Kidney Care and Depression

Kidney Care and Depression

Major depression is a complicating comorbid diagnosis in a variety of chronic medical conditions, but may be a particular diagnostic and treatment challenge to the patient with end stage renal disease (ESRD). New Medicare guidelines mandate that dialysis providers must screen for depression, and soon they will be required to document a treatment plan. This new requirement is forcing kidney care providers to seriously consider the best approaches to accurately diagnose and treat patients on dialysis once they have been identified as having depression.

Patients who need dialysis for the treatment of ESRD have a high burden of disease because they have numerous coexisting illnesses (such as diabetes and congestive heart failure), high health care utilization with frequent hospitalizations and high rates of readmission, and a very high daily pill burden. The dialysis regimen adds further to this burden, because patients have to make significant changes in their day-to-day lives, including in their diets, to accommodate the treatment schedules and minimize risks to their health.

Approximately one in five women and one in 10 men will suffer from depression over the course of their lives (1). Chronic illness generally confers an even greater risk for depression. Patients with chronic kidney disease (CKD) and in particular, those who are on hemodialysis (HD) are at a relatively high risk for depression.

What do you mean my kidneys are failing?” “What is dialysis?” “Am I going to die?” “This can’t be happening to me.” “What about my family?” “I am afraid….” The diagnosis of kidney disease is a life-changing event for individuals and their families. Their entire world has just changed. They have lost their safe and secure view of their own sense of good health and well-being. Their sense of the future is not as certain. They are in crisis and grief.

Creative arts therapy is a form of psychotherapy that draws on the creative process along with traditional talk therapy to facilitate personal growth, insight, and resilience. Because chronic illnesses, such as ESRD and chronic kidney disease, can have psychosocial and spiritual effects on one’s mind, body, and relationships, art therapy as a treatment modality can be used to supplement traditional medical approaches to help one seek balance, wholeness, and self-actualization instead of just focusing on the cure.

Having recently experienced an excellent meeting on mental health, chronic kidney disease (CKD), and ESRD, I wanted to offer some thoughts about the extraordinary role that psychology and people play in the course of this illness and its treatment. I commend the Rogosin Institute for convening a marvelous group of leaders from various parts of the country to deliberate on these issues.