Prevalence of Anxiety and Its Impact on Hemodynamic Parameters in Patients Undergoing Kidney Biopsy

Prevalence of Anxiety and Its Impact on Hemodynamic Parameters in Patients Undergoing Kidney Biopsy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Prevalence of Anxiety and Its Impact on Hemodynamic Parameters in Patients Undergoing Kidney Biopsy Kittiphan Chienwichai, Sirin Jiwakanon, Kamonrat Chaiviriyawong, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5963719/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Preprocedural anxiety remains understudied in patients undergoing kidney biopsy despite its potential to impact hemodynamic stability and procedural outcomes. This study aimed to evaluate the prevalence of anxiety, its associated factors, and its effects on hemodynamic parameters in patients undergoing percutaneous kidney biopsy. A prospective observational study was conducted at a tertiary hospital in Thailand, enrolling 151 adult patients. Anxiety was assessed 24 hours before the procedure using the validated Thai State-Trait Anxiety Inventory Y1, with a score of 40 or higher indicating anxiety. Hemodynamic parameters, including blood pressure and pulse rate, were measured at baseline and 30 minutes before the biopsy. The prevalence of preprocedural anxiety was 55%, with 43.4% of anxious patients reporting very high anxiety. Anxiety status was not an independent predictor of hemodynamic changes. However, higher serum creatinine and a history of prior kidney biopsy were significantly associated with anxiety. This study highlights the high prevalence of preprocedural anxiety among patients undergoing kidney biopsy and underscores the need for structured preprocedural anxiety assessments in clinical practice. Although anxiety did not significantly alter hemodynamic parameters, future studies should explore its potential role in post-biopsy complications to optimize patient management and procedural safety. Health sciences/Nephrology/Kidney Health sciences/Risk factors kidney biopsy preprocedural anxiety hemodynamic parameters STAI-Y1 Figures Figure 1 Figure 2 Introduction Despite advances in non-invasive biochemical and imaging investigation in nephrology, percutaneous kidney biopsy remains a gold standard method for diagnosing various kidney diseases 1 , 2 . Biopsy rates have increased over time 3 , 4 , with reported incidences ranging from 10 to 200 per million people per year 5 . Clinical guidelines recommend ultrasound-guided kidney biopsies to minimize complications related to the procedure 6 . Nonetheless, complications such as pain at the biopsy site, hematoma, hematuria, the need for blood transfusions, or interventions to manage bleeding can still occur. Severe complications, including death, are rare and occur in approximately 0.06% of patients 7 . In Thailand, the most common kidney pathologies are lupus nephritis and IgA nephropathy 8 . Post-biopsy complications occur in 3.3% of cases 9 . Among these complications, gross hematuria (2–11%) 9,10 and perinephric hematoma (1–5%) 9,10 are the most prevalent. Furthermore, kidney biopsies are typically performed while patients are awake and under local anesthesia, which may induce stress and anxiety before and during the procedure 11 . Other nephrology-related interventions, such as arteriovenous fistula (AVF) creation 12 and cannulation of AVF 13 , have been linked to anxiety. However, evidence linking kidney biopsies to increased patient anxiety remains limited. Anxiety is defined as a subjective state of emotional uneasiness, distress, apprehension, or fear associated with autonomic and somatic features, which can impair functioning or activity 14 . The magnitude of preoperative anxiety among patients undergoing a procedure varies based on factors such as gender 15 , preoperative information 15 , type of procedure 16 , socioeconomic status 17 , 18 , and the patient’s country of origin 14 , 19 , 20 . Identifying risk factors helps healthcare providers offer psychological support, anxiolytic medication, or interventions during preoperative visits and procedures to reduce stress. Preprocedural anxiety has several clinical implications. In patients undergoing major surgery, high preoperative anxiety levels increase morbidity 21 and mortality 22 , 23 . Additionally, elevated preoperative anxiety levels are associated with more significant postoperative pain 24 , 25 and more extended hospital stays 25 , 26 . Anxiety can also cause autonomic disturbances such as an increased heart rate, higher blood pressure, and arrhythmia 15 , 27 , 28 . Elevated blood pressure, in particular, is a known risk factor for bleeding after a kidney biopsy 29 and is a common reason for postponing the procedure. Consequently, high levels of anxiety in patients undergoing a kidney biopsy may contribute to a higher risk of postprocedural complications and delays in scheduling the procedure. The extent of anxiety levels before kidney biopsy remains poorly documented. This study aims to examine the prevalence of preprocedural anxiety among patients undergoing kidney biopsy at a tertiary center in Thailand. Additionally, we examine the association between baseline demographic factors and anxiety levels, as well as the impact of anxiety on hemodynamic parameters before kidney biopsy. We hypothesize that preprocedural anxiety is high and comparable to that experienced by patients undergoing surgery, driven by the fear of kidney disease and the risk of bleeding associated with the procedure. Method Adult patients (aged 18 years and older) admitted for percutaneous kidney biopsy were included in this prospective observational study, conducted from June 2023 to January 2025 at the Department of Nephrology, Hatyai Hospital, Thailand. The exclusion criteria included the inability to complete a self-assessment questionnaire, a history of kidney transplant, pregnancy, and the use of concurrent medications (such as analgesics or anxiolytics) within 72 hours prior to the assessment. Additionally, patients with pre-existing psychiatric conditions, such as anxiety disorders or depression, were excluded from the study. This exclusion was implemented to focus specifically on anxiety related to the kidney biopsy procedure and to minimize confounding effects from pre-existing psychiatric conditions that might not be directly associated with the procedure. This study was carried out in accordance with the Declaration of Helsinki. The study protocol (Thai Clinical Trials Registry, TCTR20240526005) was approved by the Institutional Review Board of Hatyai Hospital (HYH EC 030-66-01). All patient data were analyzed anonymously, and written informed consent was obtained from all patients or their legal guardians, as applicable. Kidney biopsy protocol After the nephrologist assesses the clinical indications and contraindications for a kidney biopsy, the nurse coordinator schedules the procedure for the patient. A trained nurse provides patients with detailed information about the kidney biopsy procedure, covering its process, potential risks and benefits, and care required before, during, and after the procedure. Contraindications for kidney biopsy include known bleeding disorders, thrombocytopenia (platelet count 160 mmHg or diastolic blood pressure (DBP) > 100 mmHg), or morbid obesity (body mass index > 40 kg/m²). For patients with poorly controlled hypertension, the procedure is postponed, and the treating physician is notified to adjust the antihypertensive medications before rescheduling the biopsy. If the patient takes antiplatelet or anticoagulant medications, these are held before the biopsy: at least 7 days for aspirin and 5 days for P2Y12 receptor blockers or anticoagulants. Patients requiring elective percutaneous kidney biopsy are instructed to fast overnight for 8 hours. Pre-biopsy evaluations include a complete blood count, prothrombin time, partial thromboplastin time, blood type, and cross-matching. Patients are admitted the day before the procedure and monitored for at least 24 hours afterward. An interventional radiologist performs the biopsy using a 16-gauge automated spring-loaded device under real-time ultrasound guidance. Patients do not receive anxiolytics or sedation before or after the procedure. Routine imaging is performed immediately after the biopsy to assess for hematoma formation, with follow-up imaging conducted only if clinically indicated. The