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. 2023 Sep 1;4(9):e1265-e1275.
doi: 10.34067/KID.0000000000000213. Epub 2023 Jul 18.

Correlates of Rates and Treatment Readiness for Depressive Symptoms, Pain, and Fatigue in Hemodialysis Patients: Results from the TĀCcare Study

Susan M Devaraj  1 , Maria-Eleni Roumelioti  2 , Jonathan G Yabes  3 , Mary Schopp  1 , Sarah Erickson  4 , Jennifer L Steel  5 , Bruce L Rollman  6 , Steven D Weisbord  7 , Mark Unruh  2 , Manisha Jhamb  1
Affiliations

Correlates of Rates and Treatment Readiness for Depressive Symptoms, Pain, and Fatigue in Hemodialysis Patients: Results from the TĀCcare Study

Susan M Devaraj et al. Kidney360. .

Abstract

Key Points:

  1. Lower neighborhood walkability was associated with higher depressive symptoms and fatigue and younger age with depressive symptoms.

  2. Depressive symptoms, pain, and fatigue were frequently reported, often occurred together, and were often not all already treated.

  3. Patients with a higher symptom burden and men may be more likely to be ready to seek treatment for depressive symptoms, pain, or fatigue.

Background: Patients on hemodialysis (HD) often experience clinically significant levels of pain, fatigue, and depressive symptoms. We explored potential sociodemographic differences in symptom burden, current treatment, and readiness to seek treatment for these symptoms in patients screened for the TĀCcare trial.

Methods: In-center HD patients from Pennsylvania and New Mexico were screened for fatigue (≥5 on 0–10-point Likert scale), pain (Likert scale ≥4), depressive symptoms (≥10 Patient Health Questionnaire-9), and readiness to seek treatment (5–item Stages of Behavior Change questionnaire). Symptom burden and treatment status by sociodemographic factors were evaluated using chi square, Fisher exact tests, and logistic regression models.

Results: From March 2018 to December 2021, 506 of 896 (57%) patients screened met eligibility criteria and completed the symptom screening (mean age 60±13.9 years, 44% female, 17% Black, 25% American Indian, and 25% Hispanics). Of them, 77% screened positive for ≥1 symptom and 35% of those were receiving treatment for ≥1 of these symptoms. Pain, fatigue, and depressive symptom rates were 52%, 64%, and 24%, respectively. Age younger than 65 years was associated with a higher burden of depressive symptoms, pain, and reporting ≥1 symptom (P<0.05). The percentage of patients ready to seek treatment increased with symptom burden. More men reported readiness to seek treatment (85% versus 68% of women, P<0.001). Among those with symptoms and treatment readiness, income was inversely associated with pain (>$60,000/yr: odds ratio [OR]=0.16, confidence interval [CI]=0.03 to 0.76) and living in less walkable neighborhoods with more depressive symptoms (OR= 5.34, CI=1.19 to 24.05) and fatigue (OR= 5.29, CI=1.38 to 20.33).

Conclusions: Pain, fatigue, and depressive symptoms often occurred together, and younger age, less neighborhood walkability, and lower income were associated with a higher burden of symptoms in HD patients. Male patients were less likely to be receiving treatment for symptoms. These findings could inform priority HD patient symptom identification and treatment targets.

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Conflict of interest statement

S.M. Devaraj reports the following: Employer: Omada Health (began working for this company after submitting this manuscript); and Ownership Interest: AAPL, AMZN, DIS, DKS, EA, ENB, FB, MSFT, PNC, SIRI. M. Jhamb reports the following: Consultancy: Boehringer Ingelheim LLC, Networks of Excellence, Xcenda, LLC; Research Funding: Bayer LLC, Dialysis Clinic, Inc., NIH, Pfizer; and Other Interests or Relationships: Member of ASN and National Kidney Foundation. M.-E. Roumelioti reports the following: Other Interests or Relationships: Participating in DCI quality meetings and receiving financial support. J.L. Steel reports the following: Patents or Royalties: Springer. S.D. Weisbord reports the following: Consultancy: Takeda. J.G. Yabes reports the following: Research Funding: Bayer. All remaining authors have nothing to disclose.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Participant flow chart.
Figure 2.
Figure 2.
Venn diagram of depressive symptoms, pain, and fatigue burden (n=387).
Figure 3.
Figure 3.
Distribution of symptom burden by treatment status (n=387). Ready=ready to seek treatment; Not ready=not ready to seek treatment.
See this image and copyright information in PMC

Comment in

References

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