: Depression and anxiety often coexist and share symptoms. The observational design of this study limits inferences about causal mechanisms between anxiety and clinical outcomes. Conclusions: Anxiety symptoms are independently associated with increased risk for mortality and 1-year hospitalization. Anxiety symptoms are a clinically relevant risk factor for morbidity and mortality in dialysis patients and warrant further research on effective treatment.",
keywords = "Anxiety, depression, dialysis, end-stage renal disease (ESRD), hospitalization, mental health, mood disorder, mortality, quality of life",
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Anxiety symptoms, mortality, and hospitalization in patients receiving maintenance dialysis: a cohort study. / Schouten, Robbert W.; Haverkamp, Gertrud L.; Loosman, Wim L.; Chandie Shaw, Prataap K.; van Ittersum, Frans J.; Smets, Yves F. C.; Vleming, Louis-Jean; Dekker, Friedo W.; Honig, Adriaan; Siegert, Carl E. H.

In: American Journal of Kidney Diseases, Vol. 74, No. 2, 01.08.2019, p. 158-166.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Anxiety symptoms, mortality, and hospitalization in patients receiving maintenance dialysis: a cohort study

AU - Schouten, Robbert W.

AU - Haverkamp, Gertrud L.

AU - Loosman, Wim L.

AU - Chandie Shaw, Prataap K.

AU - van Ittersum, Frans J.

AU - Smets, Yves F. C.

AU - Vleming, Louis-Jean

AU - Dekker, Friedo W.

AU - Honig, Adriaan

AU - Siegert, Carl E. H.

PY - 2019/8/1

Y1 - 2019/8/1

N2 - Rationale & Objective: Anxiety symptoms are common in dialysis patients and have a large impact on quality of life. The association of anxiety symptoms with adverse clinical outcomes in dialysis patients is largely unknown. This study examined the association of anxiety symptoms with hospitalization and mortality in patients receiving maintenance dialysis. Study Design: Prospective cohort study. Setting & Participants: Maintenance dialysis patients treated at 10 dialysis centers in the Netherlands between 2012 and 2016. Exposures: Time-varying symptoms of anxiety and depression using the Beck Anxiety Inventory and Beck Depression Inventory. Outcomes: All-cause mortality, 1-year hospitalization rate, and hospital length of stay. Analytical Approach: Cox proportional hazards and Poisson regression models adjusted for sociodemographic and clinical variables. Sensitivity analyses included multiple imputation of missing data and restriction to incident patients only. Results: 687 patients were included, composed of 433 prevalent and 242 incident dialysis patients. Median follow-up time was 3.1 (IQR, 3.0-3.5) years, during which 172 deaths occurred. 22% of patients had anxiety symptoms and 42% had depressive symptoms. Anxiety symptoms were associated with all-cause mortality and 1-year hospitalization rate and length of stay in all multivariable models. Anxiety symptoms showed a clear dose-response relationship with mortality. Limitations: Depression and anxiety often coexist and share symptoms. The observational design of this study limits inferences about causal mechanisms between anxiety and clinical outcomes. Conclusions: Anxiety symptoms are independently associated with increased risk for mortality and 1-year hospitalization. Anxiety symptoms are a clinically relevant risk factor for morbidity and mortality in dialysis patients and warrant further research on effective treatment.

AB - Rationale & Objective: Anxiety symptoms are common in dialysis patients and have a large impact on quality of life. The association of anxiety symptoms with adverse clinical outcomes in dialysis patients is largely unknown. This study examined the association of anxiety symptoms with hospitalization and mortality in patients receiving maintenance dialysis. Study Design: Prospective cohort study. Setting & Participants: Maintenance dialysis patients treated at 10 dialysis centers in the Netherlands between 2012 and 2016. Exposures: Time-varying symptoms of anxiety and depression using the Beck Anxiety Inventory and Beck Depression Inventory. Outcomes: All-cause mortality, 1-year hospitalization rate, and hospital length of stay. Analytical Approach: Cox proportional hazards and Poisson regression models adjusted for sociodemographic and clinical variables. Sensitivity analyses included multiple imputation of missing data and restriction to incident patients only. Results: 687 patients were included, composed of 433 prevalent and 242 incident dialysis patients. Median follow-up time was 3.1 (IQR, 3.0-3.5) years, during which 172 deaths occurred. 22% of patients had anxiety symptoms and 42% had depressive symptoms. Anxiety symptoms were associated with all-cause mortality and 1-year hospitalization rate and length of stay in all multivariable models. Anxiety symptoms showed a clear dose-response relationship with mortality. Limitations: Depression and anxiety often coexist and share symptoms. The observational design of this study limits inferences about causal mechanisms between anxiety and clinical outcomes. Conclusions: Anxiety symptoms are independently associated with increased risk for mortality and 1-year hospitalization. Anxiety symptoms are a clinically relevant risk factor for morbidity and mortality in dialysis patients and warrant further research on effective treatment.

KW - Anxiety

KW - depression

KW - dialysis

KW - end-stage renal disease (ESRD)

KW - hospitalization

KW - mental health

KW - mood disorder

KW - mortality

KW - quality of life

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UR - https://www.ncbi.nlm.nih.gov/pubmed/31027882

U2 - 10.1053/j.ajkd.2019.02.017

DO - 10.1053/j.ajkd.2019.02.017

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EP - 166

JO - American Journal of Kidney Diseases

JF - American Journal of Kidney Diseases

SN - 0272-6386

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