CKD Patients Aren't Having Mental Health Needs Fully Met

— Study: Those with CKD had double the rate of self-reported unmet mental healthcare needs


Chronic kidney disease (CKD) may pose a greater mental health burden than some other chronic conditions, researchers reported.

A study that drew on 2015-2018 data from the National Survey of Drug Use and Health compared mental health outcomes of over 2,000 adults with CKD, nearly 26,000 people with diabetes or hypertension free of CKD (HTN/DM), and over 94,000 healthy individuals with no chronic conditions (NCC).

Suffering from any type of mental illness within the past year was significantly more common in people with CKD compared with people who had HTN/DM and healthy controls (30% vs 23% vs 15%, respectively, P<0.001) in a model adjusted for demographic and socioeconomic factors, reported Adam Wilk, PhD, of the Rollins School of Public Health at Emory University in Atlanta, and colleagues.

People with CKD also had a significantly higher prevalence of any psychological distress (17.3% vs 13.4% vs 12.0%), any serious mental illness (9% vs 6% vs 3%), and any suicidal ideation within the previous year (6% vs 5% vs 3%) compared with people with HTN/DM or people with NCC, they said in a poster at the virtual National Kidney Foundation Spring Clinical Meeting.

"While the fact that we observed these differences was not too surprising, just how large the differences were was striking, particularly with respect to serious mental illness," Wilk explained to MedPage Today.

The observational, retrospective cohort study found that CKD patients were more likely than HTN/DM or people with NCC to do the following within the past year:

  • Receive any mental health services 21% for CKD vs 19% HTN/DM vs 11% NCC
  • Receive outpatient services: 12% vs 10% vs 6%
  • Receive any prescription medication: 21% vs 18% vs 10%

Compared with people with NCC, those with CKD had double the rate of self-reported unmet mental healthcare needs within the past year, defined as needing but not receiving any treatment (8% vs 4%, P<0.001). The finding is particularly noteworthy, Wilk explained.

"Given that adults with CKD are much more likely than adults with HTN/DM or NCC to regularly encounter the healthcare system -- and so have regular opportunities to obtain referrals for mental health treatment -- we were surprised that the differences in untreated needs were still so large," he stated. "It is well-understood that adults with CKD have much more complex healthcare needs than adults with HTN/DM or adults with NCC, and providers often take extra measures to help address this complexity."

The current findings "showed this complexity...with respect to mental health needs," he added. "But it was somewhat discouraging, in that the extra measures providers take to work with CKD patients still appear to leave many mental health needs unaddressed."

He added that these mental health differences can have a direct impact on the type of kidney care available to these patients. In particular, poorly controlled mental health illnesses can be considered contraindications to receiving a kidney transplant or home dialysis, typically considered the preferred treatment options for end-stage kidney disease (ESKD). This is usually due to concerns of treatment adherence among these patients, Wilk explained.

"We would encourage nephrologists, and other providers who see patients with CKD prior to ESKD onset, to be proactive in screening and identifying patients with mental health needs and referring them for evaluation and treatment," he said. "To make the biggest impact for their patients, CKD care providers might focus particularly on patients who do not have regular visits with primary care providers, nurse care managers, or other providers regularly in contact with the mental healthcare system."


Wilk and co-authors disclosed no relevant relationships with industry.