Post-traumatic stress disorder (PTSD) is associated with increased cardiovascular risk, in part through effects on traditional risk factors such as hypertension. People with chronic kidney disease (CKD) have elevated cardiovascular risk and a unique cardiovascular risk factor profile compared to the general population. We assessed associations of cardiovascular risk factors with PTSD among men and women with CKD. In this cross-sectional study, we identified adults with incident non-dialysis CKD stages 3-5 from 2009 to 2020 in the Veterans Affairs healthcare system. Prevalent PTSD was defined by the use of at least two PTSD diagnosis codes within 12 months prior to incident CKD. Of 1,443,878 Veterans in the cohort, PTSD was prevalent in 18.5% of women and 9.6% of men, p < 0.0001. In multivariable models, younger age, Black race, hypertension, depression, anxiety, alcohol, and/or substance use disorder, the use of antidepressant medications other than selective serotonin reuptake inhibitors (SSRIs), and higher estimated glomerular filtration rate were associated with increased odds of PTSD in both men and women, with significant interactions by sex for each of these (interaction p < 0.001 for each), except for anxiety (interaction p = 0.11). SSRI antidepressant use was associated with PTSD among men but not women. PTSD was differentially associated with cardiovascular risk factors among men and women with CKD. Further studies of the mechanisms of cardiovascular risk in people with CKD should stratify by sex.

People with chronic obstructive pulmonary disease (COPD) face increased risk of social isolation and loneliness. However, social dimensions are frequently overlooked in respiratory care. We aimed to explore the role of social connection in living with COPD, including influences on health and function. We conducted a reflexive thematic analysis of semi-structured interviews with 19 people with COPD (median age 78 years [range 58-88]; 14 with severe airflow obstruction). Three themes were identified: social connection supports COPD self-management, the "triple threat" of COPD to social connection, and the inseparable nature of social health. Participants described how worsening symptoms, particularly breathlessness, contribute to disconnection through physical restrictions, psychological reactions, and societal unawareness, with negative impacts on self-management and wider physical and psychological health. We conclude that social connections become increasingly valuable, yet increasingly difficult to maintain, as COPD progresses. Supporting individuals to maintain connections within a biopsychosocial approach may unlock wider health benefits.

Multiple long-term conditions, and particularly mental health conditions, are common in adults with chronic kidney disease (CKD). Some mental health conditions increase the risk of developing CKD, contribute to faster disease progression, and complicate care experiences and outcomes. Depression and anxiety are particularly prevalent and are associated with reduced quality of life, unplanned service use and poorer clinical outcomes. The manner in which depression and anxiety are detected and managed as part of routine kidney care can vary widely. Evidence for effective and acceptable treatments is mixed overall, although meta-analyses highlight the benefits of physical activity and cognitive behavioural therapy. Data on the use of antidepressants in people with CKD are also variable, limited by the lack of robust clinical trials. People with particularly complex needs, such as those with severe mental illness and CKD, have markedly shorter lifespans and higher rates of emergency hospitalizations than those without severe mental illness and are also less likely to access specialist nephrology care and to receive a transplantation. Health inequalities are amplified for those contending with wider disadvantages related to social and structural determinants of health. Reducing the burden of mental health in people with CKD is an urgent priority to alleviate personal and health system impacts. Here, we examine current evidence on mental health and CKD to inform policy and research and to support advances in prevention and management approaches. This Review examines the bidirectional relationship between mental health conditions, particularly depression, anxiety and severe mental illness, and chronic kidney disease. The authors discuss the impact of these comorbid conditions; provide insights and recommendations on patient management, with a focus on integrated care; and highlight key research gaps.

