Cogley Clodagh, Smith-Jones Mimi, Ralston Elizabeth R, Bramham Jessica, Chilcot Joseph, D'Alton Paul, Carswell Claire, Sin Fai Lam Chun Chiang, Ratnam Ashutosh, Al-Agil Mohammad, Cairns Hugh, Etuk Kufreabasi Imo, Bramham Kate
School of Psychology, University College Dublin, Newman Building, Dublin 4, Ireland.
Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
J Nephrol. 2024 Dec;37(9):2609-2620. doi: 10.1007/s40620-024-02103-6. Epub 2024 Nov 2.
People with severe mental health difficulties, including schizophrenia, bipolar disorder and psychosis, have higher risk of chronic kidney disease (CKD). Little was known regarding clinical outcomes and utilisation of kidney care for people with CKD and severe mental health difficulties.
We conducted a retrospective cohort analysis of individuals with CKD attending a tertiary renal unit in London, between 2006 and 2019. Individuals with severe mental health difficulty diagnoses were identified, and differences between those with and without severe mental health difficulties were analysed.
Of the 5105 individuals with CKD, 112 (2.2%) had a recorded severe mental health difficulty diagnosis. The mean lifespan of those with severe mental health difficulties was 13.1 years shorter than those without severe mental health difficulties, t(1269) = 5.752, p < 0.001. People with severe mental health difficulties had more advanced CKD at their first nephrology appointment. There were no statistically significant differences between groups in the rates of kidney failure, age at onset of kidney failure, or time elapsed between first appointment and death/kidney failure. The number of inpatient admissions was similar between groups, but those with severe mental health difficulties had higher rates of emergency and ICU admissions. Among individuals on renal replacement therapy (RRT), those with severe mental health difficulties were less likely to receive a kidney transplant and peritoneal dialysis. For patients receiving haemodialysis, those with severe mental health difficulties had a higher proportion of shortened sessions, greater mean weight loss during sessions, and a higher proportion of serum potassium and phosphate levels outside normal ranges.
Findings illustrate a number of disparities in kidney healthcare between people with and without severe mental health difficulties, underscoring the need for interventions which prevent premature mortality and improve kidney care for this population.
患有严重心理健康问题的人群，包括精神分裂症、双相情感障碍和精神病患者，患慢性肾脏病（CKD）的风险更高。对于患有CKD和严重心理健康问题的人群的临床结局以及肾脏护理的利用情况，人们知之甚少。
我们对2006年至2019年期间在伦敦一家三级肾脏科就诊的CKD患者进行了一项回顾性队列分析。识别出患有严重心理健康问题诊断的个体，并分析了有和没有严重心理健康问题的个体之间的差异。
在5105例CKD患者中，有112例（2.2%）有记录的严重心理健康问题诊断。患有严重心理健康问题的患者的平均寿命比没有严重心理健康问题的患者短13.1年，t(1269) = 5.752，p < 0.001。患有严重心理健康问题的患者在首次肾病科就诊时CKD病情更严重。两组在肾衰竭发生率、肾衰竭发病年龄或首次就诊至死亡/肾衰竭的时间间隔方面没有统计学上的显著差异。两组的住院次数相似，但患有严重心理健康问题的患者急诊和重症监护病房入院率更高。在接受肾脏替代治疗（RRT）的个体中，患有严重心理健康问题的患者接受肾脏移植和腹膜透析的可能性较小。对于接受血液透析的患者，患有严重心理健康问题的患者缩短透析疗程的比例更高，透析期间平均体重减轻更多，血清钾和磷酸盐水平超出正常范围的比例更高。
研究结果表明，有和没有严重心理健康问题的人群在肾脏医疗保健方面存在一些差异，强调需要采取干预措施来预防过早死亡并改善该人群的肾脏护理。
