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Psychiatric illness in dialysis patients

Rebecca J Schmidt, DO, FACP
Jean L Holley, MD, FACP
Section Editor
Jonathan M Silver, MD
Deputy Editor
David Solomon, MD


Psychiatric illness is common among patients with chronic disorders, particularly in those with end-stage renal disease (ESRD). A review found the following mental disorders were frequently observed [1]:

Affective disorders, particularly depression

Organic brain diseases (eg, dementia and delirium)

Drug-related disorders (such as alcoholism)

Schizophrenia and other psychoses

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Literature review current through: Nov 2017. | This topic last updated: Nov 17, 2017.
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  1. Kimmel PL, Thamer M, Richard CM, Ray NF. Psychiatric illness in patients with end-stage renal disease. Am J Med 1998; 105:214.
  2. Fukunishi I, Kitaoka T, Shirai T, et al. Psychiatric disorders among patients undergoing hemodialysis therapy. Nephron 2002; 91:344.
  3. Iacovides A, Fountoulakis KN, Balaskas E, et al. Relationship of age and psychosocial factors with biological ratings in patients with end-stage renal disease undergoing dialysis. Aging Clin Exp Res 2002; 14:354.
  4. Fishbein, LJ. Depression in end-stage renal disease patients. Semin Dial 1994; 7:181.
  5. Kimmel PL, Weihs K, Peterson RA. Survival in hemodialysis patients: the role of depression. J Am Soc Nephrol 1993; 4:12.
  6. Kimmel PL, Peterson RA, Weihs KL, et al. Psychosocial factors, behavioral compliance and survival in urban hemodialysis patients. Kidney Int 1998; 54:245.
  7. Peterson RA, Kimmel PL, Sacks CR, et al. Depression, perception of illness and mortality in patients with end-stage renal disease. Int J Psychiatry Med 1991; 21:343.
  8. Klein O, Korzets Z, Bernheim J. Is a major psychiatric illness a contraindication to chronic dialysis? Nephrol Dial Transplant 2005; 20:2608.
  9. Cohen SD, Norris L, Acquaviva K, et al. Screening, diagnosis, and treatment of depression in patients with end-stage renal disease. Clin J Am Soc Nephrol 2007; 2:1332.
  10. Palmer S, Vecchio M, Craig JC, et al. Prevalence of depression in chronic kidney disease: systematic review and meta-analysis of observational studies. Kidney Int 2013; 84:179.
  11. Andrade L, Caraveo-Anduaga JJ, Berglund P, et al. The epidemiology of major depressive episodes: results from the International Consortium of Psychiatric Epidemiology (ICPE) Surveys. Int J Methods Psychiatr Res 2003; 12:3.
  12. Watnick S, Kirwin P, Mahnensmith R, Concato J. The prevalence and treatment of depression among patients starting dialysis. Am J Kidney Dis 2003; 41:105.
  13. Hedayati SS, Minhajuddin AT, Toto RD, et al. Prevalence of major depressive episode in CKD. Am J Kidney Dis 2009; 54:424.
  14. Cukor D, Coplan J, Brown C, et al. Course of depression and anxiety diagnosis in patients treated with hemodialysis: a 16-month follow-up. Clin J Am Soc Nephrol 2008; 3:1752.
  15. Cukor D, Coplan J, Brown C, et al. Anxiety disorders in adults treated by hemodialysis: a single-center study. Am J Kidney Dis 2008; 52:128.
  16. Hedayati SS, Grambow SC, Szczech LA, et al. Physician-diagnosed depression as a correlate of hospitalizations in patients receiving long-term hemodialysis. Am J Kidney Dis 2005; 46:642.
  17. Lacson E Jr, Bruce L, Li NC, et al. Depressive affect and hospitalization risk in incident hemodialysis patients. Clin J Am Soc Nephrol 2014; 9:1713.
  18. Hedayati SS, Minhajuddin AT, Afshar M, et al. Association between major depressive episodes in patients with chronic kidney disease and initiation of dialysis, hospitalization, or death. JAMA 2010; 303:1946.
  19. Palmer SC, Vecchio M, Craig JC, et al. Association between depression and death in people with CKD: a meta-analysis of cohort studies. Am J Kidney Dis 2013; 62:493.
  20. Farrokhi F, Abedi N, Beyene J, et al. Association between depression and mortality in patients receiving long-term dialysis: a systematic review and meta-analysis. Am J Kidney Dis 2014; 63:623.