INTRODUCTION:People with kidney failure receiving haemodialysis experience significantly high rates of depression. However, there is a lack of evidence on how to treat depression in this population. A significant barrier to effective treatment is the high treatment burden of haemodialysis, which makes additional appointments prohibitive. Behavioural activation (BA) is an evidence-based brief therapy for depression that has been delivered in a variety of different clinical settings. However, it has not previously been evaluated in the haemodialysis setting. METHODS:This study aims to evaluate the feasibility and acceptability of a cluster randomised controlled trial (cRCT) of intradialytic BA for people with kidney failure. The study consists of three main components: A pilot cRCT, where we will recruit 52 people who are receiving haemodialysis and experiencing symptoms of depression across two sites. Patients will be cluster-randomised to either BA or usual care and will be followed up for three months; a qualitative process evaluation using semi-structured interviews to explore the experiences of patients, healthcare professionals and carers; and a feasibility economic evaluation exploring the feasibility of collecting healthcare resource use data. RESULTS:Key findings will include the feasibility of screening and recruiting participants, participant retention, completion of clinical outcome measures, and the acceptability of the intervention. CONCLUSION:If feasible, the next step will be to conduct a definitive, adequately powered cRCT to determine the effectiveness of the intervention in this population, so that we can improve the identification and management of depression for people with kidney failure.

Background People with severe mental illness (SMI) are more likely to develop long-term physical health conditions compared with those without SMI, contributing to an inequality in life expectancy. Chronic kidney disease (CKD) is a growing global health concern set to be the fifth leading cause of life-years lost by 2040. Although people with SMI may have a higher risk of CKD, there is limited research exploring the relationship between CKD and SMI. Aims This review aimed to examine the prevalence, incidence and risk of CKD among people with SMI. Method We searched Medline, Embase, PsycINFO, CINAHL, Scopus and Web of Science for epidemiological research reporting the prevalence of CKD (of any stage according to Kidney Disease Improving Global Outcomes guidelines) among people with SMI. Records were imported into Covidence and screened by two reviewers. Meta-analyses were conducted using random-effects models to examine the prevalence, incidence and risk of CKD among people with SMI. Results Forty-eight studies were included in the review. The pooled prevalence of CKD was 8% in studies of people with SMI (95% CI 5%, 18%) and was highest in studies focused only on participants with bipolar disorder (95% CI 0.15 (0.06, 0.26)). The pooled incidence rate of CKD was 26.83 cases (95% CI 18.66, 38.58) per 1000 person-years. People with SMI had significantly higher odds of CKD compared with those without SMI (odds ratio 2.33 [95% CI 1.70, 3.21]). Conclusion People with SMI are at a significantly higher risk of having CKD compared with those without SMI. Although psychiatric medication and high rates of diabetes may play a role, the drivers of this inequality are under-researched.

Background Breathlessness has functional, psychological and social impacts. Loneliness is a health priority under-researched in relation to breathlessness, despite breathlessness impacting social interactions. Methods We estimated the prevalence of loneliness and associated characteristics in adults (≥50 years) with breathlessness in the English Longitudinal Study of Ageing (ELSA, 2010–11). Breathlessness was assessed using the adapted modified Medical Research Council Dyspnoea Scale from grade 0 (none) to 3 (stops on level due to breathlessness). Grade 4 was not assessed in ELSA. Loneliness was measured using the 3-Item University of California, Los Angeles Loneliness Scale (scores ≥6 = lonely). Logistic regression was adjusted for age, sex and ethnicity. Results Of the 8195 participants, 28.4% reported breathlessness and 19.3% were lonely. Greater breathlessness was associated with older age, female sex and lower wealth (p<0.001). Those with greater breathlessness were more likely to be lonely (16.3% for no breathlessness vs 34.9% for grade 3), live alone (18.2% vs 36.6%) and be unmarried (26.7% vs 45.7%) (all p<0.001). Greater breathlessness was associated with depressive symptoms, limiting longstanding illness, mobility issues (all p<0.001) and social isolation (p=0.012). Of those with worse breathlessness (graded 2–3, n=1149), 32.8% were lonely. Characteristics associated with loneliness in those with grade 2–3 breathlessness were female sex (OR 1.32, 95% CI 1.02 to 1.71), lower wealth (OR 2.75, 95% CI 1.63 to 4.64), no qualifications versus having a degree (OR 1.65, 95% CI 1.03 to 2.66), being unmarried (OR 3.45, 95% CI 2.64 to 4.52), living alone (OR 3.71, 95% CI 2.80 to 4.91), depressive symptoms (OR 1.58, 95% CI 1.47 to 1.69), limiting longstanding illness (OR 1.76, 95% CI 1.30 to 2.38), smoking (OR 1.42, 95% CI 1.04 to 1.97), difficulties with activities of daily living (OR 1.34, 95% CI 1.21 to 1.47) or mobility (OR 1.15, 95% CI 1.10 to 1.21). Age, ethnicity or social isolation was not significantly associated with loneliness in adults with breathlessness. Conclusions Adults with breathlessness are more likely to be lonely, especially those with lower socio-economic status, who are unmarried or live alone or who have poorer physical function. Findings highlight priority groups for loneliness interventions among adults with breathlessness.

