Prevalence and risk factors associated with Anxiety Symptoms and Disorders Among Chronic Kidney Disease patients – A Systematic Review and Meta-analysis of studies

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Background Anxiety is associated with poor health outcomes among chronic kidney disease (CKD) patients. This review summarizes the prevalence and risk factors associated with anxiety symptoms and disorders among CKD patients. Methods Articles evaluating the prevalence and risk factors associated with anxiety symptoms and disorders among CKD patients, as diagnosed via DSM 4 th or 5 th edition criteria, clinical interviews or validated questionnaires, were searched in Medline®, Embase®, PsychINFO® and CINAHL®. Using random-effects meta-analyses, prevalence of anxiety was estimated. A narrative review on the risk factors associated with anxiety was presented. Results From 4941 articles, 61 studies were included. Pooled prevalence of anxiety disorders (9 studies, n=1071) among CKD patients across studies was 18.9% while that of anxiety symptoms (52 studies, n=10,739) was 42.8%. Across continents, prevalence of anxiety symptoms was highest in Europe and Asia. Between pre-dialysis and dialysis patients, prevalence of anxiety symptoms was statistically comparable at 30.5% and 42.1% respectively. Most commonly studied risk factors associated with anxiety were female gender, increased age, concomitant depression, and increased comorbidities. Conclusion Given the high prevalence of anxiety disorders and symptoms, there is a need for developing clinical guidelines on anxiety screening among CKD patients, facilitating early identification of at-risk patients.