Impact of COVID-19 Pandemic on Elevated Anxiety Symptoms of Maintenance Hemodialysis Patients in China: A One-Year Follow-Up Study

Abstract

Recent studies have shown that coronavirus disease 2019 (COVID-19) aggravates anxiety in patients with maintenance hemodialysis (MHD), but it is still unclear how long this adverse effect will last. This study aims to investigate the impact of COVID-19 on the elevated anxiety symptoms of MHD patients 1 year after the outbreak. Assessment of elevated anxiety symptoms was performed on patients with MHD during early COVID-19 (February 17-February 29, 2020) and 1-year follow-up (March 1-March 13, 2021), and a total of 100 patients had completed face-to-face questionnaires at the first and 1-year follow-up. At the beginning of the outbreak, 40% of the patients with MHD had anxiety symptoms [self-rating anxiety scale (SAS) score ≥ 50], and 11% (SAS score: 60–69) and 2% (SAS score ≥ 70) of the patients had moderate and severe anxiety symptoms, respectively. Multivariate analysis shows that possibility of unaccompanied transfer, possibility of family members or themselves being infected in a hospital, added body temperature monitoring during dialysis, and increased medical procedures are the risk factors in elevated anxiety symptoms during early COVID-19. At the 1-year follow-up, the incidence of anxiety symptoms in the same group of patients declined to 28%, and all the patients had mild anxiety symptoms (SAS score: 50–59), which is significantly lower than that of the early COVID-19 pandemic with statistically significant difference (p = 0.003). Increased protective measures taken by the medical staves were the only risk factor in elevated anxiety symptoms during the 1-year follow-up. This study shows that COVID-19 has a direct impact on the deterioration of anxiety symptoms in patients with MHD. With the changes of the requirements for COVID-19 prevention and control, as well as the enhancement of propaganda and education of the pandemic and psychological care, the severity and risk factors of anxiety symptoms in the patients with MHD are changing. Thus, targeted interventions are suggested to improve the psychological endurance of the patients with MHD.

Impact of the COVID-19 Pandemic on the Provision of Dialysis Service and Mortality in Veterans Receiving Maintenance Hemodialysis in the VA: An Interrupted Time-Series Analysis

“…During the months of May and June 2020, all-cause mortality was 26% higher than that during 2017-2019. The higher mortality during the early pandemic months is likely due to missed dialysis treatments [22][23][24][25][26]. Thus, the more modest increase in mortality in Veteran patients receiving maintenance hemodialysis in the VA is likely due to lack of disruption in the delivery and receipt of dialysis treatments which involve both patient and systemrelated factors.…”

Association between negative psychology and sleep quality in dialysis patients during the COVID‐19 pandemic

“…In this investigation, depression and perceived stress were prominent contributors to poor sleep quality among dialysis patients. In the COVID‐19 outbreak, haemodialysis patients travel between home and healthcare facilities (Yu et al, 2021 ), are at constant risk of contracting the virus, and are under tremendous pressure on their health and their families (Bulbul et al, 2022 ; Lv et al, 2022 ). In addition, loneliness, fear of death, and financial concerns are stressors that lead to anxiety and depression during the COVID‐19 pandemic, and the poor sleep quality caused by such stress is expected (Duru, 2022 ).…”

Differences in mental health status during the COVID-19 pandemic between patients undergoing in-center hemodialysis and peritoneal dialysis

“…Peritoneal dialysis patients were preferably contacted by telephone by the treatment center, and could more easily self-isolate during lockdowns. In ICHD patients, fear of contracting COVID-19 during group patient transfers or dialysis treatment has previously been related to increased anxiety [ 17 , 18 ]. These concerns seem reasonable given the high COVID-19-related mortality rate in this population at that time [ 4 , 5 , 19 ].…”

“…These experiences could have frequently confronted ICHD patients with the possibility and consequences of being infected. Additional measures, such as targeted psychosocial support or information provision could be considered to decrease the impact of mental stressors present within dialysis centers [ 17 , 20 , 21 ]. However, these supporting care facilities were not always available during the pandemic.…”