patient’s blood pressure, cardiac rhythm, and oxygen saturation are continuously monitored during the procedure. Post-biopsy, patients remain in bed, lying on their backs, for a 24-hour observation period. During this time, clinical signs (e.g., gross hematuria, flank pain, or hypotension) and ultrasound evaluations (e.g. presence, size, and location of hematomas) are performed as needed to identify potential bleeding complications. The nurse who measured blood pressure and recorded clinical data was blinded to the results of the anxiety assessment. Hemodynamic assessment To evaluate the effect of anxiety status on hemodynamic parameters, patients’ blood pressure and pulse rate will be recorded during their outpatient department (OPD) visit before the kidney biopsy. Additionally, these measurements will be retaken 30 minutes before the procedure using an automated office blood pressure device. Continuous monitoring was not performed due to resource limitations and the need to maintain a practical clinical workflow. Anxiety assessment Patient anxiety assessment before kidney biopsy was conducted using the State-Trait Anxiety Inventory Y1 (STAI-Y1) 30 , which was translated into Thai and validated by Kunthonluxamee et al. 31 with a Cronbach’s α of 0.88. The STAI Form Y is the definitive instrument for measuring anxiety in adults 32 and has been used in several studies 21 , 33 . Furthermore, the inventory’s simplicity makes it ideal for evaluating individuals with lower educational backgrounds 32 . Subjects were asked to rate the intensity of their anxiety on 20 items using a self-report questionnaire. Each item was scored on a 4-point scale: “not at all,” "somewhat," “moderately so,” or “very much so.” The total score ranged from 20 to 80. STAI-Y1 values of \(\:\ge\:\:\) 40 defined the presence of clinically significant anxiety. The STAI-Y1 was administered 24 hours before the kidney biopsy upon hospital admission for the procedure. Statistical analysis Patients were categorized into two groups based on STAI-Y1 scores: the Anxiety group (STAI-Y1 ≥ 40) and the Non-Anxiety group (STAI-Y1 < 40). Categorical variables are presented as numbers and percentages, and differences between the two groups were assessed using the chi-square test or Fisher’s exact test, as appropriate. Continuous variables were summarized as means and standard deviations or medians and interquartile ranges, depending on distribution normality. Differences between groups were evaluated using the Student’s t-test for normally distributed data or the Wilcoxon rank-sum test for non-normally distributed data. To test the hypothesis that anxiety impacts hemodynamic parameters, as measured by the change in blood pressure and pulse rate from the OPD visit (baseline) to 30 minutes before kidney biopsy (pre-biopsy), we will use a mixed-effects model for repeated measures (MMRM). This model is well-suited for longitudinal data and accounts for within-subject correlations. Fixed effects in the model will include the anxiety group (anxiety vs. non-anxiety), time (baseline vs. pre-biopsy), and covariates such as sex, age, BMI, and serum creatinine. In addition, the number of antihypertensive drugs will be included as a fixed effect to adjust for baseline hypertension and its severity, thereby refining the estimates for systolic and diastolic blood pressure. For the pulse rate analysis, beta blocker usage will be included as an adjustment variable. An interaction term between the anxiety group and time will be included to evaluate whether changes in blood pressure over time differ by anxiety status. A random intercept for each patient will be incorporated to account for within-subject correlations across repeated measures. An unstructured variance-covariance matrix will be used to model the correlations among repeated measurements within the same patient, providing flexibility in capturing the correlation pattern. This approach will allow us to assess whether anxiety levels significantly influence the change in blood pressure from baseline to pre-biopsy while controlling for potential confounders. We will also perform a subgroup analysis to examine whether the effect of anxiety on hemodynamic parameters differs by antihypertensive drug use. In this analysis, the variable representing the number of antihypertensive drugs in the MMRM will be replaced with a categorical indicator that reflects whether patients are on antihypertensive medication. To investigate factors associated with anxiety, we employed a logistic regression model. Variables with a p-value < 0.1 in univariate analyses (including sex, age, and other relevant factors) were subsequently entered into a multivariable logistic regression model. Statistical significance was defined as p < 0.05. The sample size calculation was based on an expected prevalence of 0.85 34 and a margin of error 0.05. Given that our hospital is expected to perform kidney biopsies on 350 patients during the study period, the required sample size was determined to be 145 35 . All statistical analyses were conducted using the statistical software package R (R Core Team, 2024) 36 , with a significance level (α) set at 5%. Result Figure 1 illustrates the patient flow in the study. Between June 2023 and January 2025, 345 patients underwent kidney biopsies. Of these, 151 completed the questionnaires, and 141 subsequently had their biopsies performed; 10 patients had their biopsies canceled (7 due to severe hypertension and 3 due to dyspnea). Four patients were excluded due to pre-existing psychiatric disorders: 2 with depressive disorder and 2 with anxiety disorder. Using an STAI-Y1 score of ≥ 40 to define anxiety, 55.0% (83/151) of patients reported experiencing anxiety. Among those with anxiety, 56.6% (47/83) exhibited a high level of anxiety (STAI-Y1 40–49), while 43.4% (36/83) displayed very high anxiety (STAI-Y1 ≥ 50). The mean score on the STAI was 32.0 ± 5.6 for the Non-Anxiety group compared to 47.3 ± 5.8 for the Anxiety group. This difference was statistically significant (p < 0.001). Baseline characteristics (Table 1 ) were generally comparable between the Anxiety (n = 83) and Non-Anxiety (n = 68) groups. The groups did not differ significantly in age (median, 42 vs. 45 years; p = 0.304), sex (54.2% vs. 60.3%; p = 0.342), or BMI (23.3 vs. 25.1 kg/m²; p = 0.552). However, a significantly lower proportion of patients in the anxiety group was married (65.1% vs. 80.9%; p = 0.048), and a greater percentage had undergone a previous kidney biopsy (26.5% vs. 8.8%; p = 0.010). While baseline SBP, DBP, and pulse rate were similar between the groups, the Anxiety group showed significantly higher blood urea nitrogen levels (30 vs. 21 mg/dL; p = 0.001) and serum creatinine levels (1.85 vs. 1.15 mg/dL; p = 0.031). There were no significant differences in estimated glomerular filtration rate or hemoglobin levels between the two groups. Table 1 Baseline demographic data for included patients by Anxiety Status Variable Anxiety Group (STAI-Y1 ≥ 40; n = 83) Non-Anxiety Group (STAI-Y1 < 40; n = 68) P Value Age, years 42 [30.5–54] 45 [33.2–54] 0.304 Female, n (%) 45 (54.2) 41 (60.3) 0.342 BMI, kg/m² 23.3 [21.0–27.7] 25.1 [22.0–28.0] 0.552 Married, n (%) 54 (65.1) 55 (80.9) 0.048 Education, n (%) 0.975 Illiterate 2 (2.4) 2 (2.9) Elementary School 25 (30.1) 19 (27.9) High School 37 (44.6) 34 (50.0) Bachelor’s Degree 17 (20.5) 12 (17.6) Master’s Degree 2 (2.4) 1 (1.5) Unemployed, n (%) 33 (39.8) 27 (39.7) 1.000 Previous Kidney Biopsy, n (%) 22 (26.5) 6 (8.8) 0.010 Comorbid Conditions, n (%) Hypertension 38 (53.1) 36 (46.3) 0.509 Diabetes Mellitus 25 (69.1) 18 (73.1) 0.725 Dyslipidemia 17 (26.9) 19 (21.0) 0.520 Chronic Kidney Disease 35 (43.2) 22 (32.8) 0.262 Systemic Lupus Erythematosus 18 (22.2) 19 (28.4) 0.505 Number of Antihypertensive Drugs 2 [1–3.0] 2 [1–3.8] 0.714 Beta Blocker Use, n (%) 18 (77.8) 14 (78.9) 1.000 Receive antihypertensive medication 69 (85.2) 55 (83.3) 0.937 Systolic BP, mmHg 135 [126–153] 140 [128–151] 0.383 Diastolic BP, mmHg 81 [71–79] 83 [72–93] 0.587 Pulse Rate, per Minute 80 [70–93] 80 [71–92] 0.940 Indication for Kidney Biopsy, n (%) 0.525 Acute Nephritis 22 (27.2) 15 (22.1) Nephrotic Syndrome 48 (59.3) 42 (61.8) Non-Nephrotic Range Proteinuria 8 (9.9) 5 (7.4) Others 3 (3.7) 6 (8.8) Blood Urea Nitrogen, mg/dL 30 [19–51] 21 [15–30] 0.001 Serum Creatinine, mg/dL 1.85 [0.88–4.25] 1.15 [0.85–2.43] 0.031 eGFR, ml/min/1.73 m² 43.7 [12.9–91.3] 55.2 [25.8–85.7] 0.231 Hemoglobin, g/dL 10.2 [8.7–12.0] 10.4 [8.9–13.0] 0.256 Data are presented as median [interquartile range] or number (percent). Abbreviations: BMI, body mass index; BP, blood pressure; eGFR, estimated glomerular filtration rate; STAI, State-Trait Anxiety Inventory. Impact of anxiety on hemodynamic parameter Table 2 presents the mixed-effects model results evaluating the impact of anxiety on hemodynamic parameters. For SBP, the model estimated an increase of 4.29 mmHg from baseline to pre‐biopsy (95% CI − 1.66 to 10.22, p = 0.159), which was not statistically significant (Fig. 2 A). Similarly, the main effect of anxiety on SBP was − 2.16 mmHg (95% CI − 9.35 to 5.02, p = 0.562), and the interaction between time and anxiety was also non-significant (− 1.48 mmHg, 95% CI − 9.37 to 6.44, p = 0.715). Table 2 Mixed-Effects Model Results for Hemodynamic Parameters Variable SBP, mmHg (95% CI) † P value DBP, mmHg (95% CI) † P value Pulse rate, bpm (95% CI) ‡ P value Time 4.29 (− 1.66 to 10.22) 0.159 5.45 (1.47 to 9.43) 0.008 −0.42 (− 5.21 to 4.37) 0.863 Anxiety −2.16 (− 9.35 to 5.02) 0.562 −3.04 (− 7.72 to 1.65) 0.212 −1.55 (− 7.02 to 3.91) 0.584 Time x Anxiety −1.48 (− 9.37 to 6.44) 0.715 −3.23 (− 8.52 to 2.07) 0.235 0.17 (− 6.21 to 6.54) 0.958 Note: Values are presented as the estimated effect (with 95% confidence intervals) and corresponding p values. Abbreviations: SBP, systolic blood pressure; DBP, diastolic blood pressure; bpm, beats per minute. † Mixed‐Effects Model Results for blood pressure are adjusted for age, sex, BMI, serum creatinine, and number of antihypertensive drugs. ‡ Mixed‐Effects Model Results for pulse rate are adjusted for age, sex, BMI, serum creatinine, and beta-blocker use. In contrast, DBP significantly increased over time, rising 5.45 mmHg (95% CI 1.47 to 9.43, p = 0.008) from baseline to pre-biopsy (Fig. 2 B). However, neither the main effect of anxiety nor the time-by-anxiety interaction reached statistical significance for DBP. Similarly, no significant effects were observed for pulse rate for time, anxiety, or their interaction. In the subgroup analysis, the main effect of anxiety did not significantly alter blood pressure. Specifically, the effect of anxiety was associated with a − 2.4 mmHg difference in SBP (95% CI: −9.6 to 4.8, p = 0.523) and a − 3.1 mmHg difference in DBP (95% CI: −7.8 to 1.6, p = 0.208). Similarly, no significant effect of anxiety was observed on pulse rate (− 1.4 bpm difference; 95% CI: −6.9 to 4.2, p = 0.639). Factors associated with anxiety Table 3 summarizes the factors related to anxiety among the study participants. Univariate analysis indicated that demographic factors such as female sex, age, and BMI were not significantly associated with anxiety. Similarly, clinical factors, including hypertension, diabetes mellitus, and dyslipidemia, demonstrated no significant associations. In contrast, marital status was significantly associated with anxiety, with married patients showing lower odds (OR 0.44, 95% CI 0.20–0.92, p = 0.033) compared to single patients. Furthermore, a history of previous kidney biopsy was significantly linked to higher odds of anxiety (OR 3.73, 95% CI 1.49–10.69, p = 0.008), and increased serum creatinine levels were also significantly correlated with anxiety (OR 1.24, 95% CI 1.06–1.50, p = 0.014). Table 3 Factors associated with anxiety among the study patients: Univariate and Multivariate Analysis Univariate analysis Multivariate analysis Variable Odds ratio 95% CI p value Odds ratio 95% CI P value Female 0.78 0.41–1.49 0.453 0.91 0.43–1.92 0.812 Age (years) 0.99 0.97–1.01 0.299 0.99 0.97–1.02 0.499 BMI (kg/m²) 0.99 0.94–1.05 0.799 Hypertension 0.76 0.40–1.45 0.409 Diabetes mellitus 1.22 0.60–2.51 0.594 Dyslipidemia 0.72 0.34–1.55 0.403 Marital status Single reference Married 0.44 0.20–0.92 0.033 0.59 0.23–1.44 0.252 Education, n (%) Illiterate reference Elementary School 1.32 0.15–11.79 0.793 High School 1.09 0.12–9.48 0.934 Bachelor’s Degree 1.42 0.15–13.20 0.744 Master’s Degree 2.00 0.09–69.06 0.661 Employment status Employed reference Unemployed 1.00 0.52–1.94 0.995 Previous kidney biopsy 3.73 1.49–10.69 0.008 4.28 1.64–12.72 0.004 Indication of kidney biopy Others reference Acute nephritis 2.93 0.67–15.67 0.169 Nephrotic syndrome 2.29 0.57–11.34 0.263 Hematuria or non-nephrotic range proteinuria 3.20 0.57–21.47 0.200 Serum creatinine (mg/dL) 1.24 1.06–1.50 0.014 1.29 1.07–1.59 0.012 Urine protein creatinine ratio 1.00 0.99–1.00 0.930 Abbreviations: BMI, body mass index; OPD, outpatient department. After adjusting for potential confounders, multivariate analysis confirmed that serum creatinine remained a significant predictor of anxiety (OR 1.29, 95% CI 1.07–1.59, p = 0.012). A history of previous kidney biopsy was independently associated with anxiety (OR 4.28, 95% CI 1.64–12.72, p = 0.004). However, marital status showed no association with anxiety. Discussion Our prospective cohort study shows a high prevalence of preprocedural anxiety among patients undergoing kidney biopsy, with 55% of respondents meeting the threshold for clinically significant anxiety. Notably, anxiety did not significantly affect overall hemodynamic parameters; however, DBP increased notably from the OPD visit to immediately before the kidney biopsy. Additionally, multivariate analysis identified higher serum creatinine levels and a history of previous kidney biopsy as significant factors associated with anxiety. To our knowledge, no prospective cohort study has evaluated the prevalence of anxiety in patients undergoing kidney biopsy. A previous randomized trial conducted in Italy examined the effect of music therapy on anxiety in this population, including a total of 80 patients 34 . Notably, all participants in that study had STAI-Y1 scores exceeding 40, measured 30 minutes before the kidney biopsy procedure. The difference in prevalence between our study and the previous study may be attributed to several factors, including differences in the timing of anxiety evaluation 37 , 38 , socioeconomic status 39 , the patient’s country of origin 14 , 19 , 20 , doctor-patient communication 40 , social support 18 , and clinical practices (e.g., the information provided about the procedure and its associated risks) 41 . The physiological response to anxiety involves heightened sympathetic nervous system (SNS) activity coupled with reduced parasympathetic nervous system (PNS) activity 34 . Overactivation of the SNS can result in adverse effects such as arterial and venous constriction, increased myocardial stimulation, and bronchoconstriction 34 . In contrast, the PNS facilitates relaxation by triggering the release of acetylcholine through the vagus nerve, which in turn helps modulate heart function 34 . Based on this physiological response and previous studies showing that preoperative anxiety is associated with higher blood pressure in patients awaiting surgery 42 , we speculate that anxiety may play an essential role in elevating blood pressure before kidney biopsy. Contrary to our speculation, our study shows that anxiety did not significantly impact physiological parameters during biopsy. This finding is consistent with a previous study of surgical patients 43 , 44 , although other studies have reported different results 45 – 47 . Moreover, our subgroup analysis indicates that this absence of effect is not due to patients receiving antihypertensive medication. Several factors may explain these results. First, anxiety was assessed 24 hours before the biopsy, which may not capture the acute anxiety experienced immediately before or during the procedure. Studies have shown that anxiety levels are highest when assessed closer to the time of surgery 37 , 38 . Second, hemodynamic parameters were measured at only two-time points, potentially missing transient anxiety-related changes. Blood pressure varibility and heart rate variability may be a more precise measure for assessing autonomic nervous system activity associated with anxiety 47 , 48 . Third, the small sample size may have resulted in insufficient statistical power to detect clinically significant effects of anxiety. Additionally, anxiety may not be the sole factor influencing physiological responses; other psychological aspects—such as depression, stress, personal attitudes, or personality traits—may also play important roles. Anxiety can acutely elevate blood pressure—often referred to as white-coat hypertension—which typically manifests as a spike in SBP 49 . In our study, although both SBP and DBP increased from the OPD visit to the pre-biopsy measurement, only DBP reached statistical significance. We cannot definitively explain this selective effect. One possibility is that our limited, two-point measurement (OPD vs. pre-biopsy) may have missed transient SBP spikes. As mentioned above, assessing blood pressure variability or heart rate variability may be a more suitable alternative for evaluating the effect of anxiety on hemodynamic parameters 47 , 48 . Only a prior kidney biopsy and elevated serum creatinine are associated with anxiety. A past kidney biopsy may trigger anxiety for two reasons: first, patients might fear their ongoing abnormal kidney function necessitating another biopsy, and second, they may have had an unpleasant experience during the previous procedure 49 . Elevated serum creatinine is related to anxiety, as patients worry about their biopsy results and the potential implications for their long-term kidney health. Our study results have several implications. First, our findings indicate that the prevalence of anxiety in patients undergoing kidney biopsy is high and comparable to that of patients undergoing surgery 14 , 50 . However, this anxiety is often overlooked, possibly because there is limited data about anxiety in this specific population. Although clinical guidelines recommend that patients and their caregivers receive education and information about renal biopsies to alleviate anxiety 6 , there are no specific recommendations on how to assess or manage anxiety before a kidney biopsy. Second, the factors associated with anxiety in patients undergoing kidney biopsy may be distinct from those associated with other procedures. In many surgical procedures, a history of prior anesthesia or surgical exposure has been shown to reduce the risk of preoperative anxiety 50 . However, in the case of kidney biopsy, a history of a previous kidney biopsy appears to increase preprocedural anxiety. This suggests that the target population for interventions aimed at reducing preprocedural anxiety in kidney biopsy patients may differ from those in other procedures. Our study has several limitations. First, we did not use objective evidence such as electrical skin potential 51 , urine catecholamines 52 , or plasma catecholamine 53 to measure anxiety levels. Instead, we relied solely on the STAI-Y1, which is inherently subjective and has not been specifically validated for patients undergoing kidney biopsy. However, the STAI-Y1 is the most widely used instrument in studies aiming to measure the severity of anxiety 54 . Future studies should consider supplementing the STAI-Y1 with additional validated instruments, such as the Amsterdam Preoperative Anxiety and Information Scale (APAIS) 55 or the Generalized Anxiety Disorder-7 (GAD-7) scale 56 , along with objective measures, to provide a more comprehensive assessment of anxiety. Second, the STAI-Y1 assessment was conducted 24 hours before the kidney biopsy, primarily capturing anticipatory anxiety rather than immediate fear. Fear, characterized by an acute response to an imminent threat, may have a stronger and more direct effect on hemodynamic parameters. Future studies should consider incorporating repeated assessments closer to the procedure to evaluate both anxiety and fear. Third, our study sample size is small, which may limit its statistical power to detect the clinical significance of anxiety in elevating blood pressure. Fourth, as an observational study, the relationship between prior kidney biopsy, elevated serum creatinine, and anxiety may be confounded rather than causal. Although we adjusted for variables such as sex, age, comorbidities, education, and laboratory measurements, we could not account for other potential confounders, including negative previous experiences, health literacy, socioeconomic status, and psychological factors such as fear and depression. Fifth, we acknowledge the challenges in adhering to standardized blood pressure measurement protocols. As a result, this study relies on office blood pressure measurements, which may introduce some limitations in measurement reliability. Sixth, the exclusion of patients with psychiatric illnesses may limit the generalizability of our findings, as these conditions are prevalent and could influence both anxiety levels and hemodynamic parameters. By excluding these patients, we may have underestimated the true prevalence of anxiety and its impact on blood pressure in the broader population undergoing kidney biopsy. Seventh, the timing of hemodynamic measurements, which were taken at only two-time points, may have missed brief anxiety-related variations in blood pressure and heart rate. Continuous monitoring would provide a more comprehensive assessment of hemodynamic changes associated with anxiety. Finally, our study was conducted in a tertiary center in Thailand, a middle-income country, which may limit its generalizability to other settings. Despite these limitations, a key strength of our study is that it is the first prospective cohort study specifically designed to assess the prevalence of anxiety before kidney biopsy. In conclusion, this study highlights the high prevalence of preprocedural anxiety among patients undergoing kidney biopsy, with higher serum creatinine levels and a history of previous biopsies identified as key contributing factors. While anxiety did not significantly impact overall hemodynamic parameters, the observed increase in diastolic blood pressure from baseline to pre-biopsy suggests a potential physiological stress response. These findings underscore the need for structured preprocedural anxiety assessments. Future research should explore the potential link between anxiety and post-kidney biopsy bleeding complications. Declarations Acknowledgments: We thank all the study teams and patients who participated in our study. Author Contributions: KC led the trial design, with contributions from SJ, KC, JW, TS, PM, SS, AC, and SP. SP and TS acquired, analyzed, and interpreted the data. SS and KC analyzed the data. KC, AC, SP, and TS designed and conceptualized the study, interpreted the data and critically revised the manuscript for important intellectual content. All authors have reviewed and approved the final version of the manuscript. All authors attest to the accuracy and completeness of the data and confirm that the study was conducted in accordance with the approved protocol. Data Availability Statement: The deidentified individual participant data collected during the study and a data dictionary defining each field in the dataset will be made available to researchers who propose to use the data for individual patient data meta-analysis. Requests for data access can be directed to the corresponding author at [email protected] Funding: This study did not receive any external funding. Competing interests The authors declare no competing interests. References Najafian, B., Lusco, M. A., Alpers, C. E. & Fogo, A. B. Approach to Kidney Biopsy: Core Curriculum 2022. 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SAGE Open Med 7 , 2050312119849770 (2019). https://doi.org:10.1177/2050312119849770 Toal, M. et al. 'Was my kidney biopsy worth it?'