Research is required to estimate the prevalence of anxiety disorders including comorbid

depression in CKD and examine their influence on functioning and outcomes. Social support refers to an individuals’ perception of the availability and adequacy of social resources and characteristics of social networks. Access to social support has been consistently linked to improved health outcomes in various chronic diseases including CVD.[28] Cohort studies indicate that higher perceived social support predicts decreased risk of mortality,[10, 11, 29] and higher HRQOL in dialysis populations.[29] However, to our knowledge, there are no comparable prospective data in people with CKD. Limited cross-sectional analyses indicate that social support is positively associated with various domains Bortezomib price of HRQOL. For example, higher perceived social support (Multidimensional Scale of Perceived Social Support) has been associated with better BMS-354825 cost cognitive functioning and emotional well-being (Kidney Disease Quality of Life Short-form) in adults with CKD 4.[25] Further, Porter and colleagues found that higher perceived social support (Interpersonal Support

Evaluation List-16) was related to better mental and physical health (SF-36) in a cohort of African Americans with hypertensive CKD.[30] Religious or spiritual affiliation may also play a role in improving health outcomes via enhanced social networks and social support. For example, people who identify as religious or spiritual are often involved in religious communities and typically report higher perceived social support compared with those not identifying as religious.[31] In dialysis patients,

religiosity and spirituality are associated with less depression, greater social support[32] and appears to be an important determinant of HRQOL.[33] Rebamipide Of note, Spinale and colleagues found that higher levels of spirituality predicted improved survival in dialysis patients, with higher social support appearing to mediate this relationship.[34] While preliminary, these studies indicate that improving social networks and social support may be efficacious in people with CKD. The roles of religious and spiritual affiliation in the health of patients with kidney disease before and after dialysis initiation warrant further exploration. HRQOL describes the subjective assessment of the impact of disease and its treatment across the physical, psychological and social domains of functioning and well-being.[35] HRQOL is a marker of disease burden and may be used to assess treatment effectiveness and predict risk for adverse outcomes. Frequently cited dimensions of HRQOL in CKD include depression, anxiety, reduced social interaction, cognitive dysfunction, pain, sleep disturbance, reduced physical functioning, sexual dysfunction, and a reduced global perception of general health or overall quality of life.