Mental health and addiction service utilization among people living with chronic kidney disease

Background. Mental health problems, particularly anxiety and depression, are common in patients with chronic kidney disease (CKD) and negatively impact quality of life, treatment adherence and mortality. However, the degree to which mental health and addiction services are utilized by those with CKD is unknown. We examined the history of mental health and addiction service use of individuals across levels of kidney function. Methods. We performed a population-based cross-sectional study using linked healthcare databases from Ontario, Canada from 2009 to 2017. We abstracted the prevalence of individuals with mental health and addiction service use within the previous 3 years across levels of kidney function [estimated glomerular filtration rate (eGFR) >= 60, 45 to <60, 30 to <45, 15 to <30, <15 ml/min/1.73 m(2) and maintenance dialysis]. We calculated prevalence ratios (PRs) to compare prevalence across kidney function strata, while adjusting for age, sex, year of cohort entry, urban versus rural location, area-level marginalization and Charlson comorbidity index. Results. Of 5 956 589 adults, 9% (n = 534 605) had an eGFR <60 ml/min/1.73 m(2) or were receiving maintenance dialysis. Fewer individuals with an eGFR <60 ml/min/1.73 m(2) had a history of any mental health and addiction service utilization (crude prevalence range 28-31%) compared with individuals with an eGFR >= 60 ml/min/1.73 m(2) (35%). Compared with an eGFR >= 60 ml/min/1.73 m(2), the lowest prevalence of individuals with any mental health and addiction service utilization was among those with an eGFR of 15 to <30 ml/min/1.73 m(2) {adjusted PR 0.86 [95% confidence interval (CI) 0.85 to 0.88]}, an eGFR <15 ml/min/1.73 m(2) [adjusted PR 0.81 (95% CI 0.76-0.86)] and those receiving maintenance dialysis [adjusted PR 0.83 (95% CI 0.81-0.84)]. Less use of outpatient services accounted for differences in service utilization. Conclusions. Mental health and addiction service utilization is common but less so in individuals with advanced CKD in Ontario, Canada.