Mental Health Service, St. Vincent's Hospital, Melbourne, Australia.
Department of Psychiatry, University of Melbourne, Melbourne, Australia.
Nephrology (Carlton). 2021 May;26(5):442-453. doi: 10.1111/nep.13850. Epub 2021 Feb 2.
The current study evaluated the feasibility and preliminary efficacy of a psychosocial intervention, the Kidney Optimal Health Program, in reducing symptoms of depression and anxiety in individuals with advanced chronic kidney disease.
Patients with stage 4 or 5 chronic kidney disease were randomized to either a nine-session psychosocial intervention programme or usual care. Feasibility was assessed through recruitment and retention rates and programme acceptability. Participants completed assessments of depression, anxiety and psychosocial health at baseline and at 3-, 6- and 12-month follow-up. A repeated-measures analysis of variance was used to compare groups on outcomes over time.
One hundred and twenty-eight patients were screened for eligibility; 84 consented to participant and were randomized to receive the intervention (N = 42) or usual care (N = 42). 27 (32.1%) participants withdrew prior to baseline assessment. Of those who completed the baseline assessment (N = 57), trial retention was high (75.4% at 3-month, 80.7% at 6-month and 70.2% at 12-month follow-up). Participants reported high levels of programme acceptability. The patients who completed the intervention (N = 17) demonstrated significantly decreased depression at 12-month follow-up compared to the usual care group (N = 13).
The results support the feasibility of the Kidney Optimal Health Program intervention in recruitment, retention and programme acceptability with an improved screening protocol. Preliminary support is provided for improvement in depressive symptoms in patients with advanced chronic kidney disease. Further investigation through a fully powered randomized controlled trial is warranted.
本研究评估了一种心理社会干预措施——肾脏最佳健康计划的可行性和初步疗效，该计划旨在减轻终末期慢性肾脏病患者的抑郁和焦虑症状。
将 4 或 5 期慢性肾脏病患者随机分为 9 节心理社会干预方案组或常规护理组。通过招募和保留率以及方案可接受性评估可行性。参与者在基线和 3、6 和 12 个月随访时完成抑郁、焦虑和心理社会健康评估。采用重复测量方差分析比较两组随时间的结果。
对 128 名符合条件的患者进行了筛查；84 名同意参加并随机分配接受干预（N=42）或常规护理（N=42）。27 名（32.1%）参与者在基线评估前退出。完成基线评估的（N=57）中，试验保留率较高（3 个月时为 75.4%，6 个月时为 80.7%，12 个月时为 70.2%）。参与者报告了高水平的方案可接受性。与常规护理组（N=13）相比，完成干预的患者（N=17）在 12 个月随访时抑郁症状明显减轻。
这些结果支持肾脏最佳健康计划干预在招募、保留和方案可接受性方面的可行性，改进了筛选方案。初步支持终末期慢性肾脏病患者抑郁症状的改善。需要通过一项完全随机对照试验进行进一步研究。
