Correlates of self-reported distress in end-stage kidney dialysis patients using the distress thermometer score

Introduction Haemodialysis patients self-report increased levels of anxiety and depression. We wished to determine the prevalence of distress in a multi-ethnic dialysis population and patient factors associated with distress. Methods We reviewed self-reported distress thermometer (DT) scores from 971 haemodialysis patients with corresponding laboratory investigations, bioimpedance body composition and hand grip strength (HGS). Results The median age was 66.0 (55-75) years, 62.9% were male, 46.5% were of white ethnicity and 45.4% were diabetic. The results showed that 57.4% were classified as having no/minimal, 34% moderate, and 8.7% severe distress. Frailty increased from 31.5% to 47.9% and 56%, in the none/minimal, mild to moderate and severe distress groups ([chl].sup.2 17.6, p = 0.001), as did smoking (12.9% versus 16.7% versus 25%, [chl].sup.2 12.5, p = 0.001), and more patients reporting severe distress had suffered a previous myocardial infarction (MI) (17.4% versus 16.7% versus 27.4%, [chl].sup.2 7.1, p = 0.029). Haemoglobin decreased (109.6 ± 14.6 versus 107.6 ± 14.2 versus 103.5 ± 14.4 g/L, p < 0.001) as did HGS (18.9 (12.8-26.5) versus 17.1 (11.8-23.9) versus 15.4 (11.1-22.6) kg, p < 0.05). On ordinal multivariable analysis, increasing distress was associated with smoking ([beta] 0.55, 95% confidence interval (CI) (0.17-0.92), p = 0.004), previous MI ([beta] 0.47 (0.09-0.83), p = 0.015), serum calcium ([beta] 1.11, (0.3-1.9), p = 0.007), lower age ([beta] -0.016, (-0.03 to -0.005), p = 0.003), haemoglobin ([beta] -0.014 (-0.02 to -0.004), p = 0.008) and HGS ([beta] -0.12 (-0.04 to -0.005), p = 0.013). Conclusion Younger age, higher calcium, lower haemoglobin and muscle strength, previous MI and smoking were associated with increasing levels of distress in this multi-ethnic dialysis population. Thus, both psychological and physical treatments are required to reduce stress levels for haemodialysis patients. Keywords: Dialysis, End-stage kidney disease, Distress thermometer, Sarcopenia, Frailty, Co-morbidity, Smoking, Age