Premature mortality and disparities in kidney healthcare for people with chronic kidney disease and severe mental health difficulties

Abstract

Background: People with severe mental health difficulties, including schizophrenia, bipolar disorder and psychosis, have higher risk of chronic kidney disease (CKD). Little was known regarding clinical outcomes and utilisation of kidney care for people with CKD and severe mental health difficulties.

Methods: We conducted a retrospective cohort analysis of individuals with CKD attending a tertiary renal unit in London, between 2006 and 2019. Individuals with severe mental health difficulty diagnoses were identified, and differences between those with and without severe mental health difficulties were analysed.

Results: Of the 5105 individuals with CKD, 112 (2.2%) had a recorded severe mental health difficulty diagnosis. The mean lifespan of those with severe mental health difficulties was 13.1 years shorter than those without severe mental health difficulties, t(1269) = 5.752, p < 0.001. People with severe mental health difficulties had more advanced CKD at their first nephrology appointment. There were no statistically significant differences between groups in the rates of kidney failure, age at onset of kidney failure, or time elapsed between first appointment and death/kidney failure. The number of inpatient admissions was similar between groups, but those with severe mental health difficulties had higher rates of emergency and ICU admissions. Among individuals on renal replacement therapy (RRT), those with severe mental health difficulties were less likely to receive a kidney transplant and peritoneal dialysis. For patients receiving haemodialysis, those with severe mental health difficulties had a higher proportion of shortened sessions, greater mean weight loss during sessions, and a higher proportion of serum potassium and phosphate levels outside normal ranges.

Conclusions: Findings illustrate a number of disparities in kidney healthcare between people with and without severe mental health difficulties, underscoring the need for interventions which prevent premature mortality and improve kidney care for this population.

Keywords: Healthcare access; Kidney disease; Mental health; Severe mental illness.

Fig. 1

Cohort selection of individuals with CKD, with and without SMHD diagnoses. AKCC = advanced kidney care clinic; CKD = chronic kidney disease; HD = haemodialysis; PD = peritoneal dialysis; SMHD = severe mental health difficulty; Tx = Transplant

Fig. 2

Kaplan Meier Curve illustrating time from first nephrology appointment to kidney failure/death