-A qualitative phenomenological study of patient experiences and perceived barriers to kidney biopsy. PLoS One 19 , e0310358 (2024). https://doi.org:10.1371/journal.pone.0310358 Cimen, S. G. et al. Listening to music during arteriovenous fistula surgery alleviates anxiety: A randomized single-blind clinical trial. World J Transplant 10 , 79-89 (2020). https://doi.org:10.5500/wjt.v10.i4.79 Ibrahim, M. B., Abdelaal Badawi, S. E. & Alameri, R. A. Assessment of Pain and Anxiety During Arteriovenous Fistula Cannulation Among Hemodialysis Patients: A Cross-Sectional Study in Saudi Arabia. J Multidiscip Healthc 15 , 705-718 (2022). https://doi.org:10.2147/jmdh.S344256 Bedaso, A., Mekonnen, N. & Duko, B. Prevalence and factors associated with preoperative anxiety among patients undergoing surgery in low-income and middle-income countries: a systematic review and meta-analysis. BMJ Open 12 , e058187 (2022). https://doi.org:10.1136/bmjopen-2021-058187 Mulugeta, H., Ayana, M., Sintayehu, M., Dessie, G. & Zewdu, T. Preoperative anxiety and associated factors among adult surgical patients in Debre Markos and Felege Hiwot referral hospitals, Northwest Ethiopia. BMC Anesthesiology 18 , 155 (2018). https://doi.org:10.1186/s12871-018-0619-0 Maheshwari, D. & Ismail, S. Preoperative anxiety in patients selecting either general or regional anesthesia for elective cesarean section. J Anaesthesiol Clin Pharmacol 31 , 196-200 (2015). https://doi.org:10.4103/0970-9185.155148 Y.B, W., G.L, F., H.T, Y. & A.G, H. Prevalence and factors associated with preoperative anxiety among elective surgical patients at University of Gondar Hospital. Gondar, Northwest Ethiopia, 2017. A cross-sectional study. International Journal of Surgery Open 10 , 21-29 (2018). https://doi.org:https://doi.org/10.1016/j.ijso.2017.11.001 Kok, X. L. F., Newton, J. T., Jones, E. M. & Cunningham, S. J. Social support and pre-operative anxiety in patients undergoing elective surgical procedures: A systematic review and meta-analysis. J Health Psychol 28 , 309-327 (2023). https://doi.org:10.1177/13591053221116969 Duivenvoorden, T. et al. Anxiety and depressive symptoms before and after total hip and knee arthroplasty: a prospective multicentre study. Osteoarthritis Cartilage 21 , 1834-1840 (2013). https://doi.org:10.1016/j.joca.2013.08.022 Bedaso, A. & Ayalew, M. Preoperative anxiety among adult patients undergoing elective surgery: a prospective survey at a general hospital in Ethiopia. Patient Saf Surg 13 , 18 (2019). https://doi.org:10.1186/s13037-019-0198-0 Kassahun, W. T. et al. The effect of preoperative patient-reported anxiety on morbidity and mortality outcomes in patients undergoing major general surgery. Scientific Reports 12 , 6312 (2022). https://doi.org:10.1038/s41598-022-10302-z Székely, A. et al. Anxiety Predicts Mortality and Morbidity After Coronary Artery and Valve Surgery—A 4-Year Follow-Up Study. Biopsychosocial Science and Medicine 69 , 625-631 (2007). https://doi.org:10.1097/PSY.0b013e31814b8c0f Williams, J. B. et al. Preoperative Anxiety as a Predictor of Mortality and Major Morbidity in Patients Aged >70 Years Undergoing Cardiac Surgery. American Journal of Cardiology 111 , 137-142 (2013). https://doi.org:10.1016/j.amjcard.2012.08.060 Pinto, P. R., McIntyre, T., Nogueira-Silva, C., Almeida, A. & Araújo-Soares, V. Risk factors for persistent postsurgical pain in women undergoing hysterectomy due to benign causes: a prospective predictive study. J Pain 13 , 1045-1057 (2012). https://doi.org:10.1016/j.jpain.2012.07.014 Ali, A. et al. The effect of preoperative anxiety on postoperative analgesia and anesthesia recovery in patients undergoing laparascopic cholecystectomy. Journal of Anesthesia 28 , 222-227 (2014). https://doi.org:10.1007/s00540-013-1712-7 Oteri, V., Martinelli, A., Crivellaro, E. & Gigli, F. The impact of preoperative anxiety on patients undergoing brain surgery: a systematic review. Neurosurgical Review 44 , 3047-3057 (2021). https://doi.org:10.1007/s10143-021-01498-1 Yuzkat, N., Soyalp, C., Turk, O., Keskin, S. & Gulhas, N. Effects of showing the operating room on preoperative anxiety and hemodynamics among patients with hypertension: A randomized controlled trial. Clinical and Experimental Hypertension 42 , 553-558 (2020). https://doi.org:10.1080/10641963.2020.1723619 Tully, P. J. et al. Anxiety, depression, and stress as risk factors for atrial fibrillation after cardiac surgery. Heart & Lung 40 , 4-11 (2011). https://doi.org:https://doi.org/10.1016/j.hrtlng.2009.12.010 Kriegshauser, J. S. et al. Risk of Bleeding after Native Renal Biopsy as a Function of Preprocedural Systolic and Diastolic Blood Pressure. Journal of Vascular and Interventional Radiology 26 , 206-212 (2015). https://doi.org:https://doi.org/10.1016/j.jvir.2014.10.020 State-Trait Anxiety Inventory: Bibliography . 2nd ed. edn, (Consulting Psychologists Press, 1989). Kunthonluxamee, A., Pitimana-aree, S. & Laurujisawat, P. Validity and Reliability of the Amsterdam Preoperative Anxiety and Information Scale (APAIS); Thai version in adult Thai pre-operative patients. Journal of the Psychiatric Association of Thailand 54 , 83-92 (2013/03/28). Bansal, T. & Joon, A. Preoperative anxiety-an important but neglected issue: A narrative review. The Indian Anaesthetists Forum 17 , 37-42 (2016). https://doi.org:10.4103/0973-0311.195955 Hermes, D., Matthes, M. & Saka, B. Treatment anxiety in oral and maxillofacial surgery. Results of a German multi-centre trial. J Craniomaxillofac Surg 35 , 316-321 (2007). https://doi.org:10.1016/j.jcms.2007.03.004 Giordano, F. et al. Effect of music therapy intervention on anxiety and pain during percutaneous renal biopsy: a randomized controlled trial. Clinical Kidney Journal 16 , 2721-2727 (2023). https://doi.org:10.1093/ckj/sfad246 Cochran, W. G. Sampling Techniques . 3rd ed. edn, (John Wiley & Sons, 1977). R: A Language and Environment for Statistical Computing (R Foundation for Statistical Computing, 2024). Goyal, P. et al. Assessment of perioperative anxiety levels at three time-points during hospital stay in patients undergoing elective surgery. Perioperative Medicine 14 , 27 (2025). https://doi.org:10.1186/s13741-025-00504-0 Kumar, A., Dubey, P. K. & Ranjan, A. Assessment of Anxiety in Surgical Patients: An Observational Study. Anesth Essays Res 13 , 503-508 (2019). https://doi.org:10.4103/aer.AER_59_19 Yüksel, A. & Bahadir-Yilmaz, E. The effect of sociodemographic factors on anxiety, depression, and perceived social support in patients with internal medicine and surgical problems. Perspectives in Psychiatric Care 56 , 837-843 (2020). https://doi.org:https://doi.org/10.1111/ppc.12499 Nikumb, V. B., Banerjee, A., Kaur, G. & Chaudhury, S. Impact of doctor-patient communication on preoperative anxiety: Study at industrial township, Pimpri, Pune. Ind Psychiatry J 18 , 19-21 (2009). https://doi.org:10.4103/0972-6748.57852 McDonald, S., Page, M. J., Beringer, K., Wasiak, J. & Sprowson, A. Preoperative education for hip or knee replacement. Cochrane Database Syst Rev 2014 , Cd003526 (2014). https://doi.org:10.1002/14651858.CD003526.pub3 Chunhui, L. et al. ASSA13-14-26 Preoperative Anxiety is Associated with Higher Blood Pressure in Patients Waiting For Surgery. Heart 99 , A66-A66 (2013). https://doi.org:10.1136/heartjnl-2013-303992.203 Ahmetovic-Djug, J., Hasukic, S., Djug, H., Hasukic, B. & Jahic, A. Impact of Preoperative Anxiety in Patients on Hemodynamic Changes and a Dose of Anesthetic During Induction of Anesthesia. Med Arch 71 , 330-333 (2017). https://doi.org:10.5455/medarh.2017.71.330-333 Ayasrah, S. M. & Ahmad, M. M. Educational Video Intervention Effects on Periprocedural Anxiety Levels Among Cardiac Catheterization Patients: A Randomized Clinical Trial. Res Theory Nurs Pract 30 , 70-84 (2016). https://doi.org:10.1891/1541-6577.30.1.70 Tadesse, M., Ahmed, S., Regassa, T., Girma, T. & Mohammed, A. The hemodynamic impacts of preoperative anxiety among patients undergoing elective surgery: An institution-based prospective cohort study. International Journal of Surgery Open 43 , 100490 (2022). https://doi.org:https://doi.org/10.1016/j.ijso.2022.100490 Kim, W. S., Byeon, G. J., Song, B. J. & Lee, H. J. Availability of preoperative anxiety scale as a predictive factor for hemodynamic changes during induction of anesthesia. Korean J Anesthesiol 58 , 328-333 (2010). https://doi.org:10.4097/kjae.2010.58.4.328 Farbood, A., Sahmeddini, M. A., Bayat, S. & Karami, N. The effect of preoperative depression and anxiety on heart rate variability in women with breast cancer. Breast Cancer 27 , 912-918 (2020). https://doi.org:10.1007/s12282-020-01087-y Shahimi, N. H. et al. Association between mental illness and blood pressure variability: a systematic review. Biomed Eng Online 21 , 19 (2022). https://doi.org:10.1186/s12938-022-00985-w Eberhart, L. et al. Preoperative anxiety in adults - a cross-sectional study on specific fears and risk factors. BMC Psychiatry 20 , 140 (2020). https://doi.org:10.1186/s12888-020-02552-w Abate, S. M., Chekol, Y. A. & Basu, B. Global prevalence and determinants of preoperative anxiety among surgical patients: A systematic review and meta-analysis. International Journal of Surgery Open 25 , 6-16 (2020). https://doi.org:https://doi.org/10.1016/j.ijso.2020.05.010 NISBET, H. I. A., NORRIS, W. & BROWN, J. OBJECTIVE MEASUREMENT OF SEDATION IV: THE MEASUREMENT AND INTERPRETATION OF ELECTRICAL CHANGES IN THE SKIN. BJA: British Journal of Anaesthesia 39 , 798-805 (1967). https://doi.org:10.1093/bja/39.10.798 Martinez, L. R., von Euler, C. & Norlander, O. P. The sedative effect of premedication as measured by catecholamine excretion. Br J Anaesth 38 , 780-786 (1966). https://doi.org:10.1093/bja/38.10.780 Fell, D. et al. Measurement of plasma catecholamine concentrations. An assessment of anxiety. Br J Anaesth 57 , 770-774 (1985). https://doi.org:10.1093/bja/57.8.770 Julian, L. J. Measures of anxiety: State-Trait Anxiety Inventory (STAI), Beck Anxiety Inventory (BAI), and Hospital Anxiety and Depression Scale-Anxiety (HADS-A). Arthritis Care Res (Hoboken) 63 Suppl 11 , S467-472 (2011). https://doi.org:10.1002/acr.20561 Moerman, N., van Dam, F. S., Muller, M. J. & Oosting, H. The Amsterdam Preoperative Anxiety and Information Scale (APAIS). Anesth Analg 82 , 445-451 (1996). https://doi.org:10.1097/00000539-199603000-00002 Zigmond, A. S. & Snaith, R. P. The hospital anxiety and depression scale. Acta Psychiatr Scand 67 , 361-370 (1983). https://doi.org:10.1111/j.1600-0447.1983.tb09716.x Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5963719","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":440528279,"identity":"f4638467-266d-46d4-a3dc-b624cbd1ec3f","order_by":0,"name":"Kittiphan Chienwichai","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABFklEQVRIiWNgGAWjYBACCWYgkcBwAMRmAzIY5BgYGBsYeBgkgAI8OLQwMzYgazFGaGHDoYUBqIUBpgUIEhsYYObj0CLZzn/8wcMdd+TNGZifPXhQcSe9f3Zz24c3DBZ5DPK9B7BpkQY5LPHMM8OdDWzmBglnnuXOuHOweeYcBoliBja+BGxa5MBa2g4zbjjAwyYBZORukEhsZgb6JbGBjccAnxZ7iJZ/h9MNCGmRhmpJhGhpOJxAUItkM7PhjMQzh5M3HGYzk0g4dtgQ5BfGOUCNbWw5WLVInD/44OPPHYdtNxxvfib5o+awPP/s9scMbyrqEvuZz2DVAgagmGFghpsCIgyg0YRXC8JifEpHwSgYBaNgJAIAjo5d6Ce1xTEAAAAASUVORK5CYII=","orcid":"","institution":"Hatyai Hospital","correspondingAuthor":true,"prefix":"","firstName":"Kittiphan","middleName":"","lastName":"Chienwichai","suffix":""},{"id":440528280,"identity":"d0f3b7eb-28aa-400c-8b48-0bc7497423bc","order_by":1,"name":"Sirin Jiwakanon","email":"","orcid":"","institution":"Hatyai Hospital","correspondingAuthor":false,"prefix":"","firstName":"Sirin","middleName":"","lastName":"Jiwakanon","suffix":""},{"id":440528281,"identity":"a21cb18e-aa12-43ac-ac93-6f73963470b4","order_by":2,"name":"Kamonrat Chaiviriyawong","email":"","orcid":"","institution":"Hatyai Hospital","correspondingAuthor":false,"prefix":"","firstName":"Kamonrat","middleName":"","lastName":"Chaiviriyawong","suffix":""},{"id":440528282,"identity":"37fc1feb-9566-4614-a43b-d3ecfac8c4e5","order_by":3,"name":"Jananya Wattanakul","email":"","orcid":"","institution":"Hatyai Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jananya","middleName":"","lastName":"Wattanakul","suffix":""},{"id":440528283,"identity":"ec9a2aee-8a98-4fe7-82c3-6e8a41f7a720","order_by":4,"name":"Thanapong Sungworawongpana","email":"","orcid":"","institution":"Hatyai Hospital","correspondingAuthor":false,"prefix":"","firstName":"Thanapong","middleName":"","lastName":"Sungworawongpana","suffix":""},{"id":440528284,"identity":"0af9ab1c-7e70-4947-a293-5f21fde55839","order_by":5,"name":"Sorawat Sangkaew","email":"","orcid":"","institution":"Hatyai Hospital","correspondingAuthor":false,"prefix":"","firstName":"Sorawat","middleName":"","lastName":"Sangkaew","suffix":""},{"id":440528285,"identity":"7bf6545a-7d89-4e2b-b5cc-2a6039795cdd","order_by":6,"name":"Arunchai Chang","email":"","orcid":"","institution":"Hatyai Hospital","correspondingAuthor":false,"prefix":"","firstName":"Arunchai","middleName":"","lastName":"Chang","suffix":""},{"id":440528286,"identity":"1c540dbc-5e5d-4f3f-b5c2-863dd54babeb","order_by":7,"name":"Pannawat Mongkolrattanakul","email":"","orcid":"","institution":"Phanatnikhom Hospital","correspondingAuthor":false,"prefix":"","firstName":"Pannawat","middleName":"","lastName":"Mongkolrattanakul","suffix":""},{"id":440528287,"identity":"aa373717-f694-4499-b788-62c00ae0c7d4","order_by":8,"name":"Songklod Pakdeejit","email":"","orcid":"","institution":"Hatyai Hospital","correspondingAuthor":false,"prefix":"","firstName":"Songklod","middleName":"","lastName":"Pakdeejit","suffix":""}],"badges":[],"createdAt":"2025-02-05 08:23:30","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5963719/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5963719/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":80297025,"identity":"29ef51c2-5be6-4da3-adea-86f1c9a29bf2","added_by":"auto","created_at":"2025-04-10 08:39:00","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":88534,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePatient Flow Diagram\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFlowchart depicting the selection process of study patients.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5963719/v1/260b48c24d4adab60f93fffe.png"},{"id":80297027,"identity":"f0f0d093-0b77-4aee-8bb9-d0c70b47ca94","added_by":"auto","created_at":"2025-04-10 08:39:01","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":38384,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSystolic and Diastolic Blood Pressure Changes in Patients Undergoing Kidney Biopsy, Stratified by Anxiety Status\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLeast-squares mean changes in systolic blood pressure (SBP; Panel A) and diastolic blood pressure (DBP; Panel B) from baseline (outpatient visit) to pre-biopsy (30 minutes before the procedure), stratified by anxiety status (clinically significant anxiety: STAI-Y1 ≥40 vs. non-anxiety: STAI-Y1 \u0026lt;40). Error bars represent 95% confidence intervals derived from mixed-effects models adjusted for age, sex, BMI, serum creatinine, and number of antihypertensive drugs.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5963719/v1/431792d8e193d5b25baf6b78.png"},{"id":81183881,"identity":"908efc2b-71ff-4247-9541-83d0db51d48a","added_by":"auto","created_at":"2025-04-23 08:02:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1477524,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5963719/v1/0253f788-3f2a-477e-bf8e-e102d1a75a10.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence of Anxiety and Its Impact on Hemodynamic Parameters in Patients Undergoing Kidney Biopsy","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDespite advances in non-invasive biochemical and imaging investigation in nephrology, percutaneous kidney biopsy remains a gold standard method for diagnosing various kidney diseases\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. Biopsy rates have increased over time\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e, with reported incidences ranging from 10 to 200 per million people per year\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. Clinical guidelines recommend ultrasound-guided kidney biopsies to minimize complications related to the procedure\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. Nonetheless, complications such as pain at the biopsy site, hematoma, hematuria, the need for blood transfusions, or interventions to manage bleeding can still occur. Severe complications, including death, are rare and occur in approximately 0.06% of patients\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. In Thailand, the most common kidney pathologies are lupus nephritis and IgA nephropathy\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. Post-biopsy complications occur in 3.3% of cases\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. Among these complications, gross hematuria (2\u0026ndash;11%)\u003csup\u003e9,10\u003c/sup\u003e and perinephric hematoma (1\u0026ndash;5%)\u003csup\u003e9,10\u003c/sup\u003e are the most prevalent. Furthermore, kidney biopsies are typically performed while patients are awake and under local anesthesia, which may induce stress and anxiety before and during the procedure\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. Other nephrology-related interventions, such as arteriovenous fistula (AVF) creation\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e and cannulation of AVF\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e, have been linked to anxiety. However, evidence linking kidney biopsies to increased patient anxiety remains limited.