Treatment of Psychiatric Disorders in Chronic Kidney Disease Patients

Patients with chronic kidney disease (CKD) have a high rate of comorbid psychiatric conditions, including mood and anxiety disorders, substance use disorders, and eating disorders. Treatment of psychiatric disorders in CKD patients can be complicated by altered pharmacokinetics, unclear safety and efficacy of treatments, and lack of supporting evidence to guide treatment decisions. Furthermore, some psychiatric interventions may lead to renal complications, such as fluid and electrolyte disorders or worsening CKD. We review the evidence base regarding treatment of psychiatric disorders in CKD patients. We also present practical considerations regarding the management of psychiatric disorders in patients with CKD, including identifying candidates for therapy or mental health referral, the evidence for pharmacologic and nonpharmacologic therapy in CKD patients, the effects of CKD on psychiatric treatment, and consequences of these interventions that may prompt nephrology consultation.