Abstract Background Psychological distress is common in chronic kidney disease (CKD) and associated with reduced quality of life, treatment non-adherence, and worse clinical outcomes. Distress in CKD is also linked to difficulties adjusting to the demands of illness management. Despite this, psychological support remains inconsistently integrated within kidney care pathways, and existing interventions often lack clear theoretical specification and explicit targeting of mechanisms underpinning adjustment to CKD. Objectives To describe the systematic development of iADJUST, a theory-informed patient co-designed digital psychological intervention targeting key cognitive and behavioural mechanisms involved in adjustment to CKD. Methods Intervention development was guided by the Medical Research Council framework for complex interventions. A structured, iterative process integrated empirical evidence, psychological theory, and patient and public involvement and engagement. The Common-Sense Model of Self-Regulation and cognitive behavioural theories informed the identification of modifiable maintaining mechanisms associated with adjustment to CKD. Intervention components were mapped onto these mechanisms and refined through co-design with people living with CKD. Results iADJUST is a six-session self-guided digital psychological intervention delivered over 12 weeks and supplemented by therapist contact. The intervention targets illness-related uncertainty, fatigue-related activity dysregulation, catastrophic “what-if” thinking, self-critical evaluation, and behavioural withdrawal. It integrates psychoeducation, cognitive and behavioural strategies, maintenance planning, and elements from acceptance and commitment therapy and compassion-focused approaches. Content is delivered through video, audio, and guided tasks and activities. Conclusion iADJUST provides a theory-informed, evidence-based psychological intervention for CKD explicitly mapping intervention components to maintaining cognitive and behavioural mechanisms implicated in adjustment. Feasibility evaluation is underway.

BACKGROUND:This study investigated the association between body mindsets-established, but mutable beliefs a person holds about their body-with psychological distress in people with chronic kidney disease (CKD). METHODS:A cross-sectional, mixed methods survey was conducted in people with CKD at various stages of treatment. Participants completed the Patient Health Questionnaire-4 (PHQ-4) to capture distress, the Body Mindset Inventory (BMI), and qualitative free-text responses elaborating on their mindsets. Hierarchical regression models explored associations of body mindsets with psychological distress, controlling for demographic variables, treatment modalities, and comorbidities. RESULTS:Two hundred and thirty-two adults with CKD (62% female) completed the survey; 27.6% were receiving dialysis and 34.7% had received a kidney transplant. Those who more strongly endorsed the mindset that their Body is an Adversary reported greater psychological distress, while those who more strongly endorsed the mindsets that their Body is Capable or their Body is Responsive reported less psychological distress. Together, all three mindsets explained 12% unique variance in psychological distress, even after accounting for demographic factors, treatment modalities, and comorbidities. Mixed methods analyses illustrated the range of body mindsets in people with CKD, with some describing their body as "A ticking time bomb" and others stating "My body is a fighter just like me. My body is amazing." CONCLUSION:Mindsets about the body are significantly associated with psychological distress in people with CKD. These cross-sectional data provide a foundation for future longitudinal and interventional studies on the relationship between mindsets and distress outcomes in people living with CKD.

