Background/Aims: Chronic kidney disease (CKD) and serious mental illness (SMI) are both associated with an increased risk for repeated hospitalization. The objective of this study was to determine if co-occurring SMI exacerbates the risk for subsequent hospitalization, particularly through the emergency department (ED), among people with CKD. Methods: People hospitalized in Washington State from April 2006 to December 2008 were separated into cohorts with diagnoses of CKD (n = 31,166), SMI (defined by schizophrenia and/or mood disorder; n = 20,167) or CKD with co-occurring SMI (n = 717), and a reference cohort without either diagnosis (n = 548,532). Main outcomes were rehospitalization for condition(s) other than mental illness: (1) through the ED; (2) any admission, and (3) admission resulting in death. Cox regression was used to analyze time to main outcomes controlling for prespecified covariates associated with rehospitalization. Results: The risk of rehospitalization via the ED was increased for people with CKD (hazard ratio, HR = 1.24, 95% confidence interval, CI = 1.21-1.28, p < 0.001) and co-occurring SMI (HR = 1.33, 95% CI = 1.29-1.38, p < 0.001) cohorts, but was significantly greater in the combined cohort (HR = 1.55, 95% CI = 1.40-1.73, p < 0.001). Similarly, the risk of any rehospitalization was increased for CKD (HR = 1.21, 95% CI = 1.17-1.25, p < 0.001) and co-occurring SMI (HR = 1.14, 95% CI = 1.11-1.17, p < 0.001) cohorts, while a significantly greater risk was observed for the combined cohort (HR = 1.36, 95% CI = 1.24-1.48, p < 0.001). The risk of rehospitalization resulting in death was not significantly increased in the combined cohort. Conclusion: In people with CKD, co-occurring SMI increased the risk of experiencing rehospitalization, particularly through the ED. Studies of strategies to address SMI in the CKD population are needed to mitigate the risk of repeat hospital admissions.

Keywords:
Chronic kidney disease, Outcomes, Epidemiology, End-stage renal disease
1.
Daratha KB, Short RA, Corbett CF, Ring ME, Alicic R, Choka R, Tuttle KR: Risks of subsequent hospitalization and death in patients with kidney disease. Clin J Am Soc Nephrol 2012;7:409-416.
2.
Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY: Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004;351:1296-1305.
3.
Weiner DE, Tighiouart H, Amin MG, Stark PC, MacLeod B, Griffith JL, Salem DN, Levey AS, Sarnak MJ: Chronic kidney disease as a risk factor for cardiovascular disease and all-cause mortality: a pooled analysis of community-based studies. J Am Soc Nephrol 2004;15:1307-1315.
4.
Collins AJ, Foley RN, Herzog C, Chavers B, Gilbertson D, Ishani A, Kasiske B, Liu J, Mau LW, McBean M, Murray A, St Peter W, Guo H, Li Q, Li S, Peng Y, Qiu Y, Roberts T, Skeans M, Snyder J, Solid C, Wang C, Weinhandl E, Zaun D, Arko C, Chen SC, Dalleska F, Daniels F, Dunning S, Ebben J, Frazier E, Hanzlik C, Johnson R, Sheets D, Wang X, Forrest B, Constantini E, Everson S, Eggers P, Agodoa L: United States renal data system 2008 annual data report. Am J Kidney Dis 2009;53:S1-S374.
5.
Collins AJ, Vassalotti JA, Wang C, Li S, Gilbertson DT, Liu J, Foley RN, Chen SC, Arneson TJ: Who should be targeted for CKD screening? Impact of diabetes, hypertension, and cardiovascular disease. Am J Kidney Dis 2009;53:S71-S77.
6.
Nitsch D, Nonyane BA, Smeeth L, Bulpitt CJ, Roderick PJ, Fletcher A: CKD and hospitalization in the elderly: a community-based cohort study in the United Kingdom. Am J Kidney Dis 2011;57:664-672.
7.
Daratha KB, Barbosa-Leiker C, Burley MH, Short R, Layton ME, McPherson S, Dyck DG, McFarland BH, Tuttle KR: Co-occurring mood disorders among hospitalized patients and risk for subsequent medical hospitalization. Gen Hosp Psychiatry 2012;34:500-505.
8.
Callahan CM, Wolinsky FD: Hospitalization for major depression among older Americans. J Gerontol A Biol Sci Med Sci 1995;50:M196-M202.
9.
Kartha A, Anthony D, Manasseh CS, Greenwald JL, Chetty VK, Burgess JF, Culpepper L, Jack BW: Depression is a risk factor for rehospitalization in medical inpatients. Prim Care Companion J Clin Psychiatry 2007;9:256-262.
10.
Levy B, Medina AM, Manove E, Weiss RD: The characteristics of a discrete mood episode, neuro-cognitive impairment and re-hospitalization in bipolar disorder. J Psychiatr Res 2011;45:1048-1054.
11.
Kang EW, Pike F, Ramer S, Abdel-Kader K, Myaskovsky L, Dew MA, Unruh M: The association of mental health over time with cardiac outcomes in HEMO study patients. Clin J Am Soc Nephrol 2012;7:957-964.
12.
