Alberta’s 3,000 kidney failure patients who are on dialysis are being asked to report on their mental health during the COVID-19 pandemic.
Kara Schick-Makaroff
“When we talk about people who are highly vulnerable for COVID-19, that includes people living with kidney failure,” said lead researcher Kara Schick-Makaroff, associate professor in the Faculty of Nursing. “They are often older adults with comorbidities, who are already experiencing high mental stress and tremendous social isolation.”
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“We had planned the survey before COVID, but in some ways it’s perfect timing,” she said. “We want them to know they are not forgotten now.”
Schick-Makaroff said this is the first time all Alberta dialysis patients have been surveyed directly about their mental health and their preferences for support, although issues were reported in broader surveys completed between 2017 and 2019.
“What we heard from patients was that their mental health concerns were not being addressed, and we heard from clinicians that they didn’t know what to do when mental health was coming up with their patients,” Schick-Makaroff said. “We were surprised because we weren’t looking for this.”
Schick-Makaroff said earlier research indicates that before the COVID-19 pandemic began, the rate of depression was as high as 40 per cent among kidney failure patients, compared with 4.4 per cent for the global general population, and the rate of anxiety was as high as 52 per cent, compared with 3.6 per cent for the global general population. Canadians’ experience of mental health distress has skyrocketed during the pandemic, and Schick-Makaroff worries the same is happening for kidney failure patients.
Dialysis treatment is the mechanical removal of waste, extra water and chemicals from the blood, and is required when a person’s kidneys fail. Dialysis usually means a visit to hospital three times a week, although some patients in Alberta can dialyze at home. Many dialysis patients are on a waiting list for a kidney transplant and four Canadians on that list die every day.
It can be hard to diagnose depression in people with kidney disease because symptoms such as fatigue are common to both conditions. At the same time, untreated depression can lead to poorer outcomes in kidney treatment, including lower quality of life, increased hospitalization, even death.
“Dialysis is taxing on the body – it changes how your organs work, how your brain works, your blood levels,” Schick-Makaroff said. “To what degree does that influence how you feel your emotions, your energy, your ability to cope? These are all interconnected.”
The survey questions were developed with input from a community advisory committee of patients, caregivers and other community members, and they include whether patients would be willing to receive psychosocial care by phone or over the internet. There are also optional questions about violence in the home, a concern that has been on the rise during COVID-19. Invitations to participate in the survey are being sent to patients this month, along with a list of resources that are available to them.
Schick-Makaroff said her team will continue to work with health-care providers to ensure they know what mental health resources are available for people with kidney disease.
The main treatments for depression in dialysis patients are cognitive behavioural therapy, exercise, relaxation techniques and antidepressants, although dosing is not straightforward due to the side effects of medication coupled with dialysis.
Schick-Makaroff pointed to resources available through the Kidney Foundation of Canada, as well as a kidney patient-led project on mental wellness.
The research is funded by Alberta Health Services’ Kidney Health Strategic Clinical Network. Schick-Makaroff was one of two winners of the U of A’s Martha Cook Piper Research Prize for 2020.
| By Gillian Rutherford for © Troy Media
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