Patients with schizophrenia undertaking dialysis have a higher risk for mortality than the general end-stage renal disease (ESRD) patients, according to a study recently published in the journal PLos ONE.
Schizophrenia has been linked to many physical illnesses, and recent studies have showed the disease is closely associated with hypertension, metabolic syndrome, obesity, type-2 diabetes, and dyslipidemia. Because schizophrenia and chronic kidney disease (CKD)/end-stage renal disease (ESRD) share many common cardiovascular risk factors, it is reasonable to speculate that the prevalence of CKD/ESRD might be higher in patients with schizophrenia.
For patients suffering from CKD/ESRD, the quality of pre-dialysis renal care is a crucial determinant of health outcomes. This includes indices of good quality for pre-dialysis renal care such as nephrologist referral, preparation for vascular access, erythropoietin (EPO) prescription, and planned dialysis initiation. Better pre-dialysis renal care contributes to a lower risk of death and hospitalization.
In the study entitled “Lower Incidence of End-Stage Renal Disease but Suboptimal Pre-Dialysis Renal Care in Schizophrenia: A 14-Year Nationwide Cohort Study,” Chih-Cheng Hsu from the Institute of Population Health Sciences, National Health Research Institutes in Taiwan, Department of Health Services Administration, China Medical University in Taiwan, and colleagues conducted a retrospective study, using data from a nationwide health insurance. The team was able to identify 54,361 ESRD-free patients with a diagnosis of schizophrenia and a cohort of age and gender-matched patients without schizophrenia (schizophrenia cohort). The researchers also identified a cohort of 1,244 adult dialysis patients with and without a diagnosis of schizophrenia, this way comparing the quality of renal care prior to dialysis and clinical outcomes (the dialysis cohort).
The results revealed that, when compared to the general population, schizophrenia patients were less likely to develop ESRD but were found to have a higher death risk. Moreover, schizophrenia patients at a pre-ESRD stage received suboptimal pre-dialysis renal care, were less likely to visit nephrologists, and received fewer prescription of erythropoietin. However, they were found to have a higher risk of hospitalization in the twelve months after dialysis initiation.
Based on the results the authors concluded that “closer collaboration between psychiatrists and nephrologists or internists to enhance attention to and treatment of CKD in individuals with schizophrenia is recommended.”