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Patients with chronic kidney disease need mental health support – as well as renal dialysis

As the world marked World Kidney Day on 9 March, new research has revealed that – besides its physical impact – kidney disease is taking a serious toll on patients’ mental health.

A patient with chronic kidney disease (CKD) will often require up to three, four-hour dialysis sessions every week – a huge disruption to their previous way of life.

Life Healthcare's acknowledgement of the disease impact, supported by a recent survey by Kidney Research UK scientific studies, recognises that besides the impact of the disease condition on family, work and social life, two-thirds of patients being treated for chronic kidney disease are also affected by some form of significant mental health concern ranging from depression to suicide.  The survey authors called for intervention, saying there was an urgent need for better mental health support for kidney patients.      

In South Africa, Life Healthcare has introduced an integrated care pathway that aims to provide holistic and standardised care at every Life Renal Dialysis unit, acknowledging the complex needs of patients living with chronic kidney disease. This enhanced journey sees the progressive integration of a care coordinator into the Life Renal Dialysis units to improve the patient experience and clinical outcomes. Their role involves working together with clinical teams to provide support and guidance to patients about their condition and treatments. The CC role further supports the coordination and management of various administrative functions, that would otherwise be burdensome to a patient.

“We understand the huge effect kidney dialysis has on patients’ lives, and we work to support every patient’s overall well-being,” says Dr Karisha Quarrie, Operations Manager: Clinical Directorate at Life Healthcare Group. “This is one of the reasons why we introduced our integrated care programme.”

The programme’s care coordinators are assigned to Life Renal Dialysis facilities, to share information, provide guidance and ensure patients get emotional support if needed, with the understanding that patients living with chronic kidney disease require more than just their treatment of dialysis. Patients with CKD may have to deal with co-morbidities, side effects, complications or psychosocial needs that would require care from other medical disciplines. These coordinators create a collective understanding between the patient and the clinicians involved in the patient’s care.

Where fully integrated the programme has had a positive response. Patients enrolled in the programme say it has given them a better understanding of their condition, and their treatment, and it makes them feel they’re not alone on their dialysis journey.

“My care coordinator has helped me understand my renal journey and made it seem far less overwhelming,” says one patient. “My care coordinator, Sister Asme, has really helped me, especially with my wound care journey,” says another patient. “My kidney condition affected my circulation, and my foot almost had gangrene. But, she referred me to the wound clinic and now my foot has healed completely.”

The recent Kidney Research UK report surveyed 1 000 kidney patients in the United Kingdom. Of the patients surveyed, 67% experienced depression symptoms, 36% were unable to fully take care of their physical health because of mental health problems, and 27% had considered self-harm or suicide due to their kidney disease. 

“Research confirms the negative mental-health effects of chronic kidney disease, and our priority is the wellbeing of our patients,” says Dr Quarrie. “The ability to track our patients more closely, and also gather more data, makes it easier to identify when patients have health and mental health issues, and to help them.”

The programme has achieved great success. According to Life Healthcare Group data, patient satisfaction rose from 6,8 out of 10 before the introduction of the renal care coordinators, to 9,4 out of 10, indicating a significant improvement in sentiment.

In addition, the programme pilot raised patient compliance to dialysis from 96,4% to 99,9% for twice-a-week treatments, and from 84,4% to 100% compliance for thrice-a-week treatments across the piloted renal units.  

“With the improved patient experience and patient outcomes noted in the pilot phase of the programme in 2022, we have been able to successfully negotiate our first renal value-based care contract with a leading medical scheme. This contract promotes improved patient outcomes and shared value, while providing the patient with the financial structure for the holistic care that they require”, added Dr Quarrie.

Dr Shoyab Wadee, a nephrologist at Life The Glynnwood says that once a person starts dialysis, they form a lifetime partnership with their healthcare provider. A patient with end-stage chronic renal failure cannot stop dialysis unless they receive a donor kidney via a transplant.

Dr Wadee added: “The most common risk factors for kidney disease are diabetes and hypertension. Other risk factors include old age, cigarette smoking, the use of pain medication, and a family history of cardiovascular or kidney disease.

In the early stages of chronic kidney disease, people may not have symptoms. But as the disease worsens, they may feel tired, and experience swelling, or itching. They may also have difficulty sleeping or become short of breath. “If you have these symptoms, see a general practitioner.”

“If you’re at risk of developing chronic kidney disease, it's important that you reduce that risk by not smoking, following a healthy diet, reducing salt and protein in your diet, and drinking enough water,” says Dr Wadee.

Chronic kidney disease can be detected in simple blood and urine tests conducted during an annual General Practitioner (GP) check-up who can ensure a swift referral to a nephrologist should you need further investigation into your test results or symptoms. 

For patients who do develop chronic kidney disease, life-saving chronic treatment is essential. However, besides the best possible renal care and dialysis, it is now becoming clear that support for patients’ mental health and well-being is also vital – throughout their treatment journey.

For more information on chronic kidney disease

Chronic kidney disease education material is available in the Life Renal Dialysis FAQ available here.

About Life Renal Dialysis

Life Renal Dialysis is a specialised healthcare service with 30 chronic renal units across five provinces and is part of  Life Healthcare’s service offerings providing acute and chronic renal dialysis. Services support patients in renal failure who require out-patient based chronic renal dialysis or home-based peritoneal dialysis; or acute renal dialysis in hospital. Life Renal Dialysis encourages and emphasises the importance of education about the harmful consequences of obesity and its association with kidney disease, early detection and a healthy lifestyle to increase awareness and prevention of kidney disease. For more info about Life Renal Dialysis click here.