Examining internet-delivered cognitive behaviour therapy for patients with chronic kidney disease on haemodialysis: A feasibility open trial.
Treating depression among patients with chronic kidney disease (CKD) is imperative because of its high prevalence and health-related costs. However, many patients with CKD experience significant barriers to effective face-to-face psychological treatments. Internet-delivered cognitive behaviour therapy (iCBT) may help overcome the treatment barriers. The aim of the present study was to explore the acceptability and preliminary efficacy of iCBT for depression and anxiety among patients with CKD on haemodialysis.



A single-group open trial design involving 22 patients on dialysis and an established iCBT treatment for anxiety and depression was employed. The primary outcomes were symptoms of depression, anxiety and general psychological distress. The secondary and tertiary outcomes were disability, quality of life, kidney disease-related loss and kidney disease burden. A generalised estimation equation modelling technique was employed.



Clinically significant improvements (avg. % of improvement) were observed in the primary outcomes of depression (34%), anxiety (31%) and general distress (26%), which were maintained or further improved to 3-month follow-up. Improvements were also observed for quality of life (12%) and kidney disease-related loss (30%). However, no improvements in disability and kidney disease burden were found. High levels of acceptability were reported and relatively little clinician time (99.45min; SD=14.61) was needed to provide the treatment.



The present results provide encouraging support for the potential of iCBT as an innovative way of increasing access to effective psychological treatment for CKD patients. These results provide much needed support for further research in this area.



Australian and New Zealand Clinical Trials Registry: ACTRN12613000103763.
Renal Unit, Liverpool Hospital, Sydney, Australia; Consultation Liaison Psychiatry, Liverpool Hospital, Sydney, Australia; The University of New South Wales, Sydney, Australia. Electronic address: ramony.chan@sswahs.nsw.gov.au.
Ramony
R
Chan
eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia.
Blake F
BF
Dear
eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia.
Nick
N
Titov
Clinical Innovation & Business Unit, South Western Sydney Local Health District, Sydney, Australia; The University of Sydney, Sydney, Australia; The University of Tasmania, Hobart, Australia.
Josephine
J
Chow
Renal Unit, Liverpool Hospital, Sydney, Australia; The University of New South Wales, Sydney, Australia; Western Sydney University, Sydney, Australia.
Michael
M
Suranyi
D000328:Adult; D000368:Aged; D001007:Anxiety / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D001315:Australia; D015928:Cognitive Behavioral Therapy / Q000379:methods* / Q000639:trends; D003863:Depression / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020407:Internet / Q000639:trends; D008297:Male; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology; D006435:Renal Dialysis / Q000523:psychology* / Q000639:trends; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy*; D013813:Therapy, Computer-Assisted / Q000379:methods / Q000639:trends; D016896:Treatment Outcome
Anxiety; Chronic; Clinical trial; Cognitive behaviour therapy; Depression; Internet based intervention; Kidney disease related loss; Kidney failure; Mental health; Psychological adaptation; Renal dialysis