\u003c/p\u003e \u003cp\u003eAnxiety is defined as a subjective state of emotional uneasiness, distress, apprehension, or fear associated with autonomic and somatic features, which can impair functioning or activity\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. The magnitude of preoperative anxiety among patients undergoing a procedure varies based on factors such as gender\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e, preoperative information\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e, type of procedure\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e, socioeconomic status\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e, and the patient\u0026rsquo;s country of origin\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. Identifying risk factors helps healthcare providers offer psychological support, anxiolytic medication, or interventions during preoperative visits and procedures to reduce stress.\u003c/p\u003e \u003cp\u003ePreprocedural anxiety has several clinical implications. In patients undergoing major surgery, high preoperative anxiety levels increase morbidity\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e and mortality\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e,\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. Additionally, elevated preoperative anxiety levels are associated with more significant postoperative pain\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e,\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e and more extended hospital stays\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e,\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. Anxiety can also cause autonomic disturbances such as an increased heart rate, higher blood pressure, and arrhythmia\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e,\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e. Elevated blood pressure, in particular, is a known risk factor for bleeding after a kidney biopsy\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e and is a common reason for postponing the procedure. Consequently, high levels of anxiety in patients undergoing a kidney biopsy may contribute to a higher risk of postprocedural complications and delays in scheduling the procedure.\u003c/p\u003e \u003cp\u003eThe extent of anxiety levels before kidney biopsy remains poorly documented. This study aims to examine the prevalence of preprocedural anxiety among patients undergoing kidney biopsy at a tertiary center in Thailand. Additionally, we examine the association between baseline demographic factors and anxiety levels, as well as the impact of anxiety on hemodynamic parameters before kidney biopsy. We hypothesize that preprocedural anxiety is high and comparable to that experienced by patients undergoing surgery, driven by the fear of kidney disease and the risk of bleeding associated with the procedure.\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003eAdult patients (aged 18 years and older) admitted for percutaneous kidney biopsy were included in this prospective observational study, conducted from June 2023 to January 2025 at the Department of Nephrology, Hatyai Hospital, Thailand. The exclusion criteria included the inability to complete a self-assessment questionnaire, a history of kidney transplant, pregnancy, and the use of concurrent medications (such as analgesics or anxiolytics) within 72 hours prior to the assessment. Additionally, patients with pre-existing psychiatric conditions, such as anxiety disorders or depression, were excluded from the study. This exclusion was implemented to focus specifically on anxiety related to the kidney biopsy procedure and to minimize confounding effects from pre-existing psychiatric conditions that might not be directly associated with the procedure.\u003c/p\u003e \u003cp\u003e This study was carried out in accordance with the Declaration of Helsinki. The study protocol (Thai Clinical Trials Registry, TCTR20240526005) was approved by the Institutional Review Board of Hatyai Hospital (HYH EC 030-66-01). All patient data were analyzed anonymously, and written informed consent was obtained from all patients or their legal guardians, as applicable.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eKidney biopsy protocol\u003c/h2\u003e \u003cp\u003eAfter the nephrologist assesses the clinical indications and contraindications for a kidney biopsy, the nurse coordinator schedules the procedure for the patient. A trained nurse provides patients with detailed information about the kidney biopsy procedure, covering its process, potential risks and benefits, and care required before, during, and after the procedure. Contraindications for kidney biopsy include known bleeding disorders, thrombocytopenia (platelet count\u0026thinsp;\u0026lt;\u0026thinsp;100,000/mm\u0026sup3;), hydronephrosis, poorly controlled hypertension (systolic blood pressure (SBP)\u0026thinsp;\u0026gt;\u0026thinsp;160 mmHg or diastolic blood pressure (DBP)\u0026thinsp;\u0026gt;\u0026thinsp;100 mmHg), or morbid obesity (body mass index\u0026thinsp;\u0026gt;\u0026thinsp;40 kg/m\u0026sup2;).\u003c/p\u003e \u003cp\u003eFor patients with poorly controlled hypertension, the procedure is postponed, and the treating physician is notified to adjust the antihypertensive medications before rescheduling the biopsy. If the patient takes antiplatelet or anticoagulant medications, these are held before the biopsy: at least 7 days for aspirin and 5 days for P2Y12 receptor blockers or anticoagulants.\u003c/p\u003e \u003cp\u003ePatients requiring elective percutaneous kidney biopsy are instructed to fast overnight for 8 hours. Pre-biopsy evaluations include a complete blood count, prothrombin time, partial thromboplastin time, blood type, and cross-matching. Patients are admitted the day before the procedure and monitored for at least 24 hours afterward.\u003c/p\u003e \u003cp\u003eAn interventional radiologist performs the biopsy using a 16-gauge automated spring-loaded device under real-time ultrasound guidance. Patients do not receive anxiolytics or sedation before or after the procedure. Routine imaging is performed immediately after the biopsy to assess for hematoma formation, with follow-up imaging conducted only if clinically indicated. The patient\u0026rsquo;s blood pressure, cardiac rhythm, and oxygen saturation are continuously monitored during the procedure. Post-biopsy, patients remain in bed, lying on their backs, for a 24-hour observation period. During this time, clinical signs (e.g., gross hematuria, flank pain, or hypotension) and ultrasound evaluations (e.g. presence, size, and location of hematomas) are performed as needed to identify potential bleeding complications. The nurse who measured blood pressure and recorded clinical data was blinded to the results of the anxiety assessment.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eHemodynamic assessment\u003c/h3\u003e\n\u003cp\u003eTo evaluate the effect of anxiety status on hemodynamic parameters, patients\u0026rsquo; blood pressure and pulse rate will be recorded during their outpatient department (OPD) visit before the kidney biopsy. Additionally, these measurements will be retaken 30 minutes before the procedure using an automated office blood pressure device. Continuous monitoring was not performed due to resource limitations and the need to maintain a practical clinical workflow.\u003c/p\u003e\n\u003ch3\u003eAnxiety assessment\u003c/h3\u003e\n\u003cp\u003ePatient anxiety assessment before kidney biopsy was conducted using the State-Trait Anxiety Inventory Y1 (STAI-Y1)\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e, which was translated into Thai and validated by Kunthonluxamee et al.\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e with a Cronbach\u0026rsquo;s α of 0.88. The STAI Form Y is the definitive instrument for measuring anxiety in adults\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e and has been used in several studies\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e,\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e. Furthermore, the inventory\u0026rsquo;s simplicity makes it ideal for evaluating individuals with lower educational backgrounds\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e. Subjects were asked to rate the intensity of their anxiety on 20 items using a self-report questionnaire. Each item was scored on a 4-point scale: \u0026ldquo;not at all,\u0026rdquo; \"somewhat,\" \u0026ldquo;moderately so,\u0026rdquo; or \u0026ldquo;very much so.