Anxiety is an underrecognized yet serious clinical problem for dialysis patients

A new review looks at the potential effects of anxiety on a vulnerable patient population: individuals undergoing hemodialysis for the treatment of kidney failure. The review, which appears in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN), stresses that anxiety disorders may interfere with optimal dialysis treatment and lead to additional serious health consequences.

Paul Kimmel, MD (George Washington University and the National Institute of Diabetes and Digestive and Kidney Diseases) and his colleagues present 3 clinical vignettes that highlight the role of anxiety in kidney failure patients treated with dialysis. The vignettes—composites of patients that are used for illustrative purposes and to protect patient privacy—show how anxiety can interfere with patients' well-being and productivity, as well as their ability to make decisions and participate in self-care. Anxiety disorders can manifest at any time, in various ways, and along with other psychiatric disorders such as depression. Unfortunately, few studies have evaluated lifestyle modification, cognitive-behavioral therapy, and medical treatment of anxiety disorders in dialysis patients.

"Anxiety is an important clinical problem that is underrecognized 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."

Dr. Kimmel stressed that it is essential to evaluate dialysis patients for anxiety disorders and to go beyond simply asking patients about their moods or anxiety. For many people on dialysis, feeling anxious is their 'normal' state, and they may not readily identify it as a problem for which they can and should get help.

Study co-authors include Scott Cohen, MD, MPH, (George Washington University School of Medicine & Health Sciences) and Daniel Cukor, PhD (SUNY Downstate Medical Center).