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Jane Schell and James Tulsky

“Mrs. S, has anyone discussed moving toward comfort measures?”

I can still remember the question leaving my lips, followed by the look of surprise and discomfort on Mrs. S’s face. I was a first-year fellow caring for her husband, Mr. S, a dialysis patient whom I had admitted numerous times that year. This time he had been brought unresponsive into the emergency room, and he had been lying in bed for a week, receiving pressors and ventilator support but with no signs of neurologic recovery. As I sat with Mrs. S I felt helpless. How could I begin to explain

Nicole Bates, Jane Schell, and Allison Jordan

Psychologic concerns are prominent in chronic illness, such as ESRD, in which patients face significant morbidity, mortality, and complex treatment decisions. However, these symptoms are often not recognized or effectively treated. Because rates of depression and anxiety increase in this population, there is a need for interdisciplinary team collaboration among nephrology, palliative care, and mental health. Here, we present a guide tailored to the kidney care team for identifying and managing depressive and anxious symptoms in ESRD patients.

Clinical relevance

One in five patients with ESRD is diagnosed with depression, which is higher than in kidney transplant patients (1