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Anxiety Disorders in Adults Treated by Hemodialysis: A Single-Center Study
Abstract
Background Anxiety is a complicating comorbid diagnosis in many patients with medical illnesses. In patients with end-stage renal disease (ESRD), anxiety disorders often are perceived to represent symptoms of depression rather than independent conditions and therefore have been relatively understudied in this medical population.Study design To evaluate the psychosocial impact of anxiety disorders on patients with ESRD, we sought to identify the rates of these disorders in a sample of patients receiving hemodialysis at a single center by using a structured clinical interview. We also compared a commonly used screening measure, the Hospital Anxiety and Depression Scale (HADS), with these clinical diagnoses to determine the measure's criterion validity or ability to predict a psychiatric diagnosis in ESRD populations. Finally, we examined the relationship between anxiety diagnosis and perceptions of quality of life (QOL) and health status.Setting & participants A sample of 70 randomly selected hemodialysis patients from an urban metropolitan center.Predictor Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Axis I Diagnosis (SCID-I).Outcomes HADS and Kidney Disease Quality of Life Short Form.Results Using the SCID, 71% of the sample received a DSM-IV Axis I diagnosis, with 45.7% of subjects meeting criteria for an anxiety disorder and 40% meeting criteria for a mood disorder. The concordance between DSM-IV anxiety disorders and anxiety scores acquired by using the HADS was not significant. Thus, although the HADS may provide an acceptable measure of overall "psychic distress" compared against the SCID-I, it has poor predictive power for anxiety diagnoses in patients with ESRD. Additionally, the presence of an anxiety disorder was associated with an overall perceived lower QOL (t = 2.4; P < 0.05).Limitations Single-center study and a population not representative of US demographics.Conclusions A substantial proportion of participating patients met criteria for an anxiety disorder. The utility of the HADS as a screening tool for anxiety in patients with ESRD should be questioned. The finding that anxiety disorders negatively impact on QOL and are not merely manifestations of depression in patients with ESRD emphasizes the importance of accurate diagnosis and effective treatment. Strategic options are necessary to improve the diagnosis of anxiety disorders, potentially enhancing QOL and medical outcome in patients with ESRD.
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“Symptoms of depression (Palmer et al . 2013) and anxiety (Cukor et al . 2008) are common in end-stage kidney disease (ESKD)”
From Improving Distress in Dialysis (iDiD): A tailored CBT self-management treatment for patients undergoing dialysis. (2016) · cites this paper as Cukor et al . 2008
In the citing paper
“Diabetes complications, including peripheral neuropathy, foot ulcers, limb amputation, diabetic kidney disease, vision impairment, stroke, and heart attack, are associated with depression, anxiety, reduced autonomy, role impairment, and reduced overall physical function and quality of life (119–122).”
From Psychosocial care for people with diabetes: a position statement of the American Diabetes Association (2016) · cites this paper as [122]
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Metadata
- Authors
- Cukor, D., Coplan, J., Brown, C., Friedman, S., Newville, H., Safier, M., Spielman, L. A., Peterson, R. A., & Kimmel, P. L.
- Affiliations
- SUNY Downstate Health Sciences University (US)
- George Washington University (US)
- Corresponding author
- Cukor, Daniel
- Venue
- American Journal of Kidney Diseases
- Publisher
- Elsevier BV
- Published
- 2008-07
- Volume
- 52
- Issue
- 1
- Pages
- 128-136
- ISSN
- 0272-6386 (ISSN-L)
- OpenAlex
- W2035010066
- Cited by
- 235
- References
- 36
- Citations by year
- 2026: 3 · 2025: 9 · 2024: 15 · 2023: 6 · 2022: 14 · 2021: 13 · 2020: 12 · 2019: 11 · 2018: 20 · 2017: 17 · 2016: 20 · 2015: 21 · 2014: 9 · 2013: 17 · 2012: 14
- FWCI
- 8.75
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Kidney Diseases (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (K23DK076980, K-23 DK076980-01)
- Topics
- Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Keywords
- anxiety disorders, hemodialysis, end-stage renal disease, Hospital Anxiety and Depression Scale, screening validity, quality of life, mood disorders, psychiatric comorbidity, psychosocial impact, anxiety diagnosis
- MeSH terms
- Adaptation, Psychological, Adult, Aged, Anxiety Disorders, Depressive Disorder, Female, Follow-Up Studies, Renal Dialysis, Hemodialysis Units, Hospital, Humans, Kidney Failure, Chronic, Male, Middle Aged, Predictive Value of Tests, Probability, Psychiatric Status Rating Scales, Quality of Life, Surveys and Questionnaires, Severity of Illness Index, Cohort Studies, Incidence, Multivariate Analysis, Sickness Impact Profile, Risk Assessment
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