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Kidney Week

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Abstract: SA-PO903

Acceptance Measured as Psychological Flexibility Protecting Against Depression Among Different Severities of CKD

Session Information

Category: CKD (Non-Dialysis)

  • 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Iida, Hidekazu, You Home Clinic, Ishinomaki, Japan
  • Kurita, Noriaki, Department of Clinical Epidemiology, Fukushima Medical University, Fukushima, Japan
  • Wakita, Takafumi, Kansai University, Suita, OSAKA-FU, Japan
  • Suzuki, Tomo, Kameda Medical Center, Kamogawa, CHIBA, Japan
  • Yazawa, Masahiko, Division of Nephrology and Hypertension, Department of Internal Medicine, St.Marianna University School of Medicine, Kawasaki, Japan
  • Ishibashi, Yoshitaka, Japanese Red Cross Medical Center, Tokyo, Japan
  • Kawarazaki, Hiroo, Inagi Municipal Hospital, Inagi, Japan
  • Shibagaki, Yugo, St Marianna University Hospital, Kawasaki, Japan
Background

Depression is associated with poor survival among chronic kidney disease (CKD) patients. Psychological flexibility (PF) is conceptualized as “the ability to contact the present moment more fully (i.e., accept any physical or emotional experiences without controlling them) and to change, or persist in, behaviors to pursue identified values.” Although PF is often measured as acceptance in clinical settings and its reduction by behavioral therapy is associated with reduced depression in the general population, this concept has not been examined in CKD patients.

Methods

This multicenter cohort study included five hospitals in Japan and patients with non-dialysis stage 3-5 CKD or stage 5D CKD receiving hemodialysis or peritoneal dialysis. The main exposure was PF measured by a 7-item Acceptance and Action Questionnaire (AAQ-II). The inverse mean of its summation score was used (ranging from 1 [low PF] to 7 [high PF]). The outcome was depression defined as a Center for Epidemiologic Studies Depression (CES-D) questionnaire score of 16 points or higher. The association between PF and presence of depression among all CKD patients, and between PF and incidence of depression after one year among CKD patients without baseline depression were analyzed by logistic regression models, with adjustment for age, sex, performance status, primary renal disease, treatment modality, presence of family, work status, and comorbidities.

Results

The cross-sectional and longitudinal analyses included 433 and 195 patients, respectively. The means (standard deviations) of age, PF, and CES-D were 67.2 (13.8) years, 5.64 (1.14) points, and 13.4 (8.6) points, respectively. Higher PF was associated with lower likelihood of depression (per 1 point increase, adjusted odds ratio [AOR] 0.44, 95% confidence interval [95%CI] 0.35-0.55) and lower likelihood of developing depression (per 1 point increase, AOR 0.50, 95%CI 0.33-0.75) after one year.

Conclusion

PF measured by the AAQ-II was associated with lower prevalence and incidence of depression. Nonpharmacological interventions to improve PF, such as acceptance and commitment therapy, could be useful for preventing depression in patients with different severities of CKD.