Psychiatric Illness and Mortality in Hospitalized ESKD Dialysis Patients

Abstract

Background and objectives: Limited existing data on psychiatric illness in ESKD patients suggest these diseases are common and burdensome, but under-recognized in clinical practice.

Design, setting, participants, & measurements: We examined hospitalizations with psychiatric diagnoses using inpatient claims from the first year of ESKD in adult and pediatric Medicare recipients who initiated treatment from 1996 to 2013. We assessed associations between hospitalizations with psychiatric diagnoses and all-cause death after discharge in adult dialysis patients using multivariable-adjusted Cox proportional hazards regression models.

Results: In the first ESKD year, 72% of elderly adults, 66% of adults and 64% of children had at least one hospitalization. Approximately 2% of adults and 1% of children were hospitalized with a primary psychiatric diagnosis. The most common primary psychiatric diagnoses were depression/affective disorder in adults and children, and organic disorders/dementias in elderly adults. Prevalence of hospitalizations with psychiatric diagnoses increased over time across groups, primarily from secondary diagnoses. 19% of elderly adults, 25% of adults and 15% of children were hospitalized with a secondary psychiatric diagnosis. Hazards ratios of all-cause death were higher in all dialysis adults hospitalized with either primary (1.29; 1.26 to 1.32) or secondary (1.11; 1.10 to 1.12) psychiatric diagnoses than in those hospitalized without psychiatric diagnoses.

Conclusions: Hospitalizations with psychiatric diagnoses are common in pediatric and adult ESKD patients, and are associated with subsequent higher mortality, compared with hospitalizations without psychiatric diagnoses. The prevalence of hospitalizations with psychiatric diagnoses likely underestimates the burden of mental illness in the population.

Keywords: Adult; Aged; Child; Dementia; ESKD; Hospitalization; Humans; Inpatients; Medicare; Mood Disorders; Patient Discharge; Prevalence; Renal Dialysis; anxiety; depression; end-stage kidney disease; hemodialysis; psychiatric illness.

Graphical abstract

Figure 1.

Cohort formation flow chart. *Study cohort for Table 1. ^†Patients with ESRD aged 22–64 years hospitalized with a primary psychiatric diagnosis for Table 2. ^‡Patients with ESRD aged 65 years or above hospitalized with a primary psychiatric diagnosis for Table 3. ^§Study cohorts for Supplemental Table 4. ^¶Study cohorts for Table 4.