Journal Article Annotations
2021, 1st Quarter
Annotations by Sahil Munjal, MD
This cross-sectional study using self-rating scales between March 20-29th, 2020, found a high prevalence of anxiety and depression symptoms among maintenance haemodialysis (MHD) patients (35% and 30%, respectively). The authors reported several risk factors for high anxiety and depression including higher comorbidities, low haemoglobin, low income, high C-reactive protein, arteriovenous fistula versus catheters, and self-pay versus insurance coverage. Additionally, high phosphorous and secondary hyperparathyroidism were associated with anxiety and low albumin with depression. There were no differences based on sex.
Strength and weaknesses:
The survey was filled out on an online app to minimize contact. No longitudinal data was reported. Study was conducted only in one haemodialysis centre in China with stricter quarantine guidelines so findings may not be generalizable. It should be noted that the investigators excluded patients with a history of mental and neurological diseases, drug use, cognitive impairment, and serious medical issues, so the findings may underestimate the prevalence of anxiety and depressive symptoms among other populations.
MHD patients are particularly susceptible to COVID-19 given high co-morbidity, frequent visits to health care settings, and lower immunity. High rates of anxiety and depressive symptoms in these patients highlight the importance of implementation of effective screening and psychological interventions.
Type of study (EBM guide):
Strength and weaknesses:
The database included a large sample size of Dutch patients with long follow up. Renal progression of some patients may have been missed if they became unavailable to the database by moving outside the region.
The study adds to the association between lithium use and decrease in renal function, which happened in a minority of patients. The lack of patients developing CKD4 and ESRD is encouraging. In addition, duration of lithium exposure increased the odds of new CKD by only 1.03 per exposed patient year. The authors point out that the long-term use of lithium may be considered only an additional risk factor for CKD—monitoring and management of hypertension and diabetes potentially improves renal survival. The study reinforces the need for increased monitoring of lithium levels and renal functioning.
Type of study: