Posttraumatic Embitterment Disorder in Patients with Chronic Kidney Disease
Kyungsoo Lee 1, Chi-Un Pae 2, 3, 4*, Ho Chul Song 1, Euy Jin Choi 1, Yong Kyun Kim 1, 4
1Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea, 2Department of Psychiatry, the Catholic University of Korea College of Medicine, Seoul, Republic of Korea, 3Department of psychiatry and behavioral sciences, Duke Medical Center, Durham, NC, USA, 4Cell Death Disease Research Center, College of Medicine, The Catholic University of Korea, Seoul, Korea
Received: November 8, 2017; Revised: November 14, 2017; Accepted: November 21, 2017; Published online: November 21, 2017.
© The Korean College of Neuropsychopharmacology. All rights reserved.

Abstract
Objectives: Posttraumatic embitterment disorder (PTED), a subgroup of an adjustment disorder, is a feeling with anger and helplessness. Hemodialysis (HD) may be a trigger event leading to PTED. We investigated the prevalence of PTED in patients with each categorized stages of chronic kidney disease (CKD) and the association between PTED and depression and functional impairment.
Methods: Patients were categorized into three groups according to the stages of CKD (Stage I-II, III-IV, and V). CKD Stage (I-II) group was defined as estimated glomerular filtration rate (eGFR) > 60 ml/min/1.73 m2, CKD Stage (III-IV) group as eGFR <60 ml/min/1.73 m2, and CKD Stage (V) group as CKD stage V including patients ongoing hemodialysis. Patients were assessed for the prevalence of PTED, depression, and decreased quality of life by using the scale of PTED, PHQ-9, and EQ-5D-VAS, respectively.
Results: A total of 445 patients were analyzed. The number of patients in CKD (I-II) was 166, CKD (III-IV) was 172, and CKD (V) was 107. Multivariate analysis by binomial logistic regression demonstrated that CKD (V) was significantly associated with the prevalence of PTED (OR 4.13, 95% CI, 1.56-15.6, P = 0.006) after adjustment for age, gender, and diabetes mellitus. Also, a significant correlation existed between PTED and EQ-5D-VAS in all stages, but the correlation was nonsignificant between PTED and PHQ-9 score in group CKD (V).
Conclusions: The findings suggest that PTED is underdiagnosed in CKD patients. Acknowledgment and diagnosis of PTED in CKD patients may lead to a better quality of life.
Keywords: Posttraumatic Embitterment Disorder, Hemodialysis, depression, quality of life, chronic ki


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