SYMPTOMS AND MENTAL HEALTH SERVICE USE IN CHRONIC KIDNEY DISEASE

Abstract

Chronic kidney disease (CKD) is a multifaceted health problem with both physical and psychological manifestations. Increased symptom burden is associated with higher risk of mortality, decreased treatment adherence, and impaired quality of life. Despite the recognition of the importance of symptoms, the symptoms and mental health of individuals with CKD remain poorly understood in terms of their measurement, epidemiology and associated service use. The chapters in this dissertation aim to inform these knowledge gaps. Chapter 2 focusses on the symptom burden of patients receiving maintenance hemodialysis treatment and uses exploratory analyses to identify intra-dialytic symptom clusters associated with prolonged dialysis treatment recovery time. Chapters 3 and 4 are population-based studies examining mental health and addictions service utilization in patients with CKD using administrative data in Ontario, Canada. Chapter 3 is a cross-sectional study evaluating the prevalence of individuals with a history of mental health and addiction service use by levels of kidney function. Chapter 4 is a retrospective cohort study evaluating the rates of mental health and addiction service use over time in patients with CKD. Together, these chapters provide further understanding of how symptoms of dialysis and mental health and addiction service use may be measured in this patient population. They also inform considerations for the design of future symptom management and system-level mental health strategies in CKD.