Journal Article Annotations
2021, 1st Quarter

Pyschonephrology

Annotations by Sahil Munjal, MD
March, 2021

Analysis of the prevalence and influencing factors of depression and anxiety among maintenance dialysis patients during the COVID‑19 pandemic.
Chronic kidney disease in lithium-treated patients, incidence and rate of decline.

PUBLICATION #1 — Pyschonephrology

Analysis of the prevalence and influencing factors of depression and anxiety among maintenance dialysis patients during the COVID‑19 pandemic.

Wen Hao, Qianrong Tang, Xiaoqin Huang, Lina Ao, Jing Wang, Deqiong Xi

Abstract: Int Urol Nephrol. 2021 Mar 6;1-9. doi: 10.1007/s11255-021-02791-0. Online ahead of print.

Objective
Currently, the COVID-19 outbreak and its spread around the globe is significantly affecting mental health and health in general, worldwide. During the COVID-19 pandemic, the general medical complications have received the most attention, whereas only a few studies address the potential direct impact of SARS-CoV-2 on mental health.

Methods:
A total of 321 maintenance hemodialysis (MHD) patients were selected using random sampling from the hemodialysis center of the second people’s Hospital of Yibin. They completed Zung’s self-rating anxiety scale (SAS) for anxiety, Zung’s self-rating depression scale (SDS) for depression, and the activity of daily living scale (ADL) for the ability of living. Demographic data and laboratory tests were used to analyze the risk factors.

Results:
The proportions of the prevalence of anxiety and depression symptoms were between 34.89% and 30.02%, respectively, among the MHD patients. The SAS and SDS scores of the 321 patients were 45.42(± 10.99) and 45.23(± 11.59), respectively. The results show that monthly income, medical insurance, vascular access, the duration of dialysis, complication, hemoglobin (HGB), immunoreactive parathyroid hormone (iPTH) and blood phosphorus (P) are factors that influence anxiety among patients (p < 0.05 for all). Vascular access, monthly income, medical insurance, complication, CRP, Alb, are factors that influence depression among patients (p < 0.05 for all).

Conclusion:
Our results suggest that during the pandemic period, the prevalence of anxiety and depression symptoms among MHD patients increased. Some demographic and clinical variables were associated with it. We should, therefore, pay more attention to the patients’ psychology, start targeted intervention to alleviate the patients’ anxiety and further improve their quality of life.

Annotation

The finding:
This cross-sectional study using self-rating scales between March 20-29th, 2020, found a high prevalence of anxiety and depression symptoms among maintenance haemodialysis (MHD) patients (35% and 30%, respectively). The authors reported several risk factors for high anxiety and depression including higher comorbidities, low haemoglobin, low income, high C-reactive protein, arteriovenous fistula versus catheters, and self-pay versus insurance coverage. Additionally, high phosphorous and secondary hyperparathyroidism were associated with anxiety and low albumin with depression. There were no differences based on sex.

Strength and weaknesses:
The survey was filled out on an online app to minimize contact. No longitudinal data was reported. Study was conducted only in one haemodialysis centre in China with stricter quarantine guidelines so findings may not be generalizable. It should be noted that the investigators excluded patients with a history of mental and neurological diseases, drug use, cognitive impairment, and serious medical issues, so the findings may underestimate the prevalence of anxiety and depressive symptoms among other populations.

Relevance:
MHD patients are particularly susceptible to COVID-19 given high co-morbidity, frequent visits to health care settings, and lower immunity. High rates of anxiety and depressive symptoms in these patients highlight the importance of implementation of effective screening and psychological interventions.

Type of study (EBM guide):
Other

PUBLICATION #2 — Pyschonephrology

Chronic kidney disease in lithium-treated patients, incidence and rate of decline.

Arjan M Van Alphen, Tessa M Bosch, Ralph W Kupka, Rocco Hoekstra

Abstract: Int J Bipolar Disord. 2021 Jan 4;9(1):1. doi: 10.1186/s40345-020-00204-2.

Background:
Lithium-induced nephropathy is a known long-term complication, sometimes limiting the use of lithium as mood stabilizer. The aim of this study is to establish the incidence of chronic kidney disease and the rate of decline of renal function in patients using lithium and to identify risk factors.

Methods:
We selected 1012 patients treated with lithium from the laboratory database of the Antes Centre for Mental Health Care spanning a period from 2000 to 2015. Serum lithium and creatinine concentrations were retrieved and eGFR was calculated using the 4-variable CKD-EPI formula. We calculated the incidence of renal insufficiency and the rate of decline. We compared patients with and without chronic kidney disease (CKD) stage 3 regarding duration of lithium exposure.

Results:
Incidence of chronic kidney disease was 0.012 cases per exposed patient-year. Average decline of eGFR was 1.8 ml/min/year in patients who developed chronic kidney disease stage 3. Incidence of chronic kidney disease stage 4 was only 0.0004 per patient year. No cases of end stage renal disease were found in this cohort. Odds of reaching chronic kidney disease stage 3 were increased with longer duration of lithium exposure.

Conclusions:
The use of lithium seems to be related to a higher incidence of chronic kidney disease. Longer duration of lithium exposure significantly increased the risk of renal failure.

Annotation

The finding:
In this retrospective cohort study, the incidence of chronic kidney disease (CKD) (eGFR<60 ml/min) in patients treated with lithium was 0.012 per patient-year. A total of 12% of patients reached CKD stage 3; CKD 4 was rare, and none developed ESRD. Mean lithium levels were the same in all groups with or without CKD. Risk factors included duration of lithium exposure and age at onset of lithium therapy. Decline in renal function was most pronounced in the initial years after the start of lithium therapy.

Strength and weaknesses:
The database included a large sample size of Dutch patients with long follow up. Renal progression of some patients may have been missed if they became unavailable to the database by moving outside the region.

Relevance:
The study adds to the association between lithium use and decrease in renal function, which happened in a minority of patients. The lack of patients developing CKD4 and ESRD is encouraging. In addition, duration of lithium exposure increased the odds of new CKD by only 1.03 per exposed patient year. The authors point out that the long-term use of lithium may be considered only an additional risk factor for CKD—monitoring and management of hypertension and diabetes potentially improves renal survival. The study reinforces the need for increased monitoring of lithium levels and renal functioning.

Type of study:
Cohort study