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: COVID-19 infected more than 1.6 million Americans (0.48%) and more than 15,000 of the 500,000 (3%) Americans with chronic kidney disease treated by dialysis. The Rogosin Institute operates nine dialysis centers in New York City (NYC), the epicenter of the COVID-19 US Public Health Emergency (PHE). We followed guidance from the Centers for Disease Control and Prevention and the New York State Department of Health throughout the PHE. We screened all patients and staff for signs and symptoms of COVID-19 by measuring temperature and inquiring about symptoms on presentation to our dialysis centers. Infected patients who did not require hospitalization were treated in our centers on a dedicated shift by dedicated staff. We used a symptom-based approach to discontinuing isolation. Methods: We created a COVID-19 tool in REDCap to track the spread of Coronavirus. We surveyed our Electronic Health Record weekly using a direct data connection and automated scripting to identify patients infected with COVID-19. We reviewed demographic and clinical data for each infected patient. We used descriptive statistics to analyze our population of infected patients. Results: On February 28, 2020, 1,559 patients received dialysis at our centers. By May 11, 241 (15.5%) had been infected. Our mortality rate was 22.8% compared to general populations in NYC (10-12%), US (6.0%) and worldwide (6.5%) and rates for dialysis patients reported between 7-20%. We had a disproportionate occurrence of COVID-19 among residents of Brooklyn (49% of infections, 44% of patients) and Queens (29%;25%). Most of the infected patients were male (53%) and Black (51%). Common co-morbidities included hypertension (98%), diabetes mellitus (60%), heart failure (25%) and coronary artery disease (25%). Common outpatient medications included statins (64%) ACE inhibitors/ARBs (80%) and calcium channel blockers (63%). Fever was the only common presenting symptom (94% of patients). A significant proportion (12%) of patients were in the hospital within 14 days prior to diagnosis of COVID-19 infection. Conclusions: COVID-19 infection was common and associated with high mortality rate in our NYC population of dialysis patients despite adherence to governmental guidelines for control of disease spread. We hypothesize community spread was common in our patients residing in the epicenter of the US COVID-19 PHE.