#1022 Vulnerability in onconephrology: women and people who live alone are at greater risk of depression and anxiety
Authors: Romeo Maria José Soler , Carrillo Jorge Ivan Zamora , Garcia Sheila Bermejo , Callejo Ana , Pamplona Irene Agraz , Vergara Ander , Lopez Marina , Leon Juan Carlos , Patricio Marc , Reverchon Giorgio 
Published: May 2024

Abstract

Background and Aims
Cancer is a common entity that after the new therapeutic advances is becoming chronic disease. For that reason, kidney disease prevalence is increasing in cancer patients. Consequently, Onconephrology is becoming an essential subspecialty. Psychiatric disorders are prevalent in both cancer and kidney patients. The impact of such disorders has not been studied in onconephrology patients. Our aim is to study the prevalence of psychiatric disorders in Onconephrology patients and their impact in the survival and quality of life of patients.

Method
This is a prospective study including all patients visited in the Onconephrology Unit in our center from November-2021 to February-2023. The following questionaries were evaluated at the first visit, 6 months and 12 months: sleep disorders (Epworth scale), depression (Geriatric Depression Scale (GDS) and Patient Questionnaire Health (PHQ)), cognition (Montreal scale) and anxiety (Generalized Anxiety Disorder (GAD). Clinical and analytical characteristics of the patients were collected.

Results
A total of 182 patients were included, mean age 68 (±11) years, 70 (38.5%) women, 56 (30.8%) diabetes mellitus, mean creatinine 1.7 (±0.88) mg/dL, and glomerular filtration rate (GFR) 44 (±21) ml/min. A total of 18 (9.9%) patients lived alone, 152 (83.5%) lived accompanied and 4 (2.2%) in residence. The most common neoplasm was lung (n = 38; 20.9%) and the reason for referral to Onconephrology was chronic kidney disease (n = 94; 51.6%).
At the first visit, 81 patients (44.5%) had sleep disorder, 32.7% (n = 59) had depression, 72 (39.6%) had cognitive impairment and 14 (7.7%) had anxiety. In the univariate analysis we evidenced that patients who lived in residence presented more prevalence of depression (p = 0.013). Patients with cognitive impairment had a higher prevalence of DM (p = 0.003), worse kidney function and were older (p &lt; 0.001). Patients who had sleep disorders were older (p = 0.01) and women had more prevalence of anxiety (p &lt; 0.001). At six months of follow-up, women presented anxiety with more prevalence (p = 0.03) as well as those who presented oncological progressive disease (p &lt; 0.001). Patients who lived alone presented more depression compared to patients lived accompanied (p = 0.002). At twelve months of follow-up, oncological progression was associated with depression (p = 0.034).
In the multivariate analysis, age was identified as a risk factor for cognitive impairment (OR: 1.1; p &lt; 0.001) and female sex for depression (OR: 3.39; p = 0.001). At 6 months of follow-up woman sex for anxiety disorder (OR:8.6;p = 0.01) and patients who lived alone were identified as risk factors for depression (OR: 10.8; p &lt; 0.001).
A total of 30 patients (16.5%) died during the follow-up. In the Kaplan-Meier analysis, more mortality was observed in patients with sleep disorders (p = 0.039), worse kidney function (p = 0.003) and oncological progressive disease (p = 0.028). These were not confirmed in multivariate analysis

Conclusion
Onconephrology patients had a high prevalence of depression and anxiety, especially female and patients who live alone. Therefore, it is essential to perform a comprehensive approach and to have tools to detect the vulnerable population to improve their survival and quality of life.