Routine Monitoring of Depression and Anxiety in Patients with Chronic Kidney Disease (CKD)

About the Project

Approximately 15 million people in England, representing 1 in 4 adults, have one or more long-term conditions (LTCs).^{1 2} A LTC is an illness that cannot be cured, but may be controlled with medicines or other treatments.³ People living with LTCs face considerable challenges around the management of their long-term physical and mental health.²

Chronic kidney disease (CKD) is a LTC with a global health concern⁴, high prevalence⁵ and substantial healthcare and societal costs.^6-8 Patients with CKD commonly experience considerable symptom burden⁹ and associated poorer long-term health-related quality of life (HRQL)¹⁰ and mortality.^{11 12}

Increasingly, routine measurement of symptoms in CKD populations is undertaken using patient-reported outcome measures (PROMs): psychometrically validated questionnaires which collect informative data provided directly from the patient.¹³ PROM data can be collected between clinic appointments, often alongside information regarding HRQL, in order to augment clinical data, build a longitudinal picture of disease burden and enhance care.¹⁴ This approach has demonstrated considerable benefits in patients with cancer, including reduced A&E visits, fewer hospitalisations, increased HRQL and lower rates of mortality.^15-17 Feasibility of routine symptom monitoring has been established in patients with advanced CKD¹⁸ and exploration of effectiveness in patients receiving dialysis is currently ongoing.¹⁹

However, there remains much variation in the PROMs utilised to measure symptoms in CKD. In a recent systematic review and meta-analysis, 54 different PROMs were used to collect data on symptoms across the included studies, with no single tool measuring >45% of symptoms reported in the population.⁹ Thus, comprehensive measurement of the symptoms that matter most to patients with CKD currently requires concurrent completion of multiple PROMs, which may lead to questionnaire burden: a widely recognised threat to adherence.²⁰

Whilst there is ongoing work to standardise the PROMs used to measure HRQL and somatic symptoms in CKD, there remains uncertainty regarding the optimal PROM(s) for routine measurement of depression and anxiety. This is important, as the prevalence of both depression and anxiety is particularly high in patients with CKD^{21 22} and depression is associated with a substantially increased risk of mortality.²³

We are looking for a PhD student who would like to develop an in-depth programme of research to enhance our understanding around the optimal PROM(s) for routine measurement of depression and anxiety in patients with CKD. This multi-disciplinary, collaborative study will be conducted across both University and NHS environments, offering an opportunity for the successful applicant to develop an applied research study which could directly impact patient outcomes in this important area of CKD care.

Research Group: Living Well with Long-Term Conditions

Application Process

To begin the application process please go to https://www.worc.ac.uk/research/research-degrees/applying-for-a-phd/.

The Interview

All successful applicants will be offered an interview with the proposed Supervisory Team. You will be contacted by a member of the Doctoral School Team to find a suitable date. Interviews can be conducted in person or over Microsoft Teams.

For further information or an informal discussion on this project, please contact Dr Dez Kyte (Director of Studies) via email at d.kyte@worc.ac.uk