Psychological Distress and Poor Self-Management in CKD - EMJ

Psychological Distress and Poor Self-Management in Chronic Kidney Disease

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PATIENTS with chronic kidney disease not receiving dialysis often experience difficulties regarding self-management. A significant barrier to adhering to self-management strategies could be psychological distress, such as depressive and anxiety symptoms. The research team, led by Cinderella Cardol, Leiden University, the Netherlands, investigated relationships between psychological distress and adherence to self-management recommendations.

Patients with chronic kidney disease and an estimated glomerular filtration rate of 20–89 mL/min/1.73 m2 were recruited between April 2018–October 2020 from four hospitals in the Netherlands. In total, 406 patients were included and completed online screening questionnaires to assess psychological distress, depressive symptoms, diet, anxiety, medication adherence, BMI, physical activity, and chronic kidney disease self-management index. The majority of the cohort were male (62.4%), and had received a kidney transplant (68.9%).

In the cohort, 27.2% of patients reported psychological distress, and 69.8% were non-adherent to one or more recommendations. Furthermore, higher psychological distress was significantly associated with poorer dietary adherence, lower physical activity levels, and lower medication adherence. There was no significant association to psychological distress and smoking and BMI. Finally, depressive symptoms were associated with poorer adherence to self-management recommendations, while anxiety was linked to poorer dietary and medication adherence.

The study showed that over a quarter of patients with chronic kidney disease who are not receiving dialysis report psychological distress, most of whom have difficulties self-managing the condition. “Tailored interventions to screen for and treat both psychological and self-management difficulties in parallel may be effective in improving physical and psychological outcomes,” the authors wrote. They continued by stating: “Future research should provide more insights into causality mechanisms in relationships of psychological distress, depressive symptoms, and anxiety symptoms.”

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