Gabbay E, Meyer KB, Griffith JL, Richardson MM, Miskulin DC: Temporal trends in health-related quality of life among hemodialysis patients in the United States. Clin J Am Soc Nephrol 2010;5:261-267.
13.
Irwin MR, Miller AH: Depressive disorders and immunity: 20 years of progress and discovery. Brain Behav Immun 2007;21:374-383.
14.
Knight EL, Ofsthun N, Teng M, Lazarus JM, Curhan GC: The association between mental health, physical function, and hemodialysis mortality. Kidney Int 2003;63:1843-1851.
15.
Mapes DL, Bragg-Gresham JL, Bommer J, Fukuhara S, McKevitt P, Wikstrom B, Lopes AA: Health-related quality of life in the dialysis outcomes and practice patterns study (DOPPS). Am J Kidney Dis 2004;44:54-60.
16.
Merkus MP, Jager KJ, Dekker FW, De Haan RJ, Boeschoten EW, Krediet RT: Quality of life over time in dialysis: the Netherlands Cooperative Study on the adequacy of dialysis. Necosad study group. Kidney Int 1999;56:720-728.
17.
Hedayati SS, Minhajuddin AT, Afshar M, Toto RD, Trivedi MH, Rush AJ: Association between major depressive episodes in patients with chronic kidney disease and initiation of dialysis, hospitalization, or death. JAMA 2010;303:1946-1953.
18.
Hedayati SS, Finkelstein FO: Epidemiology, diagnosis, and management of depression in patients with CKD. Am J Kidney Dis 2009;54:741-752.
19.
Hedayati SS, Minhajuddin AT, Toto RD, Morris DW, Rush AJ: Validation of depression screening scales in patients with CKD. Am J Kidney Dis 2009;54:433-439.
20.
Hedayati SS, Minhajuddin AT, Toto RD, Morris DW, Rush AJ: Prevalence of major depressive episode in CKD. Am J Kidney Dis 2009;54:424-432.
21.
Kop WJ, Seliger SL, Fink JC, Katz R, Odden MC, Fried LF, Rifkin DE, Sarnak MJ, Gottdiener JS: Longitudinal association of depressive symptoms with rapid kidney function decline and adverse clinical renal disease outcomes. Clin J Am Soc Nephrol 2011;6:834-844.
22.
Abdel-Kader K, Unruh ML, Weisbord SD: Symptom burden, depression, and quality of life in chronic and end-stage kidney disease. Clin J Am Soc Nephrol 2009;4:1057-1064.
23.
Kutner NG, Zhang R, Huang Y, Johansen KL: Depressed mood, usual activity level, and continued employment after starting dialysis. Clin J Am Soc Nephrol 2010;5:2040-2045.
24.
Feroze U, Martin D, Reina-Patton A, Kalantar-Zadeh K, Kopple JD: Mental health, depression, and anxiety in patients on maintenance dialysis. Iran J Kidney Dis 2010;4:173-180.
25.
Elixhauser A, Halpern M, Schmier J, Luce BR: Health care CBA and CEA from 1991 to 1996: an updated bibliography. Med Care 1998;36:MS1-9, MS18-147.
26.
Ahern MM, Hendryx M: Avoidable hospitalizations for diabetes: comorbidity risks. Dis Manag 2007;10:347-355.
27.
Baldwin LM, Klabunde CN, Green P, Barlow W, Wright G: In search of the perfect comorbidity measure for use with administrative claims data: does it exist? Med Care 2006;44:745-753.
28.
Carney CP, Jones L, Woolson RF: Medical comorbidity in women and men with schizophrenia: a population-based controlled study. J Gen Intern Med 2006;21:1133-1137.
29.
Arnold LM: Gender differences in bipolar disorder. Psychiatr Clin North Am 2003;26:595-620.
30.
Kawa I, Carter JD, Joyce PR, Doughty CJ, Frampton CM, Wells JE, Walsh AE, Olds RJ: Gender differences in bipolar disorder: age of onset, course, comorbidity, and symptom presentation. Bipolar Disord 2005;7:119-125.
31.
Nolen-Hoeksema S: Emotion regulation and psychopathology: the role of gender. Annu Rev Clin Psychol 2012;8:161-187.
32.
Piccinelli M, Wilkinson G: Gender differences in depression. Critical review. Br J Psychiatry 2000;177:486-492.
33.
Winkler D, Pjrek E, Heiden A, Wiesegger G, Klein N, Konstantinidis A, Kasper S: Gender differences in the psychopathology of depressed inpatients. Eur Arch Psychiatry Clinl Neurosci 2004;254:209-214.
34.
US Renal Data System, USRDS 2012 annual Data Report: Atlas of chronic Kidney Disease and End-Stage Renal Disease in the United States. Bethesda, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2012.
35.
Sokal J, Messias E, Dickerson FB, Kreyenbuhl J, Brown CH, Goldberg RW, Dixon LB: Comorbidity of medical illnesses among adults with serious mental illness who are receiving community psychiatric services. J Nerv Ment Dis 2004;192:421-427.
36.
Blank MB, Mandell DS, Aiken L, Hadley TR: Co-occurrence of HIV and serious mental illness among Medicaid recipients. Psychiatr Serv 2002;53:868-873.
© 2014 S. Karger AG, Basel
2014
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.