- Number of end-stage renal disease (ESRD) patients undergoing dialysis is rising.
- Hemodialysis patients suffer from numerous psychological and social problems.
- Anxiety disorders may complicate health and care of hemodialysis patients.
- Anxiety in ESRD patients needs prompt recognition and treatment.
Details Of The ReviewAnxiety disorders may occur at any time, in various forms, and be associated with other psychiatric disorders such as depression. Very few studies unfortunately, have determined the effects of lifestyle modification, cognitive-behavioral therapy, or medical treatment in the management of anxiety disorders in dialysis patients.
‘Addressing anxiety disorders in hemodialysis patients improves their quality of life.’
AdvertisementPaul Kimmel, MD (George Washington University and the National Institute of Diabetes and Digestive and Kidney Diseases) and his colleagues give 3 clinical vignettes that underscore the role of anxiety in kidney failure patients on dialysis. Vignettes are descriptions of patients that are used for illustrative purposes and to protect patient privacy. They show how anxiety can affect patients' general well-being and productivity, their ability to make decisions and participation in self-care.
"Anxiety is an important clinical problem that is under recognized and understudied in hemodialysis patients," said Dr. Kimmel. "Anxiety may explain some behaviors that increase health risks, such as when patients demand to use a specific dialysis machine or to stop a dialysis treatment early, or they want to receive treatment only from a particular technician."
Psychological Issues In ESRD PatientsDepression and anxiety are some of the most common comorbid conditions in people with end-stage renal disease (ESRD). Patients with ESRD face many challenges that increase the probability of their developing depression or anxiety or worsening pre-existing anxiety disorders.
Stressors in a dialysis patient are several and can include the strict dietary restrictions, time constraints, functional limitations, loss of employment, changes in self-perception, loss of self-worth, general and imagined effects of illness, medications used to treat the disease, and most importantly, fear of death.
These patients undergo major changes in their marital, familial, occupational, and societal contexts; the financial strain associated with the treatment and the illness, the uncertainty, anxiety, and incidental costs incurred while waiting for a transplant. In addition, treatment in a dialysis unit necessitates a relationship with dialysis personnel: physicians, nurses, technicians, and other staff that may or may not be smooth always.
Presence of continued employment and earnings, strong social and family support and care helps these patients to cope better with their ESRD. In the absence of such support, anxiety and depression may occur due to loss of role and identity, or may cause worsening of already existing alcohol or substance abuse.
Dr. Kimmel emphasizes the fact that it is essential to routinely evaluate dialysis patients for anxiety disorders and go beyond simply asking patients about their moods or feelings. For many people on dialysis, feeling anxious or tense is their 'normal' state, and they may not readily be able to pinpoint it as a problem for which they can and should get help.
About Anxiety DisordersAnxiety disorders often involve intense, abnormal and constant worry and fear about everyday situations. They are characterized by repeated episodes of sudden feelings of intense anxiety and fear or terror that reach a peak within minutes (panic attacks). These feelings interfere with daily activities, that patients find difficult to control. The feelings are totally out of proportion to the actual danger and can continue for a long time.
Signs and symptoms of anxiety include:
- Nervousness, and tensed feeling
- Increased heart rate
- Breathing rapidly (hyperventilation)
- Sweating and trembling
- Feeling tired and weak
- Difficulty in concentrating or thinking about other things
- Sleeping difficulties
- Gastrointestinal (GI) problems
- Having difficulty controlling worry
- Avoid things that trigger anxiety
Ill Effects Of Anxiety On HealthResearch on the mechanisms of anxiety-related illness is still in its nascent stages, but there is mounting evidence of how emotions can influence physical functioning. Still, anxiety often is overlooked as a source of other disorders, such as substance abuse or physical addiction to overcome anxious feelings. And it's often ignored as the root cause of chronic conditions like irritable bowel syndrome (IBS) or migraine headache.
Anxiety has now been linked to several chronic physical illnesses, such as heart disease, chronic respiratory disorders, gastrointestinal conditions, and even cancer. When people with these disorders are not treated for their anxiety, the disease itself becomes often more difficult to treat, their physical symptoms often become worse, and in some cases they may die sooner.
In view of such overwhelming factors and evidence, it is essential to recognize and seek treatment early for anxiety in general and specifically in ESRD patients to improve their quality of life and disease outcome.
- Howard (Jack) West et al; Performance Status in Patients with Cancer; JAMA Oncology Oct 2015, Vol 1, No 7
- The Relation Between Perceived Social Support and Anxiety in Patients Under Hemodialysis - (https:www.ncbi.nlm.nih.gov/pmc/articles/PMC4844481/)
- The Effect of Depression and Anxiety on the Performance Status of End-stage Renal Disease Patients Undergoing Hemodialysis - (http://www.sjkdt.org/article.asp?issn=1319-2442;year=2016;volume=27;issue=2;spage=331;epage=334;aulast=Rajan)
- Anxiety and Physical Illness - (http://www.health.harvard.edu/staying-healthy/anxiety_and_physical_illness)