Skip to content

Survey highlights gaps in mental health care for UK kidney patients

12 March 2024

Depression is common in people living with chronic kidney disease (CKD), but there is huge variability in how it is identified and treated across kidney centres. In new results published in the Journal of Renal Care, Dr Joe Chilcot from King’s College London and his team surveyed UK kidney centres and demonstrated a significant gap in care. This work highlights the urgent need for the development of national clinical pathways for managing depression in people with CKD and for better training for healthcare providers. 

Understanding how depression is identified and managed

Although there are national guidelines for the clinical management of people with long-term conditions with depression, we don’t know if and how these are being implemented in CKD care.  

With funding from Kidney Research UK (in partnership with the Stoneygate Trust), Kidney Care UK and the British Renal Society (now UK Kidney Association), Joe and the team designed an online survey, which included questions about general kidney care, psychological provision, and social work provision, and distributed it to UK kidney care centres.  

Dr Joe Chilcott
Dr Joe Chilcott

The impact of CKD on mental health

In the UK, approximately 7.2 million people have CKD. These individuals must deal with the stress of managing their treatments, coping with their symptoms and facing uncertainty about the future. It can also affect people’s personal relationships, education, work, and sense of identity.  

Together, these challenges can take a huge toll on mental health, and it is estimated that around one in three patients with CKD are also suffering from depression. However, it is especially difficult to identify and diagnose depression in people with CKD as there are many overlapping symptoms, such as tiredness, changes in appetite and difficulty concentrating, so it is likely that these numbers are higher. Additionally, there may be cultural or language barriers that prevent the identification of depression in some patients with CKD.  

Research has shown that people with CKD who suffer from depression have poorer physical health and lower quality of life, so it is extremely important that it is properly diagnosed and managed.

Understanding the gaps in mental health care

Out of the 68 kidney centres who were sent the survey, 48 responded. The results revealed that more than 30% of responding centres lacked access to both psychological and social care. Among those that did have psychological and social provisions, around a third were provided within the kidney unit.  

The results showed a lack of awareness of national guidelines among healthcare providers, with just one-third of centres reporting that they were aware of the NICE guidelines, or national equivalents, for recognising and managing depression in adults with chronic physical health problems.  

Of the 25 centres who answered questions on management pathways, just nine reported having a specific local pathway for identifying and managing depression in kidney patients. The most common psychological interventions offered were Cognitive Behavioural Therapy (a talking therapy which teaches coping skills to help deal with negative thoughts) and Acceptance and Commitment Therapy (a type of therapy that helps you to focus on the present moment and accept difficult emotions). The survey showed that very few centres had staff with specialised training on identification of depression (four centres had training for medical staff, and six had training for nursing staff). 

Ongoing work to improve psychological and social care for kidney patients

The findings from this national survey have highlighted the urgent need for the development of national clinical pathways and enhanced training to improve the mental health support available for patients with CKD.  

The team will now study six of the surveyed sites in detail to try to understand more about why mental health provision is variable across the UK; they will then make recommendations about how to improve support for people living with kidney disease and identify future research priorities. 

Joe says: “Our results show that there are differences in how depression is identified and managed as part of routine kidney care. Whilst some services have established psychosocial teams which include protocols to screen for symptoms of depression and anxiety, staffing levels of psychological practitioners and social workers remain insufficient. We are now finishing further research which aims to understand more about the variability of mental health support across kidney care, and what treatments and support people with kidney disease would like access to as part of their care” 

Jo Pywell, partnerships and programme manager for mental health at Kidney Research UK said: “Joe’s important research aligns perfectly with our ongoing commitment to understanding and addressing the mental health needs of people living with kidney disease. These results echo the concerns raised in our own recent mental health report, both highlighting the significant need for increased evidence, improved resources, and better training to close the current care gaps. We are proud to support this vital research and look forward to its continued impact on the lives of people with kidney disease.” 

Read more research news

Why not make a donation now?

(Every £ counts)

Scroll To Top