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the second most commonly associated pathology with CKD&#44; is a warning response produced by the body to situations of danger&#44; threat&#44; or change&#46; However&#44; when anxiety is maintained<span class="elsevierStyleBold"> </span>in the absence of danger&#44; or cannot be coped with&#44; it becomes pathological&#46; This leads to behavioural changes<span class="elsevierStyleSup">4</span> in the patient that alter relationships with health professionals and the family&#44; and can even lead to non-compliance with medical treatment&#46;</p><p class="elsevierStylePara">In addition&#44; suffering from one of these two psychological disorders in the initial stages of CKD is a predictor for elevated mortality in patients that reach later stages&#46;<span class="elsevierStyleSup">5</span> Although technological advancements have enabled us to reduce the mortality of patients with CKD&#44; depression and anxiety increase the risk of suicide&#46;<span class="elsevierStyleSup">6</span></p><p class="elsevierStylePara">The high prevalence of depression in patients with CKD is mediated by the combination of the physical symptoms of depression and the symptoms experienced by dialysis patients&#44; which are the consequence of nephrological disease&#46; Since this combination can lead to an over-estimation of the prevalence of this psychological problem in renal patients&#44; we need to improve the precision and accuracy of the diagnostic process&#46; One way to improve in this area is to use the Hospital Anxiety and Depression Scale &#40;HADS&#41;&#44;<span class="elsevierStyleSup">4</span> as we did in our study&#44; as this does not take into account physical symptoms in the overall score for diagnosing depression&#44; but only cognitive symptoms that are characteristic of this mood disorder&#46;<span class="elsevierStyleSup">7</span></p><p class="elsevierStylePara">With this in mind&#44; we examined the prevalence of anxiety and depression in patients with ADPKD&#46; We also sought to determine whether clinical variables could be correlated with the specific symptoms characteristic of these two psychological disorders&#46;<span class="elsevierStyleSup">8</span></p><p class="elsevierStylePara">The first objective of our study was to calculate the prevalence of anxiety and depression in patients with ADPKD &#40;Table 1&#41;&#46; The prevalence of these to psychological disorders in patients with ADPKD on haemodialysis &#40;HD&#41; was lower than in those without ADPKD that were undergoing the same treatment &#40;55&#46;9&#37; of patients with depression and 46&#46;72&#37; of patients with anxiety&#41;&#46; However&#44; the estimated rates of depression in non-HD patients were similar to those observed by Hedayati et al&#46;<span class="elsevierStyleSup">9</span> We are unable to establish comparisons with the prevalence of anxiety in non-HD patients&#44; since no studies have been carried out in this field&#46;</p><p class="elsevierStylePara">Our second objective was to establish which specific symptoms of these two psychological disorders were associated with two clinical variables &#40;time on HD and time since diagnosis&#41;&#46; Our predictions were less exact in this subject&#44; since no studies have specifically examined this topic&#46;</p><p class="elsevierStylePara">A detailed analysis of questionnaire items and clinical variables&#44; which specifically examined the relationship between HADS and HD&#47;non-HD&#44; time on HD&#44; and time since the diagnosis&#44; revealed several significant differences&#46;</p><p class="elsevierStylePara">We observed that HD&#47;non-HD influenced the feeling of lethargy and unrest and it appears that the duration of dialysis treatment plays an important role in several items &#40;Table 2&#41;&#46; As Watnick et al<span class="elsevierStyleSup">10 </span>showed&#44; symptoms of depression and anxiety are most common at the start of dialysis&#46;</p><p class="elsevierStylePara">We also observed that scores for a feeling of lethargy &#40;Table 2&#41; were higher in patients that had spent 2&#46;2-22 years on HD&#44; as compared to those with only 0-4 months of treatment&#46; Contrary to the aforementioned results regarding anxiety&#44; the latter finding is supported by several studies that affirm those patients that have been on dialysis for more than one year have a greater tendency for depression&#46;<span class="elsevierStyleSup">11</span></p><p class="elsevierStylePara">Our results also suggest that the time since the patient was diagnosed with kidney disease is significantly correlated with feelings of concern and sudden panic &#40;Table 2&#41;&#46; In this manner&#44; scores were higher among patients that had been diagnosed with ADPKD for 0-12 months than in those who had been diagnosed with ADPKD for 14-25 months&#46; We believe that this finding confirms that concern regarding this disease is strongest immediately following diagnosis&#46;</p><p class="elsevierStylePara">In conclusion&#44; our study shows that patients with ADPKD have a higher prevalence of symptoms of anxiety and depression than in the general population&#44;<span class="elsevierStyleSup">12</span> regardless of whether or not they are undergoing dialysis treatment&#46; More studies are necessary that examine psychological aspects of patients with ADPKD in order to attend to their biopsychosocial needs in the best possible manner&#46; An early identification of psychological problems along with a study of the context in which they have arisen allows us to reduce the disparity between long-term and short-term progression and development of kidney disease&#44; as well as to improve patients&#8217; quality of life&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Acknowledgments</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">This article was made possible by funding from the Canary Islands Savings Bank <span class="elsevierStyleItalic">&#40;Caja de Canarias&#41;</span> and the Mapfre Guanarteme Foundation for the genetic and psychosocial study of patients with autosomal dominant polycystic kidney disease in the province of Las Palmas &#40;<span class="elsevierStyleItalic">An&#225;lisis Gen&#233;tico y Evaluaci&#243;n Psicosocial de pacientes con Poliquistosis Renal Autos&#243;mica Dominante en la Provincia de Las Palmas&#41;</span>&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The authors affirm that they have no conflicts of interest related to the content of this article&#46;</p><p class="elsevierStylePara"><a href="grande&#47;11379&#95;16025&#95;30816&#95;en&#95;t1&#95;211379&#46;jpg" class="elsevierStyleCrossRefs"><img src="11379_16025_30816_en_t1_211379.jpg" alt="Scores for the hospital anxiety and depression questionnaire"></img></a></p><p class="elsevierStylePara">Table 1&#46; Scores for the hospital anxiety and depression questionnaire</p><p class="elsevierStylePara"><a href="grande&#47;11379&#95;16025&#95;30817&#95;en&#95;t2&#95;211379&#46;jpg" class="elsevierStyleCrossRefs"><img src="11379_16025_30817_en_t2_211379.jpg" alt="Mean score for each item on the hospital anxiety and depression questionnaire"></img></a></p><p class="elsevierStylePara">Table 2&#46; Mean score for each item on the hospital anxiety and depression questionnaire</p>"
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