Depression and anxiety are common in chronic kidney disease (CKD) and worsen clinical outcomes. Psycho-behavioural interventions offer a promising, non-pharmacological approach. However, most evidence comes from people with kidney failure with distinct treatment needs, limiting relevance to earlier stages of CKD, where timely support may enhance self-management and slow progression. This systematic review evaluates the effectiveness of psycho-behavioural interventions in adults with CKD without dialysis or transplantation. We searched MEDLINE, EMBASE, PsycINFO, Cochrane Central, and Web of Science (inception–March 2025) for randomised controlled trials (RCTs) testing psycho-behavioural interventions in adults with CKD (not on kidney replacement therapy), with depression and/or anxiety as primary or secondary outcomes. Risk of bias (RoB-2) and certainty of evidence were assessed. Given methodological heterogeneity across studies, vote counting by effect size and narrative synthesis were applied. PROSPERO: CRD42024515733. Five RCTs (N = 631) met the inclusion criteria, evaluating cognitive behavioural therapy, self-efficacy training, mindfulness-based stress reduction, and physical activity, delivered digitally, by phone, or in person. Moderate-certainty evidence showed consistent improvements (100

OBJECTIVE:Pain acceptance predicts better quality of life, physical functioning, and treatment outcomes in youth with chronic pain. However, we know little about the factors that promote pain acceptance in youth. This study investigated body mindsets and their associations with facets of pain acceptance, specifically pain willingness and activity engagement, in adolescents with chronic pain. METHODS:The sample comprised 102 adolescents with chronic musculoskeletal pain (aged: 8 to 17; 72.3% female, 49.5% Caucasian/White) attending a tertiary pain clinic. Hierarchical linear regression analyses examined associations of body mindsets with pain acceptance, controlling for demographic factors, pain and mental health symptoms, and basic functioning. RESULTS:There was significant variation in the mindsets that adolescents with chronic pain held about their bodies-some endorsed the mindset that their Body is an Adversary, others endorsed the mindsets that their Body is Responsive or Body is Capable. Hierarchical linear regression analyses indicated that endorsing the mindset that their Body is an Adversary was associated with lower willingness to experience pain, while endorsing the mindset that their Body is Capable was associated with greater engagement in valued activities despite pain, even after accounting for demographic factors, pain characteristics, and basic functioning. Together, all 3 mindsets explained 6.6% to 26.8% unique variance in pain acceptance. DISCUSSION:Body mindsets are significantly associated with pain acceptance in youth with chronic pain, even after controlling for pain characteristics and basic functioning. Experimental research should investigate whether body mindsets are modifiable in this population and whether they could represent interventional targets fostering pain acceptance.

Background People with severe mental illness (SMI) are more likely to develop long-term physical health conditions, including type 2 diabetes and cardiovascular disease, compared to people without SMI. This contributes to an inequality in life expectancy known as the ‘mortality gap’. Chronic kidney disease (CKD) is a growing global health concern set to be the 5th leading cause of life-years lost by 2040. However, there is limited research exploring the relationship between CKD and SMI. This systematic review will aim to examine the prevalence and incidence of CKD among people with SMI. Methods We will search Medline, Embase, PsycINFO, CINAHL, Scopus and Web of Science for primary epidemiological research reporting the prevalence or incidence of CKD among people with SMI in any setting. Retrieved records will be managed in Covidence and screened by two independent reviewers. Data will be extracted from included studies using a piloted data extraction form, and the quality of studies will be evaluated using the appropriate JBI Critical Appraisal Checklist. The certainty of evidence will be assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. Data from the included studies will be narratively synthesised. Meta-analyses will be conducted using random effects models to examine the prevalence and incidence of CKD among people with SMI. Discussion There is limited research exploring the relationship between CKD and SMI, and this proposed systematic review will be the first to examine the prevalence of CKD among people with SMI. This review will highlight the extent of the problem and provide a foundation for future research to improve health outcomes for people with SMI.

