Virtual Cognitive Behavioral Therapy Solution Assists Dialysis Patients

Research from the University of Pittsburgh and the University of New Mexico found that the severity of common dialysis symptoms, such as low energy and pain, among chronic kidney disease (CKD) patients were lower following the addition of virtual cognitive behavioral therapy.

The Centers for Disease Control and Prevention (CDC) estimates that CKD affects over one in seven United States adults, or about 35.5 million people.

Although dialysis is available to those who develop severe forms of the disease, this treatment is associated with numerous side effects. These generally relate to fatigue, pain, and depression.

“Dialysis is a life-saving treatment, but it’s a huge burden and a major life change for patients and their families,” said lead author Manisha Jhamb, MD, associate professor in the Pitt School of Medicine’s Renal-Electrolyte Division, in a press release. “Many people are unable to work or enjoy life because of the demands of the treatment and the way it affects their physical and mental health.” 

To improve CKD patient lifestyle amid dialysis, Jhamb and her colleagues created the Technology Assisted Stepped Collaborative Care (TACcare) trial. This program provides patients with 12 weekly sessions of cognitive behavioral therapy through telehealth. Through TACcare, patients can set goals and customize care based on individual issues.

Researchers aimed to determine its ability to improve dialysis side effects in a study.

In partnership with Mark Unruh, MD, professor in the University of New Mexico School of Medicine’s Division of Nephrology, Jhamb recruited 160 patients for the study. All patients were from Pennsylvania or New Mexico, receiving dialysis, and experienced noticeable symptoms. Their average age was 58; 28 percent were Black, 13 percent were Native American, and 18 percent were Hispanic.

Also, because researchers were fearful that results could be based on increased attention from telehealth, they had a comparison group engage in weekly education sessions through telehealth as well.

Compared to the control group, those involved in TACcare experienced a 6 percent increase in energy levels and a 10 percent improvement in the severity of pain. Both improvements continued for six months after therapy. Further, researchers observed improvements in depression, though they were small.

The diverse study population also indicates that the intervention could be applicable across populations, researchers noted.

“These results are really promising and in the range seen by similar interventions for cancer patients,” said Jhamb in the press release. “Until now, analgesic medications for pain and recommendations for better sleep and exercise to address fatigue have been the main suggestions we’ve been able to offer our patients, and they haven’t been satisfactory.”

Various studies have indicated the efficacy of telehealth in improving patient outcomes.

A study from August 2022 indicated that a comprehensive telehealth approach helped enhance outcomes among patients with poorly controlled type 2 diabetes.

Researchers reached this conclusion after reviewing patients who received care through simple telehealth and a comprehensive telehealth approach. The simple telehealth approach consisted of only telemonitoring and care coordination, and the comprehensive telehealth approach included telemonitoring, self-management support, diet and activity support, medication management, and depression support.

Those in the comprehensive telehealth group experienced drops in hemoglobin A1C levels along with improved overall outcomes.