Screening for Symptoms of Anxiety and Depression in Patients treated with renal replacement therapy Utility of the Edmonton Symptom Assessment System- Revised
Abstract Purpose: The Edmonton Symptom Assessment System-revised (ESASr) is widely used in clinical oncology to screen for physical and emotional symptoms. The performance of the anxiety and depression items (ESASr-A and ESASr-D, respectively) as screening tools has not been evaluated in patients treated with renal replacement therapy. Methods: Kidney transplant recipients and patients on dialysis were recruited in Toronto. Patients were classified as having moderate/severe depression and anxiety symptoms using the established cut-off score of ≥10 on the Patient Health Questionnaire-9 (PHQ-9) and the General Anxiety Disorder-7 (GAD-7) questionnaires. Results: This study included 931 participants; 62% male, mean age (SD) 55(16), and 52% White. All participants completed ESASr, however only 748 participants completed PHQ-9 and 769 participants completed GAD-7. Correlation between ESASr item scores and legacy scores were moderately strong (ESASr-D/PHQ-9: 0.61; ESASr-A/GAD-7: 0.64). We found good discrimination for moderate/severe depression and anxiety (area under the receiver operating characteristics curve [95%CI]: ESASr-D 0.82 [0.78-0.86]; ESASr-A 0.87 [0.82, 0.92]). The cut-off ≥2 for ESASr-D (Sensitivity = 0.76; Specificity = 0.77; Likelihood Ratio(LR)+ = 3.29; LR- = 0.31) and ≥4 for ESASr-A (Sensitivity = 0.75; Specificity = 0.87; LR+ = 5.76; LR- = 0.29) had the best combination of measurement characteristics. Conclusion: The identified ESASr-D and ESASr-A cut-off scores may be used to rule out patients without emotional distress with few false negatives. However, the low sensitivity identified in our analysis suggests that neither ESASr-D or ESASr-A are acceptable as standalone screening tools.