Psychological outcomes in critically ill patients receiving renal replacement therapy: a matched‐pairs analysis

Abstract

SummaryWe conducted a single-centre observational study over five years to assess the impact of renal replacement therapy on the psychological health of survivors of critical illness. We hypothesised that the added burden of renal replacement would increase the prevalence and severity of anxiety, depression and stress reactions in these patients, compared with matched pairs (matched for age, sex and APACHE II score) who did not receive renal replacement. Participants completed postal questionnaires. A total of 342 patients with acute kidney injury received renal replacement. One hundred and seventy-nine (52.3%) survived to hospital discharge, and 161 (47.1%) were alive at 90 days. Seventy-seven (47.8% of survivors) completed questionnaires. We found 77 matches for the Hospital Anxiety and Depression Scale analysis and 72 for the Impact of Events Scale analysis. Clinically relevant symptoms of psychiatric morbidity were common, with anxiety and depression affecting 49 (63.6%) patients and stress reactions affecting 24 (33.3%) patients. Mean scores (95% CI) were 11.4 (9.6-13.2) and 20.1 (15.7-24.6), respectively. On multivariate analysis, we found no significant differences between renal replacement patients and controls, in either the frequency or severity of these symptoms.

Acute kidney injury contributes to worse physical and quality of life outcomes in survivors of critical illness

“…The severity of illness and the duration of the illness may be more important predictors of emotional health deficits than the development AKI [21]. A previous study revealed that patients surviving ICU that required acute RRT also did not have differences in emotional health when compared to matched survivors not requiring RRT [20]. Thus, emotional and cognitive health outcomes may not be different simply due to the traumatic experience of critical illness for all ICU survivors independent of the occurrence of AKI and/or need of RRT.…”

“…Survivors of critical illness who suffer physical, cognitive or emotional impairments have difficulties with activities of daily living [12], reduced likelihood of returning to work [13] and driving [14], and overall worse healthrelated quality of life scores (HRQOL) [15]. The receipt of renal replacement therapy (RRT) has been recognized as a potential risk factor for developing physical impairments [16][17][18], and emotional health symptoms [19,20] in ICU survivors. However, incident AKI has not been comprehensively studied as a risk factor for worse patient-centered outcomes, particularly in survivors of critical illness.…”