Background In the UK, booster COVID-19 vaccinations have been recommended biannually to people considered immune vulnerable. We investigated, at a population level, whether the absence of detectable anti-SARS-CoV-2 spike protein IgG antibody (anti-S Ab) following three or more vaccinations in immunosuppressed individuals was associated with greater risks of infection and severity of infection. Methods In this prospective cohort study using UK national disease registers, we recruited participants with solid organ transplants (SOTs), rare autoimmune rheumatic diseases (RAIRDs), and lymphoid malignancies. All participants were tested for anti-S Ab using a lateral flow immunoassay, completed a questionnaire on sociodemographic and clinical characteristics, and were followed up for 6 months using linked data from the National Health Service in England. SARS-CoV-2 infection was primarily defined using UK Health Security Agency data and supplemented with hospitalisation and therapeutics data, and hospitalisation due to SARS-CoV-2 was defined as an admission within 14 days of a positive test. Findings Between Dec 7, 2021, and June 26, 2022, we recruited 21 575 participants. Anti-S Ab was detected in 6519 (77.0%) of 8466 participants with SOTs, 5594 (85.9%) of 6516 with RAIRDs, and 5227 (79.3%) of 6593 with lymphoid malignancies. COVID-19 infection was recorded in 3907 (185%) participants, with 556 requiring a COVID-19-related hospital admission and 17 dying within 28 days of infection. Rates of infection varied by sociodemographic and clinical characteristics but, in adjusted analysis, having detectable anti-S Ab was independently associated with a reduced incidence of infection, with incident rate ratios (IRRs) of 0.69 (95% CI 0.65-0.73) in the SOT cohort, 0.57 (0.49-0.67) in the RAIRD cohort, and 0.62 (0.54-0.71) in the lymphoid malignancy cohort. In adjusted analysis, having detectable anti-S Ab was also associated with a reduced incidence of hospitalisation, with IRRs of 0.40 (0.35-0.46) in the SOT cohort, 0.32 (0.22-0.46) in the RAIRD cohort, and 0.41 (0.29-0.58) in the lymphoid malignancy cohort. Interpretation All people with immunosuppression require ongoing access to COVID-19 protection strategies. Assessment of anti-S Ab responses, which can be performed at scale, can identify people with immunosuppression who remain most at risk, providing a mechanism to further individualise protection approaches. Copyright (c) 2025 The Author(s). Published by Elsevier Ltd.

Unspecified kidney donors (UKDs) increase the number of high-quality kidneys available for transplantation. This study aimed to determine whether the practice was acceptable, based on the noninferiority of donor physical and psychosocial outcomes when compared to specified kidney donors (SKDs). This longitudinal, prospective cohort study investigated potential living kidney donors from across all 23 UK adult kidney transplant centers. Participants completed validated questionnaires at 4 time points (recruitment, 2-4 weeks predonation, 3- and 12-months postdonation). Clinical outcome data were collected from National Health Service Blood and Transplant. Three hundred seventy-three (of 837 recruited; 45.7%) went on to donate (November 2016 to January 2021). There were no differences in donation rates (204 SKDs [54.7%] vs 169 UKDs [45.3%]; P = .944). Both groups reported being motivated by the desire to help someone (P = .157). Tests for noninferiority indicated that UKDs do no worse than SKDs on psychosocial or clinical outcomes over 12 months, and costs are similar (P > .05). This is the world's largest prospective observational study comparing SKDs and UKDs. It demonstrates no differences in primary motivation, donation rates, regret, cost, or psychosocial and physical outcomes. These data should reassure transplant professionals and potential donors and can bolster confidence in the practice around the world.

Preparing for an organ transplant is about more than medical treatment. It is about finding out what the surgery is all about, and how it will be performed by the surgeon and their team. It is also about helping to prepare the patient’s body and mind to be as healthy as possible before surgery, and to prepare them to live well with a newly transplanted organ after surgery. Transplant prehabilitation is a lifestyle treatment that involves keeping fit and active, having good mental health, and eating a healthy and balanced diet. In this article, you will learn about the research that has been done to explore prehabilitation, and discover different ways to improve fitness, support good mental health, and eat well so that the body is in the best possible shape for organ transplant surgery.

