ABSTRACT
Background: In-center hemodialysis patients have high rates of depression and anxiety. Pharmacologic interventions to ameliorate psychological burdens have proven to be limited in efficacy. Alternative therapies are increasingly used for those with chronic disease. A small number of studies have looked at the impact of meditation and yoga to improve symptoms of anxiety and depression and to promote a better quality of life. The aim of this study was to test the feasibility of implementing a chairside intradialytic yogabased breathing and relaxation technique. A secondary goal was assessing the efficacy of such an intervention. Methods: Eligible subjects were patients with a below average score on the Mental Component Summary (MCS) of a previously completed Kidney Disease Quality of Life (KDQOL-36) survey. Following consent, each subject was provided with an MP3 player, pre-loaded with a 12-minute recording of a specific yogic breathing and relaxation exercise, the Three-Part Breath. The intervention consisted of listening to the recording at each dialysis treatment over a 12-treatment period. Subjects completed a KDQOL-36 survey both at the start and the end of the study. A Likert scale to measure anxiety was completed at each dialysis treatment both pre-and post-intervention. Results: 11 subjects were enrolled over a 10-month period in 2020;10 completed the study. As measured by the Likert scale, anxiety was significantly reduced after listening to the recording. Notably, there was a larger reduction in anxiety on a per treatment basis in the period after the start of the Covid-19 pandemic compared to the pre-pandemic period. Over the study period, there was a significant improvement in the scores of the Effects of Kidney Disease on Quality of Life component of the KDQOL-36, and a trend toward significant improvement in the Mental Component Summary scores. Conclusions: A chairside intradialytic breathing and relaxation program can be integrated into a dialysis treatment session. The study demonstrates an improvement in scores related to anxiety, depression, and measures of quality of life. Larger and randomized trials using this intervention are needed to better understand its benefits and adverse effects, as well as the obstacles to large scale implementation.
ABSTRACT
Background: New York City (NYC)-based Rogosin Institute has provided a specialty case management to patients via its Program for Education in Advanced Kidney Disease (PEAK) since 2015. PEAK aims to educate patients about options for renal replacement therapy and encourages adoption of home dialysis modalities and transplantation. The global pandemic due to the novel coronavirus SARS-CoV-2 (COVID-19) hit NYC at the beginning of March 2020 and has resulted in over 40,000 hospital admissions and claimed the lives of 15,000 NYC residents. Methods: A city-wide requirement to adopt social distancing caused us to adapt our approach so we could continue our patient management and delay dialysis starts where possible. Our multidisciplinary team continued to provide regular consults via a telehealth platform. pulseData built a query to look at the standard deviation of lab results for creatinine and potassium over the prior six months leading to decreased need for patients to leave their homes for venipuncture. We also built a query to identify those patients at high risk of poor COVID-19 outcomes (those over age 65, with COPD or other respiratory conditions, and other comorbid risk factors). These high risk patients were discussed in a weekly care plan meeting. Results: The Rogosin team delivered 481 telehealth appointments between January 1 and May 1 2020. We identified 17 of 189 patients seen in PEAK over the last 12 months as high risk for poor COVID-19 outcomes. The standard deviation (SD) of the last six months of serum creatinine measurements for PEAK patients was 0.24 (IQR 0.16-0.44), patients with an SD in the top quintile were considered to be in need of repeat lab tests and home-based venipuncture was used where possible. Only 12 PEAK patients began dialysis treatment between January 1 and May 1 2020 compared with 28 patients in the same period in 2019. Most of these patients (67%) began dialysis optimally (as an outpatient and with venous access) in Jan-May 2020 vs. only 43% in the same period 2019 (a 56% increase). Conclusions: Responding to the challenges of the COVID-19 crisis were acutely felt in NYC and represented a major disruption to our ability to deliver nephrology care. Adopting a coordinated, data driven approach we were able to continue to deliver multidisciplinary care to patients and improve renal replacement therapy outcomes.