title: Event-related distress in kidney disease patients.
abstract: BACKGROUND
  Non-dialysis-dependent chronic kidney disease (CKD) and dialysis-dependent Stage 5 CKD (CKD5) are associated with a significant physical and psychosocial burden. Little is known, however, about the impact of stressful life events on CKD and CKD5 patients. This study aimed to determine the prevalence of stressful life events in CKD and CKD5 patients and identify the factors correlated with high levels of event-related distress.
  
  
  METHODS
  This cross-sectional study's sample consisted of 181 patients (91 with non-dialysis-dependent CKD Stages 4 and 5, 90 with CKD5) who filled out the Impact of Event Scale (IES), which measures subjective distress related to stressful life events. Other measures included scores from the Medical Outcomes Study Short Form-36, Patient Health Questionnaire-9 (PHQ-9) and Dialysis Symptom Index (DSI).
  
  
  RESULTS
  One hundred and three subjects reported stressors on the IES. Almost half the stressors (49.5%) related to personal health; the rest fell into other categories. There were significant differences between the no stressor, low event-related distress and high event-related distress groups in age (P < 0.001), PHQ-9 score (P < 0.001) and DSI score (P = 0.002). After adjustment, PHQ-9 score was associated with high event-related distress [odds ratio (OR) 1.20, 95% confidence interval (CI) 1.10-1.32], as was DSI score (OR 1.04, 95% CI 1.02-1.07) in a separate model.
  
  
  CONCLUSIONS
  Event-related distress is common in CKD and CKD5 patients. High event-related distress is associated with worse depressive symptoms and greater somatic and emotional symptom burden, even with adjustments for age and gender. The renal practitioner may need to address patients' event-related distress in order to provide optimal care.
authors.affiliation: Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. ramer.sarah@medstudent.pitt.edu
authors.forename: Sarah
authors.initials: S
authors.lastname: Ramer
authors.forename: Anne
authors.initials: A
authors.lastname: Germain
authors.forename: Sheena
authors.initials: S
authors.lastname: Dohar
authors.forename: Mark
authors.initials: M
authors.lastname: Unruh
mesh_terms: D000203:Activities of Daily Living; D003430:Cross-Sectional Studies; D003863:Depression / Q000209:etiology* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000523:psychology* / Q000628:therapy; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011788:Quality of Life; D006435:Renal Dialysis / Q000523:psychology*; D012720:Severity of Illness Index