  21. Kurella M, Kimmel PL, Young BS, Chertow GM. Suicide in the United States end-stage renal disease program. J Am Soc Nephrol 2005; 16:774.
  22. K/DOQI Workgroup. K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients. Am J Kidney Dis 2005; 45:S1.
  23. Dong J, Pi HC, Xiong ZY, et al. Depression and Cognitive Impairment in Peritoneal Dialysis: A Multicenter Cross-sectional Study. Am J Kidney Dis 2016; 67:111.
  24. Neumann D, Robinski M, Mau W, Girndt M. Cognitive Testing in Patients with CKD: The Problem of Missing Cases. Clin J Am Soc Nephrol 2017; 12:391.
  25. Lye WC, Chan PS, Leong SO, van der Straaten JC. Psychosocial and psychiatric morbidity in patients on CAPD. Adv Perit Dial 1997; 13:134.
  26. Wuerth D, Finkelstein SH, Finkelstein FO. The identification and treatment of depression in patients maintained on dialysis. Semin Dial 2005; 18:142.
  27. Duarte PS, Miyazaki MC, Blay SL, Sesso R. Cognitive-behavioral group therapy is an effective treatment for major depression in hemodialysis patients. Kidney Int 2009; 76:414.
  28. Cukor D, Ver Halen N, Asher DR, et al. Psychosocial intervention improves depression, quality of life, and fluid adherence in hemodialysis. J Am Soc Nephrol 2014; 25:196.
  29. Tsai SH, Wang MY, Miao NF, et al. CE: original research: The efficacy of a nurse-led breathing training program in reducing depressive symptoms in patients on hemodialysis: a randomized controlled trial. Am J Nurs 2015; 115:24.
  30. Eyler RF, Unruh ML, Quinn DK, Vilay AM. Psychotherapeutic Agents in End-Stage Renal Disease. Semin Dial 2015; 28:417.
  31. Aronoff, GR, Berns, JS, Brier, ME, et al. Drug prescribing in renal failure. In: Dosing guidelines for adults, 4th edition. ACP-ASIM, Philadelphia, 1999. p.91.
  32. Andreucci VE, Fissell RB, Bragg-Gresham JL, et al. Dialysis Outcomes and Practice Patterns Study (DOPPS) data on medications in hemodialysis patients. Am J Kidney Dis 2004; 44:S61.
  33. Fukuhara S, Green J, Albert J, et al. Symptoms of depression, prescription of benzodiazepines, and the risk of death in hemodialysis patients in Japan. Kidney Int 2006; 70:1866.
  34. Wuerth D, Finkelstein SH, Ciarcia J, et al. Identification and treatment of depression in a cohort of patients maintained on chronic peritoneal dialysis. Am J Kidney Dis 2001; 37:1011.
  35. Wuerth D, Finkelstein SH, Kliger AS, Finkelstein FO. Chronic peritoneal dialysis patients diagnosed with clinical depression: results of pharmacologic therapy. Semin Dial 2003; 16:424.
  36. Blumenfield M, Levy NB, Spinowitz B, et al. Fluoxetine in depressed patients on dialysis. Int J Psychiatry Med 1997; 27:71.
  37. Levy NB, Blumenfield M, Beasley CM Jr, et al. Fluoxetine in depressed patients with renal failure and in depressed patients with normal kidney function. Gen Hosp Psychiatry 1996; 18:8.
  38. Koo JR, Yoon JY, Joo MH, et al. Treatment of depression and effect of antidepression treatment on nutritional status in chronic hemodialysis patients. Am J Med Sci 2005; 329:1.
  39. Kimmel PL, Cukor D, Cohen SD, Peterson RA. Depression in end-stage renal disease patients: a critical review. Adv Chronic Kidney Dis 2007; 14:328.
  40. Hedayati SS, Gregg LP, Carmody T, et al. Effect of Sertraline on Depressive Symptoms in Patients With Chronic Kidney Disease Without Dialysis Dependence: The CAST Randomized Clinical Trial. JAMA 2017; 318:1876.
  41. Fava M, Rosenbaum JF, Hoog SL, et al. Fluoxetine versus sertraline and paroxetine in major depression: tolerability and efficacy in anxious depression. J Affect Disord 2000; 59:119.
  42. U.S. National Library of Medicine. Medlineplus Drug Monographs. www.nlm.nih.gov/medlineplus/druginformation.html (Accessed 3/7/05).
  43. Fabrazzo M, De Santo RM. Depression in chronic kidney disease. Semin Nephrol 2006; 26:56.
  44. O'Lone E, Connors M, Masson P, et al. Cognition in People With End-Stage Kidney Disease Treated With Hemodialysis: A Systematic Review and Meta-analysis. Am J Kidney Dis 2016; 67:925.
