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Psychiatric Illness and Mortality in Hospitalized ESKD Dialysis Patients.

ABSTRACT: BACKGROUND AND OBJECTIVES:Limited existing data on psychiatric illness in ESKD patients suggest these diseases are common and burdensome, but under-recognized in clinical practice. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:We examined hospitalizations with psychiatric diagnoses using inpatient claims from the first year of ESKD in adult and pediatric Medicare recipients who initiated treatment from 1996 to 2013. We assessed associations between hospitalizations with psychiatric diagnoses and all-cause death after discharge in adult dialysis patients using multivariable-adjusted Cox proportional hazards regression models. RESULTS:In the first ESKD year, 72% of elderly adults, 66% of adults and 64% of children had at least one hospitalization. Approximately 2% of adults and 1% of children were hospitalized with a primary psychiatric diagnosis. The most common primary psychiatric diagnoses were depression/affective disorder in adults and children, and organic disorders/dementias in elderly adults. Prevalence of hospitalizations with psychiatric diagnoses increased over time across groups, primarily from secondary diagnoses. 19% of elderly adults, 25% of adults and 15% of children were hospitalized with a secondary psychiatric diagnosis. Hazards ratios of all-cause death were higher in all dialysis adults hospitalized with either primary (1.29; 1.26 to 1.32) or secondary (1.11; 1.10 to 1.12) psychiatric diagnoses than in those hospitalized without psychiatric diagnoses. CONCLUSIONS:Hospitalizations with psychiatric diagnoses are common in pediatric and adult ESKD patients, and are associated with subsequent higher mortality, compared with hospitalizations without psychiatric diagnoses. The prevalence of hospitalizations with psychiatric diagnoses likely underestimates the burden of mental illness in the population.

SUBMITTER: Kimmel PL

PROVIDER: S-EPMC6730507 | biostudies-literature | 2019 Sep

REPOSITORIES: biostudies-literature

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Psychiatric Illness and Mortality in Hospitalized ESKD Dialysis Patients.

Kimmel Paul L PL Fwu Chyng-Wen CW Abbott Kevin C KC Moxey-Mims Marva M MM Mendley Susan S Norton Jenna M JM Eggers Paul W PW

Clinical journal of the American Society of Nephrology : CJASN 20190822 9

<h4>Background and objectives</h4>Limited existing data on psychiatric illness in ESKD patients suggest these diseases are common and burdensome, but under-recognized in clinical practice.<h4>Design, setting, participants, & measurements</h4>We examined hospitalizations with psychiatric diagnoses using inpatient claims from the first year of ESKD in adult and pediatric Medicare recipients who initiated treatment from 1996 to 2013. We assessed associations between hospitalizations with psychiatri ...[more]

PMID: 31439538

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Project description:ObjectiveThe aim of this study was to report the prevalence of peritonitis and mortality in patients with end-stage kidney disease (ESKD) treated with chronic peritoneal dialysis (PD) in Africa.DesignSystematic review.SettingAfrica.ParticipantsPatients with ESKD in Africa.InterventionsPD in its varied forms.Primary and secondary outcomesPD-related peritonitis rate (primary outcome), time-to-discontinuation of PD, mortality.Data sourcesFour databases, including PubMed, Embase, Web of Science and Africa Journal Online were systematically searched from 1 January 1980 to 31 December 2019.Eligibility criteriaStudies conducted in Africa reporting peritonitis rate and mortality in patients treated with PD.Data extraction and synthesisTwo reviewers extracted and synthesised the data using Microsoft Excel. The quality of included data was also assessed.ResultsWe included 17 studies from seven African countries representing 1894 patients treated with PD. The overall median age was 41.4 years (IQR: 38.2-44.7) with a median time on PD of 18.0 months (17.0-22.6). An overall median peritonitis rate of 0.75 (0.56-2.20) episodes per patient-year (PPY) was observed and had declined with time; peritonitis rate was higher in paediatric studies than adult studies (1.78 (1.26-2.25) vs 0.63 (0.55-1.87) episodes PPY). The overall median proportion of deaths was 21.1% (16.2-25.8). Culture negative peritonitis was common in paediatric studies and studies that reported combined outcomes of continuous ambulatory PD and automated PD. Both 1-year and 2-year technique survival were low in all studies (83.6% and 53.0%, respectively) and were responsible for a high proportion of modality switch.ConclusionsOur study identifies that there is still high but declining peritonitis rates as well as low technique and patient survival in PD studies conducted in Africa. Sustained efforts should continue to mitigate factors associated with peritonitis in patients with ESKD treated with PD in Africa.Prospero registration numberCRD42017072966.

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Psychiatric Illness and Mortality in Hospitalized ESKD Dialysis Patients.

Publications

Psychiatric Illness and Mortality in Hospitalized ESKD Dialysis Patients.

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