Psychological Distress and Self-Management in CKD: A Cross-Sectional Study

Cinderella K Cardol; Yvette Meuleman; Henriët van Middendorp; Paul J M van der Boog; Luuk B Hilbrands; Gerjan Navis; Yvo W J Sijpkens; Jacob K Sont; Andrea W M Evers; Sandra van Dijk; E-GOAL Study Group

doi:10.1016/j.xkme.2023.100712

Psychological Distress and Self-Management in CKD: A Cross-Sectional Study

Kidney Med. 2023 Aug 11;5(10):100712. doi: 10.1016/j.xkme.2023.100712. eCollection 2023 Oct.

Authors

Affiliations

¹ Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands.
² Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
³ Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands.
⁴ Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands.
⁵ Department of Nephrology, University Medical Center Groningen, Groningen, The Netherlands.
⁶ Department of Internal Medicine, Haaglanden Medical Center Bronovo, The Hague, The Netherlands.
⁷ Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands.
⁸ Medical Delta, Leiden University, TU Delft, and Erasmus University Rotterdam, The Netherlands.

Abstract

Rationale & objective: Patients with chronic kidney disease (CKD) not receiving dialysis, including kidney transplant recipients, often experience difficulties regarding self-management. An important barrier for adherence to self-management recommendations may be the presence of psychological distress, consisting of depressive and anxiety symptoms. We investigated relationships between psychological distress and adherence to self-management recommendations.

Study design: Cross-sectional online questionnaire data as part of the E-GOAL study.

Setting & participants: Patients with CKD (estimated glomerular filtration rate, 20-89 mL/min/1.73 m²) were recruited from April 2018 to October 2020 at 4 hospitals in The Netherlands and completed online screening questionnaires.

Exposures: Psychological distress, depressive symptoms, and anxiety symptoms.

Outcomes: Dietary adherence, physical activity, medication adherence, smoking, body mass index, and a CKD self-management index (ie, the sum of 5 binary indicators of nonadherence to the recommended self-management factors).

Analytical approach: Adjusted multivariable regression and ordinal logistic regression analyses.

Results: In our sample (N = 460), 27.2% of patients reported psychological distress, and 69.8% were nonadherent to 1 or more recommendations. Higher psychological distress was significantly associated with poorer dietary adherence (β^adj, -0.13; 95% CI, -0.23 to -0.04), less physical activity (β^adj, -0.13; 95% CI, -0.22 to -0.03), and lower medication adherence (β^adj, -0.15; 95% CI, -0.24 to -0.05), but not with smoking and body mass index. Findings were similar for depressive symptoms, whereas anxiety was only associated with poorer dietary and medication adherence. Every 1-point higher psychological distress was also associated with a higher likelihood of being nonadherent to an accumulating number of different recommendations (adjusted OR, 1.04; 95% CI, 1.02-1.07).

Limitations: Cross-sectional design, possible residual confounding, and self-report.

Conclusions: Many people with CKD experience psychological distress, of whom most have difficulties self-managing their CKD. Given the relationship between psychological distress and adherence to CKD self-management recommendations, behavioral interventions are needed to identify and treat psychological distress as a potential barrier to CKD self-management.

Plain-language summary: This online questionnaire study investigated relationships between psychological distress and self-management among 460 people with chronic kidney disease. Over a quarter of them reported mild-to-severe psychological distress. Alarmingly, 4 out of 5 patients with psychological distress were also nonadherent to 1 or more self-management recommendations, and higher levels of psychological distress were associated with poorer dietary and medication adherence and lower physical activity. Moreover, patients who suffered from moderate-to-severe distress were relatively more often nonadherent to 3 or more recommendations compared with patients with no or mild distress symptoms. So, it seems that psychological distress can be a barrier for self-management. To support patients in managing chronic kidney disease, researchers and health professionals should not overlook patients' mental health.

Keywords: Chronic kidney disease (CKD); adherence; kidney transplantation; lifestyle; psychological distress; self-management.