Depression and anxiety are commonly experienced by people with chronic kidney disease (CKD). This study aimed to evaluate person- and service-level factors associated with depression and anxiety symptoms. We sought to also understand utilisation of mental health treatments and preferences for future psychological support. An online survey recruited participants from six UK kidney services with varying levels of psychosocial provision. The survey was also advertised on social media. Participants completed screening questionnaires for depression and anxiety, alongside questions about mental health history, self-efficacy, treatment and support. The study included adults (18 years or older) living with CKD (stages 3b and above) or those receiving any form of Kidney Replacement Therapy (KRT), including individuals with a functioning kidney transplant. Eligible participants had to complete study measures and be proficient in reading and writing in either English or Welsh, as the survey was administered in these languages. This survey was developed with our Patient and Public Involvement group and was administered from January 2023 until 31st January, 2024 using Qualtrics and RedCap. Four hundred fifty-eight people completed the survey. Moderate-severe symptoms of depression and anxiety were 37.7

Background In people living with polycystic kidney disease (PKD), physical inactivity may contribute to poor health-related quality of life (HRQoL). To date, no research has elucidated the impact of a PKD-specific physical activity programme on HRQoL and physical health. This substudy of the Kidney BEAM Trial evaluated the impact of a PKD-specific 12-week educational and physical activity digital health intervention for people living with PKD.Methods This study was a mixed-methods, single-blind, randomized waitlist-controlled trial. Sixty adults with a diagnosis of PKD were randomized 1:1 to the intervention or a waitlist control group. Primary outcome was difference in the Kidney Disease QoL Short Form 1.3 Mental Component Summary (KDQoL-SF1.3 MCS) between baseline and 12 weeks. Six participants completed individualized semi-structured interviews.Results All 60 individuals (mean 53 years, 37% male) were included in the intention-to-treat analysis. At 12 weeks, there was a significant difference in mean adjusted change in KDQoL MCS score between the intervention group and waitlist control [4.2 (95% confidence interval 1.0-7.4) arbitrary units, P = .012]. Significant between-group differences in KDQoL subscales-burden of kidney disease (P = .034), emotional wellbeing (P = .001) and energy/fatigue (P = .001)-were also achieved. There was no significant between-group difference in KDQoL PCS scores (P = .505). Per-protocol analyses revealed significant between group differences in the PAM-13 patient activation score (P = .010) and body mass (P = .027). Mixed-methods analyses revealed key influences of the programme, including opportunities for peer support and to build on new skills and knowledge, as well as the empowerment and self-management.Conclusion A PKD-specific digital health educational and physical activity intervention is acceptable and has the potential to improve HRQoL. Further research is needed to better understand how specific education and lifestyle management may help to support self-management behaviour.

OBJECTIVES:Research has linked diet to negative psychological states, but its influence on positive psychological well-being remains understudied. This study assessed the association between dietary intake of fruits and vegetables (F&V), polyunsaturated fats (PUFAs), and fish on three domains of positive well-being: eudemonic, happiness, and life satisfaction in middle-aged and older adults. DESIGN:A cross-sectional analytical sample of 3013 participants from Wave 9 (2018/19) of the English Longitudinal Study of Ageing (ELSA). METHODS:Multivariate linear regression assessed the association between diet and positive psychological well-being, adjusted for covariates including total energy intake, age, gender, ethnicity, wealth, education, living alone, social isolation, limiting long-standing illness, and depressive symptoms. RESULTS:In minimally adjusted models, F&V and fish intake were positively associated with all three domains of well-being, while PUFAs intake was positively associated with eudemonic well-being and happiness, but not life satisfaction. The positive associations between F&V intake and eudemonic well-being, and between fish intake and happiness, remained significant in all models (β = .043, 95% CI [.037, .212], p = .005; β = .033, 95% CI [.011, .243], p = .032, respectively), whereas others became non-significant after adjusting for certain covariates. CONCLUSIONS:Diet may be associated with positive psychological well-being in middle-aged and older adults. Increasing dietary intake of F&V, PUFAs, and fish could support well-being and may be encouraged through public or private initiatives aimed at making healthy diets accessible and affordable. Longitudinal studies are needed to clarify the influence of diet on well-being over time.