renal disease (ESRD) patients undergoing dialysis is rising.
patients suffer from numerous psychological and social problems.
disorders may complicate health and care of hemodialysis patients.
in ESRD patients needs prompt recognition and treatment.
The effect of anxiety disorders on ESRD
hemodialysis has been recently reviewed. It is known from previous research
that anxiety in ESRD patients undergoing hemodialysis
can pose a serious health risk, and
affect their quality of life and disease outcome.
Details Of The Review
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.’
Paul 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
In ESRD Patients
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
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.
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
). 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:
and tensed feeling
tired and weak
in concentrating or thinking about other things
difficulty controlling worry
things that trigger anxiety
Anxiety may be treated with medications, psychotherapy or a
combination of both.
Ill Effects Of Anxiety On Health
Research 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
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
- 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)