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Strategies for anxiety disorder screening in patients with end-stage renal disease 'essential'

Screening for anxiety among patients with end-stage renal disease undergoing hemodialysis is imperative, according to a review published in the Clinical Journal of the American Society of Nephrology.  

“Anxiety disorders are common in patients on hemodialysis, but are often not recognized by the treatment team, and sometimes not even by the patient themselves. However, there is limited data on the prevalence and impact of anxiety disorders in patients with dialysis,” Scott Cohen, MD, division of renal diseases and hypertension, George Washington University Medical Center, Washington, D.C., told Healio Family Medicine. “This clinical case–based review highlights the impact of anxiety disorders in hemodialysis patients by describing patient patterns that are often seen at dialysis centers, but not often interpreted as symptoms of underlying anxiety.”

Cohen and colleagues compiled three separate vignettes, composites of patients — classifying one as a “worrier,” another with a possible panic disorder, and the third a potential PTSD candidate — to illustrate some of the varying causes, symptoms and treatment options in patients with end-stage renal disease (ESRD) undergoing hemodialysis. 

According to researchers, 12% to 52% of patients undergoing hemodialysis have anxiety, which can lead to depression, poor treatment compliance, a perceived lower quality of life, and a higher risk for concurrent substance abuse. Cohen and colleagues recommend clinical evaluations for anxiety take place at several times throughout a patient’s treatment, including when a patient is experiencing stressful life events or a significant change in their health status, during a yearly mental health evaluation, at the beginning of dialysis or if the patient becomes combative during treatments. If an anxiety disorder is diagnosed, then the patient should also undergo screening for depression and suicide risk.

“Given their high prevalence, it is essential to evaluate ESRD [hemodialysis] patients for the presence of anxiety disorders as part of the overall psychosocial assessment. Assessment needs to go beyond asking patients about their moods or anxiety states, as for many people their anxious state is their ‘normal’ state, and they may not readily identify it as pathologic,” Cohen and colleagues wrote. “Strategies for screening populations of ESRD patients for anxiety disorders have not been developed, but are needed.” – by Janel Miller

Disclosures: The researchers report no relevant financial disclosures.