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Social and Behavioral Barriers to Effective Care During the Transition to End-Stage Kidney Care
Lilia Cervantes1, Matthew Sinclair2, Claudia Camacho1
1Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO.
Insights
Patients with chronic kidney disease (CKD) face significant social and mental health challenges during the transition to kidney replacement therapy. Addressing these social determinants of health and mental health needs is crucial for better patient support.
Area of Science:
- Nephrology
- Public Health
- Psychology
Background:
- Chronic kidney disease (CKD) patients experience numerous adverse outcomes.
- Transitioning to kidney failure exacerbates psychosocial and social determinants of health (SDOH) challenges.
- These challenges significantly impact patients starting kidney replacement therapy.
Purpose of the Study:
- To highlight the magnified psychosocial and SDOH challenges during the transition to kidney replacement therapy.
- To emphasize the importance of addressing these issues for patient well-being.
- To advocate for comprehensive assessment and provision of services.
Main Methods:
- This study is a review and synthesis of existing literature on CKD patient experiences.
- It focuses on identifying common social and psychosocial stressors.
- It analyzes the interaction between these stressors and the transition process.
Main Results:
- Key SDOH challenges include food/housing insecurity, poverty, transportation issues, low health literacy, and healthcare system mistrust.
- Psychosocial stressors like depression, anxiety, fatigue, and pain are prevalent.
- These factors interact, making the transition to kidney replacement therapy particularly difficult.
Conclusions:
- Integrated assessment of SDOH and mental health is critical for CKD patients.
- Providing targeted services to address identified needs is essential.
- Improved support during this transition can mitigate adverse outcomes.
Abstract:
Individuals living with CKD are disproportionately burdened by a multitude of adverse clinical and person-centered outcomes. When patients transition from advanced kidney disease to kidney failure, the psychosocial effects as well as social determinants of health challenges are magnified, making this a particularly difficult time for patients beginning kidney replacement therapy. The key social determinants of health challenges often include food and housing insecurity, poverty, unreliable transportation, low level education and/or health literacy, lack of language interpreters and culturally concordant educational materials, lack of health care insurance coverage, and mistrust of the health care system. Psychosocial and physical stressors, such as depression, anxiety, sexual dysfunction, sleep difficulty, fatigue, and pain, are often part of the illness burden among individuals living with CKD and can interact synergistically with the social challenges making the transition to kidney replacement therapy particularly challenging. To better support patients during this time, it is critical that social and structural determinants of health as well as mental health be assessed and if needs are identified, that services be provided.
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