The Role of Trait Anxiety and Depression in ESRD Health Outcomes

Abstract

Background: End-Stage Renal Disease is a critical public health issue that leads to high financial costs, hospitalizations, morbidity, and mortality. The time intensive nature of hemodialysis as well as its numerous lifestyle changes may compromise the quality of life of this population. Additionally, the adherence requirements are numerous and complex, and require considerable effort and commitment of the patient. Research has demonstrated that lower quality of life and lower adherence in the hemodialysis population contributes to worse health outcomes. The aims of this study were (1) to examine the independent and interactive impact of depression and trait anxiety on quality of life and adherence in ESRD patients and (2) to examine relationships between the ESRD-AQ Behavior scale, a self-report measure of adherence, and other subjective and objective adherence markers.;Method: Patients from SUNY Downstate Parkside Dialysis Center (N = 59, Mage = 49.4 years old, 66.1% females, 61% born outside of the US, 93.2% Black, 83.1% unemployed) participated in this study. Following the study description and informed consent procedures, participants completed self-report questionnaires assessing demographics and their depression, anxiety, quality of life, and adherence. Medical variables such as interdialytic weight gain and biomarkers were collected from their medical chart.;Results: Trait anxiety was significantly negatively correlated with self-reported adherence (95% BCa CI [-.55, -.04]), and quality of life (95% BCa CI [-.89, -.69]) but not with interdialytic weight gain. Depression was significantly negatively correlated with quality of life (95% BCa CI [-.86, -.62]), but not with self-reported adherence or interdialytic weight gain. In multivariate regression analysis, when adjusting for demographic variables (age, gender, hypertension, and diabetes), both depression (beta = -.72 , p < .001, 95% BCa CI [-1.57, -0.77]) and trait anxiety (beta = -.81, p < .001, 95% BCa CI [-1.05, -0.73]) remained significant predictors of quality of life. Neither depression nor trait anxiety significantly predicted self-reported adherence or interdialytic weight gain when adjusting for demographic variables though there was an overall trend toward significance regarding the impact of the trait anxiety on self-reported adherence (beta = -.19, p = .09, 95% BCa CI [-4.60, 0.46]). Moderation hypotheses predicting that trait anxiety would strengthen the relationship between depression and quality of life, self-reported adherence, and interdialytic weight gain were not supported. Finally, the ESRD-AQ Behavior scale was positively correlated with self-reported medication adherence (95% BCa CI [.10, .60]) and negatively correlated with phosphorus (95% BCa CI [-.47, -.05]). Contrary to expectations, there were no significant relationships between the ESRD-AQ Behavior scale and albumin, potassium, or interdialytic weight gain.;Conclusion: Trait anxiety and depression are inversely associated with and independently predict quality of life in ESRD patients. There is limited evidence for the convergent validity of the ESRD-AQ Behavior scale as several expected relationships with other adherence measures were not significant in the current sample. Developing psychosocial interventions for ESRD patients targeting depression and anxiety may have far-reaching benefits and improve medical outcomes.