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Kidney Week

Abstract: SA-PO454

Posttraumatic Stress Disorder and Outcomes among US Veterans Who Transition to Renal Replacement Therapy: A Transition of Care in CKD Study

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 306 CKD: Cognitive Dysfunction, Depression, Quality of Life

Authors

  • Ravel, Vanessa A., UC Irvine, Orange, California, United States
  • Streja, Elani, UC Irvine, Orange, California, United States
  • Rhee, Connie, UC Irvine, Orange, California, United States
  • Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Kalantar-Zadeh, Kamyar, UC Irvine, Orange, California, United States
Background

End stage renal disease (ESRD) patients starting dialysis treatment often experience worse mental health and quality of life. While poor mental health has been associated with a higher risk of mortality and hospitalization in studies of veteran patients, there is a dearth of research specifically evaluating the association of posttraumatic stress disorder (PTSD) and these outcomes in veterans transitioning to dialysis.

Methods

From a nationwide contemporary cohort of 79,331 US veterans transitioning to dialysis between 10/2007 and 3/2014, we identified 5,464 (6.9%) veterans with a PTSD diagnosis prior to transition. The association between pre-ESRD (prelude) PTSD and 1-year all-cause mortality was examined via adjusted Cox regression, and Poisson regression was used to evaluate the association between PTSD and 1-year hospitalization rate. Models were hierarchically adjusted for case-mix and laboratory covariates.

Results

Patients were 71±12 years old and included 5% women, 24% African-Americans, 61% diabetics and 9% were homeless. Patient with prelude PTSD had a higher a risk of 1-year all-cause mortality [aHR: 0.89 (0.84-0.95)], but a lower 1-year hospitalization incident rate ratio [aIRR: 1.05 (1.02-1.07)] in fully adjusted models.

Conclusion

While prelude PTSD is associated with reduced risk of post-ESRD mortality in veterans transitioning to dialysis, it is also associated with a higher hospitalization rate. Studies are warranted to examine the role of psychosocial factors between prelude PTSD and post-ESRD outcomes, and whether an increased hospitalization rate mediates better survival for veterans with PTSD transitioning to ESRD.

Funding

  • NIDDK Support