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Vol. 28. Issue. 6.December 2008
Pages 572-666
Vol. 28. Issue. 6.December 2008
Pages 572-666
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Psychotropic drugs and peritoneal dialysis
Psicofármacos y diálisis peritoneal
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Aránzazu Sastre Lópeza, Maria Rosario Bernabeu Lafuentea, Maria Victoria Íñigo Vanrella, Juan Manuel Gascó Companya
a Servicio de Nefrología, Hospital Son Llátzer, Palma de Mallorca, Islas Baleares, España,
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Sr. Director El proceso de aceptación de una enfermedad crónica, conlleva a menudo problemas de adaptación y como consecuencia trastornos ansioso-depresivos reactivos a la nueva situación. Estos trastornos se pueden ver agravados por una situación de dependencia física, típica de pacientes con pluripatologia.
To the editor: Patient acceptance of chronic disease often involves adjustment problems and thus anxiety-depressive disorders in reaction to the new situation. These problems in turn can be aggravated by situations of physical dependency typically found in patients suffering from multiple disease processes.
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To the editor: Patient acceptance of chronic disease often involves adjustment problems and thus anxiety-depressive disorders in reaction to the new situation. These problems in turn can be aggravated by situations of physical dependency typically found in patients suffering from multiple disease processes.



Patients with chronic kidney disease subjected to dialysis moreover often experience insomnia, which reduces their quality of life and increases the mortality risk.1 Restless legs syndrome is common in uremic patients, and worsens

at night ¿ preventing adequate sleep and constituting a mortality risk factor.2 On the other hand, it is known that worsened quality of sleep during the first year on dialysis is associated with a shortened life expectancy.3



The use of benzodiazepines, which are the most widely used drugs for treating anxiety, is common in patients on

dialysis. Their use is associated with important patient mortality.4-5



The present study analyzes physical dependency, comorbidity, the frequency of anxiety-depressive disorders, and sleep disturbances, as well as psychotropic drug consumption (benzodiazepines, non-benzodiazepinic hypnotics and antidepressants) among all patients in our Peritoneal dialysis Unit.



To this effect, we analyzed all our patients included in the peritoneal dialysis program of our Unit, with determination of the Barthel index (dependency scale for basic daily life activities), the Charlson-Bedhu comorbidity

scale, and the Hamilton anxiety-depression scale. Prescribed treatment was reviewed to determine psychotropic drug consumption frequency.



There were 10 patients with a mean age of 56 ± 16 years (range 33-77). The mean duration of enrollment in the peritoneal dialysis program was 12.85 ± 12.14 months (range 1-36). Forty percent of the patients were on ambulatory continuous peritoneal dialysis and 60% on automated peritoneal dialysis. The mean modified Charlson comorbidity score was 5.5 ± 2.14 (range 4-11). According to the Barthel index, 10% of the patients showed severe dependency (35 points), 20% mild dependency (75 and 85 points), and the rest (70%) no dependency (100 points). The Hamilton anxiety-depression scale in turn indicated that 20% of the patients suffered anxiety (> 8 points), while 10% scored in the depression range (> 18 points). As regards insomnia, 50% had no sleeping difficulties. The remaining 50% tended to wake up at night, and 30% were unable to fall sleep again afterwards. Psychoactive drug consumption showed two patients to use benzodiazepines, one consumed zolpidem, one used antidepressants, and

another antidepressants and benzodiazepines.



It can be concluded that our patient population suffered medium-high morbidity. Most of the patients (70%) were

independent for activities of daily living. Thirty percent of our patients suffered some anxiety-depressive disorder.

Insomnia was found to be very common (50%). Finally, psychotropic drug use was quite common - 50% of our patients being shown to use some drug of this kind.
Bibliography
[1]
Referencias bibliográficas:
[2]
1.Sleep quality predicts quality of life and mortality risk in haemodialysis patients: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Elder SJ, Pisoni RL, Akizawa T, Fissell R, Andreucci VE, Fukuhara S, Kurokawa K, Rayner HC, Furniss AL, Port FK, Saran R. Nephrol Dial Transplant. 23(3):998-1004; 2008.
[3]
Restless legs syndrome in patients on dialysis. Kavanagh D, Siddiqui S, Geddes CC. Am J Kidney Dis. 43(5):763-771;2004. [Pubmed]
[4]
Choices for Healthy Outcomes in Caring for End-Stage Renal Disease (CHOICE) Study. Sleep quality and its correlates in the first year of dialysis. Unruh ML, Buysse DJ, Dew MA, Evans IV, Wu AW, Fink NE, Powe NR, Meyer KB. Clin J Am Soc Nephrol.1(4):802-10; 2006.
[5]
4.Benzodiazepine use and mortality of incident dialysis patients in the United Status. Winkelmayer WC, Mehta J, Wang PS. Kidney Int 72(11):1388-93; 2007.
[6]
Symptoms of depression, prescription of benzodiazepines, and the risk of death in hemodialysis patients in Japan. Fukuhara S, Green J, Albert J, Mihara H, Pisoni R, Yamazaki s, Akiba T, Asano Y, Saito A, Port F, Held P, Kurokawa K. Kidney Int. 70(10):1866-72; 2006.
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