Dr Saiprasad Ravi1, Dr James Hedley2, Dr Nicole L De La Mata2, Dr Ben Beaglehole3, Dr Nicholas Cross4, Dr Heather Dunckley5, Dr John Irvine4, Dr Curtis Walker6,7, Merryn Jones9,10, Professor Kate Wyburn11,12, Professor Angela Webster2,13,14
1Te Whatu Ora Counties Manukau, Auckland, Aotearoa / New Zealand, 2Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia, 3Department of Psychological Medicine, University of Otago, Christchurch, New Zealand, 4Department of Nephrology, Te Whatu Ora – Waitaha Canterbury, Christchurch, New Zealand, 5New Zealand Transplantation and Immunogenetics Laboratory, New Zealand Blood Service, Auckland, New Zealand, 6Internal Medicine, Medical Council of New Zealand, , , 7Te Whatu Ora Mid Central District, , New Zealand, 8Auckland City Hospital, Te Whatu Ora – Te Toka Tumai Auckland, Auckland, New Zealand, 9Kidney Health New Zealand Tākihi Hauora Aotearoa, , New Zealand, 10Renal Services, Ballantyne House, Te Whatu Ora – Te Matau a Māui Hawke’s Bay, , New Zealand, 11Renal Unit, Royal Prince Alfred Hospital, Sydney Local Health District, Camperdown, Australia, 12Central Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia, 13Westmead Applied Research Centre, Westmead Hospital, Sydney, Australia, 14NHMRC Clinical Trials Centre, the University of Sydney, Camperdown, Australia
Biography:
Saiprasad (Prasad) is an Advanced Trainee in Nephrology and General Medicine. He maintains interests in all areas of Nephrology, but in particular transplantation and improving access to this.
Abstract:
Aim:
Determine the burden of pre-existing mental illness (measured as mental health service use, MHSU) in people with kidney failure, and determine its impact on transplant waitlisting.
Background:
Those with comorbid kidney failure and mental illness face barriers to accessing care, compounded by social determinants of health. Poorer outcomes have been demonstrated for these patients across several clinical measures, however, the impact of mental illness on transplant waitlisting has not been assessed.
Methods:
Adults commencing dialysis July 2008-December 2019 were identified using ANZDATA, and linked to NZ health records including pharmaceutical claims and MHSU. Mental illness included any MHSU prior to kidney failure, with inpatient MHSU considered severe. Psychiatric medication use included any dispensing of antipsychotics/lithium, or antidepressants. Comorbidity was assessed using the M3 multimorbidity index.
Results:
Among 5643 patients commencing dialysis, 655 (11%) had mental illness including 295 (5%) severe. Of 655 with mental illness, 108 (16%) used psychiatric medication. Those with mental illness were younger (median 52 vs. 61 years, p<0.001), more European (p<0.001), with more comorbidities (p<0.001). Medication use was more likely in females (aOR 1.64, p<0.001) and metropolitan residents (aOR 1.90, p=0.01). Compared with no mental illness, waitlisting was less likely among those with unmedicated mental illness (aHR 0.60, p<0.001), but more likely among those receiving medication (aHR 2.30, p<0.001).
Conclusions:
Pre-existing mental illness is present in 1 in 10 new dialysis patients, who are generally younger, European, and more comorbid. They have reduced access to the transplant waitlist but receiving regular psychiatric medications mitigates this.