Mental health in chronic and end-stage renal disease

Abstract

Center for Disease Control (CDC) estimates that 16.8% of US adults over age 20 have chronic kidney disease (CKD). CKD is the ninth cause of death in the United States. Patients with CKD have a high prevalence of psychiatric concerns. The most common psychiatric presentations in this population are depressive disorders, cognitive difficulties, sleep disorders, and psychosis. In addition to metabolic and cardiovascular changes, patients with CKD also undergo major psychological adjustments, especially in preparation for renal replacement therapies which include dialysis or transplantation. This chapter will focus on mental health presentations in patients with CKD before the beginning of renal replacement therapy. After a brief overview of the mechanisms of psychiatric presentations in CKD, we will discuss the epidemiology and the impact of the most common mental health concerns in this population. The chapter will also discuss the evidence to date in regard to treatment for psychiatric conditions in CKD. Specific mental health considerations, including psychopharmacology, in patients on dialysis will be discussed in Chap. 7.