CNSW Program 2018: Screening for substance use disorders in dialysis and kidney transplant populations

Substance use disorders are a public health issue that significantly impact individuals across the lifespan in the United States. Much attention has been given to substance use disorders recently, as the opioid crisis continues to grow. Several national programs and many state efforts are directed at reducing substance use disorders.

Substance use disorders (SUDs) are a significant psychosocial barrier to chronic kidney disease outcomes.¹ SUDs can directly and indirectly cause acute and chronic kidney

disease.^2-4 People on dialysis or who have received a kidney transplant and have a SUD may have problems self-managing their kidney disease medication and treatment regimens. For example, they may have lower albumin levels5 or may be less likely to be listed for or receive a kidney transplant.⁶ People with a history of chronic opioid use before a kidney transplant may have a significantly higher risk for death.⁷ As many as 19% of patients on hemodialysis⁸ may have a SUD.

People with kidney disease who also have mental health issues are particularly at risk for SUDs, and depression and alcohol use frequently co-occur.⁹ People with kidney disease and SUDs may also have a significantly higher risk for suicide than those who do not have a SUD.¹⁰ This is a concern in kidney disease settings, as mental health issues such as depression are recognized as a significant psychosocial concern that must be evaluated in all dialysis centers.

In addition to the impact on people with kidney disease, there are implications for SUDs in kidney transplant donors as well. One study found 4% of kidney donors had emotional, psychological or SUD issues related to their donation, and 29% of donors had a history of psychiatric conditions or SUDs pre-donation.¹¹

Therefore, all dialysis and transplant professionals need training on the impact of SUDs on kidney disease outcomes and working with people who have SUDs. One important professional skill needed in dialysis and transplant settings is the ability to screen for and identify SUDs among people with kidney disease. After patients with SUDs are identified, kidney disease professionals need to provide brief relevant interventions and referrals for treatment.

Medical settings, such as dialysis and transplant centers, can be an ideal location for the delivery of SUD services related to screening and brief interventions.12 Unfortunately, most people with SUDs do not get treatment for substance use.13 Therefore, it is critical that kidney disease professionals be familiar with the impact of SUDs on the patients they work with, and know how to identify and treat such disorders so that patients will have the best outcomes.

One helpful intervention that can assist nephrology professionals in screening and referring patients for SUD services is the Screening, Brief Intervention and Referral to Treatment (SBIRT). SBIRT is evidence-based^14-16 and has been used successfully in medical settings.^{17, 18}

We we will provide an in-depth training on SBIRT and SUDs during our session. This 4-hour course will provide attendees an overview of SUDs and kidney disease, and train participants to become proficient in SBIRT. This workshop will specifically focus on SBIRT as it relates to use in kidney disease populations and help the attendee apply this evidence-based practice in nephrology settings.

Professional development opportunities, such as this training, are one important way the kidney disease community can help patients with SUDs improve outcomes and get needed treatment. As the United States magnifies the attention on SUDs and creates initiatives to address them, we must also do so in dialysis and kidney transplant centers.

This topic will be presented during the session, “Substance use disorders and kidney disease: Implications for nephrology social work practice,” on Tuesday, April 10, from 8:00 a.m. to 12:15 p.m. at the Austin Convention Center.

References:

Browne T, et al. J Nephrol Soc Work. 2017;4:196-212.

Buettner M, et al. Am J Kidney Dis. 2014;doi:10.1053/j.ajkd.2014.01.428.

Singh VP, et al. T Korean J Physiol Pharmacol. 2013;doi:10.4196/kjpp.2013.17.4.347.

Hennessy A. Renal/metabolic consequences of drug/alcohol use. In: Textbook of Addiction Treatment: International Perspectives, edited by el-Guebaly N, Cara G, Galanter M. Springer, 2015;1655-1667.

Hegde A. Am J Kidney Dis. 2000;doi:10.1016/So272-6386(00)70037-0.

Sandhu GS, et al. Transpl. 2001;doi:10.1097/TP.0b013e3181fc8903.

Barrantes F, et al. Kidney Int. 2013;doi:10.1038/ki.2013.136.

Cukor D, et al. Clin J Am Soc Nephrol. 2007;doi:10.2215/CJN.00040107.

Richards CS, et al. Depression and alcohol use. Oxford, Oxford University Press, 2014.

Kurella M, et al. J Am Soc Nephrol. 2005;doi:10.1681/ASN.2004070550.

Jacobs CL, et al. Clin J Am Soc Nephrol. 2015;doi:102215/CJN.07120714.

WHO. Global status report on alcohol and health, Geneva, WHO, 2014.

Lundgren L, et al. J Soc Soc Work Res. 2014;doi:10.1086/679302.

Agerwala SM, et al. J Psychoactive Drugs. 2004;doi:10.1080/02791072.2012.720169.

Field C, et al. J Soc Work Pract Addict. 2012;doi:10.1080/1533256X.2012.703921.

Gryczynski J, et al. Drug Alcohol Depend. 2011;doi:10.1016/j.drugalcdep.2011.03.012.

Bliss DL, et al. J Soc Work Pract Addict. 2009;doi:10.1080/15332560802646604.

Woodruff SI, et al. West J Emerg Med. 2013;doi:10.5811/westjem.2012.9.11551.

For more information: Teri Browne, PhD, MSW, Aidyn Iachini, PhD, MSW; and Melissa Reitmeier, PhD, MSW, are from the University of South Carolina College of Social Work in Columbia, South Carolina. Browne and Iachini are associate professors and Reitmeier is the director of field education at the university. Disclosures: The authors report no relevant financial disclosures.