Differences in mental health status during the COVID-19 pandemic between patients undergoing in-center hemodialysis and peritoneal dialysis
Authors: Bouwmans Pim , Skalli Zeinab , Vernooij Robin W. M. , Hemmelder Marc H. , Konijn Wanda S. , Lips Joy , Mulder Janneke , Bonenkamp Anna A. , van Jaarsveld Brigit C. , Abrahams Alferso C. ,   the DOMESTICO study group, Abrahams A. C. , Verhaar M. C. , van Jaarsveld B. C. , Dekker F. W. , van Ittersum F. J. , Konijn W. , Hemmelder M. H. , ten Dam M. A. G. J. , van Eck van der Sluijs A. , Driehuis E. , Bonenkamp A. A. , van Lieshout T. S. , Roeterdink A. J. , Leurs P. B. , Korte M. R. , van der Net J. B. , Schrander-vd Meer A. M. , Cnossen T. T. , van Jaarsveld B. C. , van Breda G. F. , De Vriese A. , Lips J. , Krepel H. P. , ten Dam M. A. G. J. , Konings C. J. A. M. , van Eck van der Sluijs A. , Lips A. , Özyilmaz A. , Neradova A. , Boereboom F. T. J. , van Esch S. , Susanto C. R. , Hoorn E. J. , Severs D. , Boonstra A. H. , Nette R. W. , Verhoeven M. A. M. , Vermeeren Y. M. , IJpelaar D. H. T. , Hommes N. H. , van Buren M. , Hofstra J. M. , Mui K. W. , Binnenmars S. H. , Diepeveen S. H. A. , Hoogeveen E. K. , Cornelis T. , Boorsma S. , Rotmans J. I. , van Alphen A. M. , Litjens E. J. R. , Hemmelder M. H. , Janssen W. M. T. , Kuijper A. , Beerenhout C. H. , Bierma L. , Adema A. Y. , Wijering R. M. J. , Rüger W. , Bosma R. J. , Penne E. L. , de Fijter C. W. H. , Brulez H. F. H. , van Hamersvelt H. W. , van der Meijden W. A. G. , Huisman S. J. , Verhave J. C. , van Kempen G. , Klein H. H. T. I. , Douma C. E. , Bos W. J. W. , Snoep J. D. , Mulder J. , Franssen C. F. M. , Abrahams A. C. , François K. , Luik A. J. , Klaassen R. J. L. , van Tellingen A. , Dekker M. M. G. , Weenink A. G. , Krekels M. M. E. 
Published: August 2023

Abstract
Background
The mental health of dialysis patients during the COVID-19 pandemic may have been modulated by dialysis modality. Studies comparing mental health of in-center hemodialysis and peritoneal dialysis patients during the first 2 years of the pandemic are lacking.

Methods
We conducted repeated cross-sectional and multivariable regression analyses to compare the mental health of in-center hemodialysis and peritoneal dialysis patients from March 2019 until August 2021 using data from the Dutch nOcturnal and hoME dialysis Study To Improve Clinical Outcomes. The study period was divided into one pre-pandemic and six 3-month pandemic periods (period 1–period 6). Mental health was assessed with the Mental Component Summary score of the 12-item Short Form health survey and mental symptoms of the Dialysis Symptom Index.

Results
We included 1274 patients (968 on in-center hemodialysis and 306 on peritoneal dialysis). Mental Component Summary scores did not differ between in-center hemodialysis and peritoneal dialysis patients. In contrast, in-center hemodialysis patients more often reported nervousness during period 3 (27% vs 15%, P = 0.04), irritability and anxiety during period 3 (31% vs 18%, P = 0.03, 26% vs. 9%, P = 0.002, respectively) and period 4 (34% vs 22%, P = 0.04, 22% vs 11%, P = 0.03, respectively), and sadness in period 4 (38% vs 26%, P = 0.04) and period 5 (37% vs 22%, P = 0.009). Dialysis modality was independently associated with mental symptoms.

Conclusions
In-center hemodialysis patients more often experienced mental symptoms compared to peritoneal dialysis patients from September 2020 to June 2021, which corresponds to the second lockdown of the COVID-19 pandemic. Mental health-related quality-of-life did not differ between in-center hemodialysis and peritoneal dialysis patients.

Trial registration number
Netherlands Trial Register NL6519, date of registration: 22 August, 2017.

Graphical abstract