Patients with chronic kidney disease who developed end stage kidney disease that require maintaining on dialysis are commonly developed many psychiatr

Psychiatric illness in dialysis patients

 

Patients with chronic kidney disease who developed end stage kidney disease that require maintaining on dialysis are commonly developed many psychiatric illnesses that include: depressive illness, dementia, delirium, substance abuse disorders such as alcohol addiction, schizophrenic disorders, and personality illnesses.

 

Depression

Depression is considered the most common psychiatric illness necessitating hospitalization in the dialysis cohort. Almost 10% to 66% of dialysis patients are vulnerable to depressive illnesses, however, the exact percentage still uncertain. Depressive disorders may affect patient mortalities that is not possibly related to dialysis adequacy. Moreover, suicidal tendency is more significant in patients with end stage kidney disease as compared to general population. Diagnostic criteria of depression in patients with chronic kidney disease is similar to that in non-renal patients. However, depressive illness is amenable for pharmacological therapy.

 

Dementia

As many patients with chronic kidney disease usually started dialysis in old age, they are also vulnerable for development of dementia owing to the widespread presence of brain vascular diseases. Dementia can be observed in many clinical presentations like Alzheimer disease, vascular-related dementia, Parkinsonism and other related forms, frontal lobe dementia, and reversible forms of dementia. Like depressive disorders, dementia can be evaluated in the same manner like non-dialysis patients. Of note, one type of dementia could be reversible, it is that type that originates due to metabolic abnormalities related to kidney disease if properly corrected.  On the other hand, certain medications may reduce the cognitive ability of the patient, they should be reduced as much as possible.

Delirium

in regard to delirium, it has many causes that are similar to non-renal patients, however, certain causes may be particularly related to uremic patients with end stage renal failure. They include:

1]    Renally excreted drugs that may be accumulated due to absence of renal (kidney) excretion (including illicit drugs),

2]    Consumption of star fruits (e.g. Averrhoa carambola) or the mushroom Sugihiratake.

3]    Specific syndrome called, disequilibrium syndrome, related to the recently dialyzed patients.

4]    Hemodynamically unstable patients (High or low blood pressure),

5]    Cerebrovascular involvement (e.g. hypertensive encephalopathy, cerebral infarcts, cerebral hemorrhage, and subdural hematoma),

6]    Aluminum intoxication, electrolyte disorders (such as hypercalcemia, hypocalcemia, hypoglycemia, hyperglycemia, hyponatremia, and hypernatremia),

7]    Vitamin deficits (thiamine in particular),

8]    Convulsions, an organic central nervous system lesions (e.g, tumors or subdural hematoma), and

9]    Uremic encephalopathy syndrome.  

 

The management of delirium disorders in dialysis patients is generally similar to that in non-dialysis patients. The management of delirium in patients maintained on dialysis depends on the finding of behavioral abnormalities to continue regular dialysis smoothly and safely. With the finding of a particular underlying background, the plan of delirium control will be directed to this underlying cause(s).

According to clinical severity, haloperidol can be used either orally or parenterally (intravenous or intramuscular) in a safe mode, considering the serious adverse effects of other agents e.g. respiratory depression with benzodiazepine medications. Revision of the particular renal (kidney) effects is mandated to avoid their untoward effects. For example, Lithium may induce disturbance in water handling, excretion of proteins as well as kidney dysfunction.