  45. Kurella M, Chertow GM, Luan J, Yaffe K. Cognitive impairment in chronic kidney disease. J Am Geriatr Soc 2004; 52:1863.
  46. Kurella Tamura M, Wadley V, Yaffe K, et al. Kidney function and cognitive impairment in US adults: the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Am J Kidney Dis 2008; 52:227.
  47. Drew DA, Weiner DE, Tighiouart H, et al. Cognitive Decline and Its Risk Factors in Prevalent Hemodialysis Patients. Am J Kidney Dis 2017.
  48. Murray AM, Tupper DE, Knopman DS, et al. Cognitive impairment in hemodialysis patients is common. Neurology 2006; 67:216.
  49. Lass P, Buscombe JR, Harber M, et al. Cognitive impairment in patients with renal failure is associated with multiple-infarct dementia. Clin Nucl Med 1999; 24:561.
  50. Wolfgram DF, Szabo A, Murray AM, Whittle J. Risk of dementia in peritoneal dialysis patients compared with hemodialysis patients. Perit Dial Int 2015; 35:189.
  51. Kurella Tamura M, Chertow GM, Depner TA, et al. Metabolic Profiling of Impaired Cognitive Function in Patients Receiving Dialysis. J Am Soc Nephrol 2016; 27:3780.
  52. Seliger SL, Gillen DL, Longstreth WT Jr, et al. Elevated risk of stroke among patients with end-stage renal disease. Kidney Int 2003; 64:603.
  53. Kim CD, Lee HJ, Kim DJ, et al. High prevalence of leukoaraiosis in cerebral magnetic resonance images of patients on peritoneal dialysis. Am J Kidney Dis 2007; 50:98.
  54. Fazekas G, Fazekas F, Schmidt R, et al. Brain MRI findings and cognitive impairment in patients undergoing chronic hemodialysis treatment. J Neurol Sci 1995; 134:83.
  55. Martinez-Vea A, Salvadó E, Bardají A, et al. Silent cerebral white matter lesions and their relationship with vascular risk factors in middle-aged predialysis patients with CKD. Am J Kidney Dis 2006; 47:241.
  56. Neely KJ, Roxe DM. Palliative care/hospice and the withdrawal of dialysis. J Palliat Med 2000; 3:57.
  57. McCarthy JT, Milliner DS, Johnson WJ. Clinical experience with desferrioxamine in dialysis patients with aluminium toxicity. Q J Med 1990; 74:257.
  58. Pereira AA, Weiner DE, Scott T, Sarnak MJ. Cognitive function in dialysis patients. Am J Kidney Dis 2005; 45:448.
  59. Rakowski DA, Caillard S, Agodoa LY, Abbott KC. Dementia as a predictor of mortality in dialysis patients. Clin J Am Soc Nephrol 2006; 1:1000.
  60. Kurella M, Mapes DL, Port FK, Chertow GM. Correlates and outcomes of dementia among dialysis patients: the Dialysis Outcomes and Practice Patterns Study. Nephrol Dial Transplant 2006; 21:2543.
  61. Neto MM, da Costa JA, Garcia-Cairasco N, et al. Intoxication by star fruit (Averrhoa carambola) in 32 uraemic patients: treatment and outcome. Nephrol Dial Transplant 2003; 18:120.
  62. Gejyo F, Homma N, Higuchi N, et al. A novel type of encephalopathy associated with mushroom Sugihiratake ingestion in patients with chronic kidney diseases. Kidney Int 2005; 68:188.
  63. Sood P, Sinson GP, Cohen EP. Subdural hematomas in chronic dialysis patients: significant and increasing. Clin J Am Soc Nephrol 2007; 2:956.
  64. Toyoda K, Fujii K, Fujimi S, et al. Stroke in patients on maintenance hemodialysis: a 22-year single-center study. Am J Kidney Dis 2005; 45:1058.
  65. Hung SC, Hung SH, Tarng DC, et al. Thiamine deficiency and unexplained encephalopathy in hemodialysis and peritoneal dialysis patients. Am J Kidney Dis 2001; 38:941.
  66. Chow KM, Wang AY, Hui AC, et al. Nonconvulsive status epilepticus in peritoneal dialysis patients. Am J Kidney Dis 2001; 38:400.
  67. Murray AM, Pederson SL, Tupper DE, et al. Acute variation in cognitive function in hemodialysis patients: a cohort study with repeated measures. Am J Kidney Dis 2007; 50:270.
  68. U.S. National Library of Medicine. Medlineplus Drug Monographs. www.nlm.nih.gov/medlineplus/druginformation.html (Accessed January 2007).
  69. Schmith VD, Piraino B, Smith RB, Kroboth PD. Alprazolam in end-stage renal disease. II. Pharmacodynamics. Clin Pharmacol Ther 1992; 51:533.