Data indicate that patients with chronic kidney disease (CKD) and comorbid mental illnesses have higher risks of death and hospitalization and a more rapid progression toward kidney failure than those with CKD but no comorbid mental illnesses. “Mental health is often addressed in primary care, but many patients with CKD would prefer to use their kidney specialist as their primary care provider,” explains Adam S. Wilk, PhD. “This is a mismatching of patient needs and the expertise of specialty care. As a result, mental health in patients with CKD can go unaddressed or undertreated.”
Mental Illness Can Impact Treatment Courses
Comorbid mental health conditions can affect courses of treatment for progressing CKD or kidney failure, according to Dr. Wilk. “Severe mental illness that impairs functioning is often seen as a contraindication to kidney transplantation and home dialysis,” he says. “Kidney transplantation and home dialysis are cost-effective options that have the potential to improve quality of life. Missed opportunities to use these treatments can lead to higher treatment costs while also diminishing flexibility and convenience for patients and caregivers.”
For a study published in Kidney International Reports, Dr. Wilk and colleagues investigated mental health illnesses and treatment outcomes in adults with self-reported CKD. They reviewed 152,069 adults using data from the 2015-2019 National Survey on Drug Use and Health, with 2,544 CKD cases being reported. Most participants (N=117,235) had no reported chronic conditions, and others (N=32,290) reported having hypertension (HTN) or diabetes mellitus (DM) but not CKD. The authors compared the prevalence of any mental illness, serious mental illness, mental health treatment, and unmet mental healthcare needs across patient groups during the previous year.
Mental Health Needs Often Unmet in Patients With CKD
“Our study showed that about 27% of US adults reporting CKD also had mental illness, including 7% who had serious mental illness,” says Dr. Wilk. After adjusting for individual characteristics, adults who reported having CKD were 15.4 and 7.3 percentage points more likely to have any mental illness than those reporting no chronic conditions or HTN/DM, respectively. In addition, adults with CKD were 5.6 and 2.2 percentage points more likely to have a serious mental illness than those reporting they did not have chronic conditions or HTN/DM, respectively. “Adults with reported CKD were also more likely to have unmet mental healthcare needs,” Dr. Wilk says (Figure).
The observed differences in mental illness between adults reporting CKD and those reporting no chronic conditions or HTN/DM indicate that people with CKD have meaningfully greater mental health needs than these comparator groups. Of note, more than one-half of adults with self-reported CKD and mental illness did not receive any treatment for their mental illness, highlighting the need for clinicians to improve protocols for addressing comorbid mental illnesses when caring for patients with CKD.
Seize Opportunities to Meet Patients’ Mental Health Needs
“The high levels of mental illness and unmet needs for mental healthcare among adults with self-reported CKD seen in our study underscore the need to seize opportunities to better manage mental health needs,” says Dr. Wilk. “Clinicians and healthcare system leaders should consider adopting integrated care models—offering routine psychological screenings, referrals, and counseling services in CKD clinics—and implementing multidisciplinary disease management approaches. These models can help clinicians collaborate with patients to meet their complex physical and mental health needs and preferences.”
CMS has prioritized the expansion of kidney transplantation and home dialysis in patients with kidney failure. “It’s important to look at barriers to patients with CKD receiving these treatments—including mental health—so we can proactively find holistic solutions,” Dr. Wilk says. “A review of mental health needs may be appropriate for all patients if their CKD is progressing to the point that a kidney transplant or dialysis will likely be required.”
Emerging interventions to manage the high medical and mental health needs of adults with CKD should be evaluated in future clinical research, according to Dr. Wilk. “Comprehensive care management programs and psychological distress screening for patients with early-stage CKD may be promising,” he adds. “However, we also need to look at how to manage mental health in patients with more advanced CKD or end-stage disease, as well as in those who are at risk for kidney disease, including patients who currently have undiagnosed CKD.”