Neuropsychiatric complications in chronic kidney disease: Role of gender, clinical, and sociodemographic factors

Abstract

Introduction: Patients with chronic kidney disease (CKD) frequently experience neuropsychiatric conditions, such as depression, anxiety, and cognitive impairment, which not only significantly diminish their quality of life, but also contribute to longer hospitalizations, poor treatment adherence, and increased mortality. This hospital-based cross-sectional study aimed to investigate neuropsychiatric complications in CKD patients, focusing on gender differences, and clinical and other sociodemographic factors.

Materials and methods: Diagnosis of CKD was based on the Kidney Disease: Improving Global Outcomes (KDIGO) criteria, and patients aged 18 years or above were included. Delirium was assessed using the Confusion Assessment Method (CAM) Scale. Those without delirium underwent evaluation using the Hindi Mental Status Examination (HMSE), Brief Psychiatric Rating Scale (BPRS), and Hospital Anxiety and Depression Scale (HADS) to identify cognitive and psychiatric symptoms.

Results: Among the 104 participants, 50% were male, with a predominant age group over 45 years (61.5%). A majority portion of the cohort was married (72.1%), employed (57.7%), and identified as Christian (56.7%). The majority of CKD cases were diagnosed as stage 5 (87.5%) and on dialysis treatment. Delirium was present in 19.2% of participants. In those without delirium, anxiety affected 46.3%, depression impacted 50.0%, and cognitive dysfunction was present in 11.1%. A gender-based analysis revealed no significant differences in age or illness duration; however, males exhibited a higher level of education (P < 0.02). While females tended to display more severe psychiatric symptoms (P < 0.06), males had more cognitive dysfunction (P < 0.08); however, these differences did not reach statistical significance. Socioeconomic status (SES) comparisons demonstrated that lower SES correlated with a reduced number of years of education (P < 0.00).

Conclusion: Anxiety and depression were prevalent in nearly half of CKD patients, without gender or socioeconomic disparities. This underscores the imperative need for holistic, multidisciplinary interventions to effectively manage these conditions and enhance overall quality of life.

Keywords: Anxiety; chronic kidney disease; cognitive impairment; depression; gender.