\u0026rdquo; The total score ranged from 20 to 80. STAI-Y1 values of \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\ge\\:\\:\\)\u003c/span\u003e\u003c/span\u003e40 defined the presence of clinically significant anxiety. The STAI-Y1 was administered 24 hours before the kidney biopsy upon hospital admission for the procedure.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003ePatients were categorized into two groups based on STAI-Y1 scores: the Anxiety group (STAI-Y1\u0026thinsp;\u0026ge;\u0026thinsp;40) and the Non-Anxiety group (STAI-Y1\u0026thinsp;\u0026lt;\u0026thinsp;40). Categorical variables are presented as numbers and percentages, and differences between the two groups were assessed using the chi-square test or Fisher\u0026rsquo;s exact test, as appropriate. Continuous variables were summarized as means and standard deviations or medians and interquartile ranges, depending on distribution normality. Differences between groups were evaluated using the Student\u0026rsquo;s t-test for normally distributed data or the Wilcoxon rank-sum test for non-normally distributed data.\u003c/p\u003e \u003cp\u003eTo test the hypothesis that anxiety impacts hemodynamic parameters, as measured by the change in blood pressure and pulse rate from the OPD visit (baseline) to 30 minutes before kidney biopsy (pre-biopsy), we will use a mixed-effects model for repeated measures (MMRM). This model is well-suited for longitudinal data and accounts for within-subject correlations. Fixed effects in the model will include the anxiety group (anxiety vs. non-anxiety), time (baseline vs. pre-biopsy), and covariates such as sex, age, BMI, and serum creatinine. In addition, the number of antihypertensive drugs will be included as a fixed effect to adjust for baseline hypertension and its severity, thereby refining the estimates for systolic and diastolic blood pressure. For the pulse rate analysis, beta blocker usage will be included as an adjustment variable. An interaction term between the anxiety group and time will be included to evaluate whether changes in blood pressure over time differ by anxiety status. A random intercept for each patient will be incorporated to account for within-subject correlations across repeated measures. An unstructured variance-covariance matrix will be used to model the correlations among repeated measurements within the same patient, providing flexibility in capturing the correlation pattern. This approach will allow us to assess whether anxiety levels significantly influence the change in blood pressure from baseline to pre-biopsy while controlling for potential confounders.\u003c/p\u003e \u003cp\u003eWe will also perform a subgroup analysis to examine whether the effect of anxiety on hemodynamic parameters differs by antihypertensive drug use. In this analysis, the variable representing the number of antihypertensive drugs in the MMRM will be replaced with a categorical indicator that reflects whether patients are on antihypertensive medication.\u003c/p\u003e \u003cp\u003eTo investigate factors associated with anxiety, we employed a logistic regression model. Variables with a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.1 in univariate analyses (including sex, age, and other relevant factors) were subsequently entered into a multivariable logistic regression model. Statistical significance was defined as p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003cp\u003eThe sample size calculation was based on an expected prevalence of 0.85\u003csup\u003e34\u003c/sup\u003e and a margin of error 0.05. Given that our hospital is expected to perform kidney biopsies on 350 patients during the study period, the required sample size was determined to be 145\u003csup\u003e35\u003c/sup\u003e. All statistical analyses were conducted using the statistical software package R (R Core Team, 2024)\u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e, with a significance level (α) set at 5%.\u003c/p\u003e \u003c/div\u003e"},{"header":"Result","content":"\u003cp\u003eFigure \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e illustrates the patient flow in the study. Between June 2023 and January 2025, 345 patients underwent kidney biopsies. Of these, 151 completed the questionnaires, and 141 subsequently had their biopsies performed; 10 patients had their biopsies canceled (7 due to severe hypertension and 3 due to dyspnea). Four patients were excluded due to pre-existing psychiatric disorders: 2 with depressive disorder and 2 with anxiety disorder. Using an STAI-Y1 score of \u0026ge;\u0026thinsp;40 to define anxiety, 55.0% (83/151) of patients reported experiencing anxiety. Among those with anxiety, 56.6% (47/83) exhibited a high level of anxiety (STAI-Y1 40\u0026ndash;49), while 43.4% (36/83) displayed very high anxiety (STAI-Y1\u0026thinsp;\u0026ge;\u0026thinsp;50). The mean score on the STAI was 32.0\u0026thinsp;\u0026plusmn;\u0026thinsp;5.6 for the Non-Anxiety group compared to 47.3\u0026thinsp;\u0026plusmn;\u0026thinsp;5.8 for the Anxiety group. This difference was statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\n\u003cp\u003eBaseline characteristics (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e) were generally comparable between the Anxiety (n\u0026thinsp;=\u0026thinsp;83) and Non-Anxiety (n\u0026thinsp;=\u0026thinsp;68) groups. The groups did not differ significantly in age (median, 42 vs. 45 years; p\u0026thinsp;=\u0026thinsp;0.304), sex (54.2% vs. 60.3%; p\u0026thinsp;=\u0026thinsp;0.342), or BMI (23.3 vs. 25.1 kg/m\u0026sup2;; p\u0026thinsp;=\u0026thinsp;0.552). However, a significantly lower proportion of patients in the anxiety group was married (65.1% vs. 80.9%; p\u0026thinsp;=\u0026thinsp;0.048), and a greater percentage had undergone a previous kidney biopsy (26.5% vs. 8.8%; p\u0026thinsp;=\u0026thinsp;0.010). While baseline SBP, DBP, and pulse rate were similar between the groups, the Anxiety group showed significantly higher blood urea nitrogen levels (30 vs. 21 mg/dL; p\u0026thinsp;=\u0026thinsp;0.001) and serum creatinine levels (1.85 vs. 1.15 mg/dL; p\u0026thinsp;=\u0026thinsp;0.031). There were no significant differences in estimated glomerular filtration rate or hemoglobin levels between the two groups.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eBaseline demographic data for included patients by Anxiety Status\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAnxiety Group (STAI-Y1\u0026thinsp;\u0026ge;\u0026thinsp;40; n\u0026thinsp;=\u0026thinsp;83)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNon-Anxiety Group (STAI-Y1\u0026thinsp;\u0026lt;\u0026thinsp;40; n\u0026thinsp;=\u0026thinsp;68)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP Value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge, years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42 [30.5\u0026ndash;54]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45 [33.2\u0026ndash;54]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.304\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45 (54.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41 (60.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.342\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI, kg/m\u0026sup2;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.3 [21.0\u0026ndash;27.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.1 [22.0\u0026ndash;28.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.552\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarried, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e54 (65.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55 (80.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.048\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.975\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIlliterate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (2.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eElementary School\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25 (30.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19 (27.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh School\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37 (44.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBachelor\u0026rsquo;s Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17 (20.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12 (17.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMaster\u0026rsquo;s Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (2.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnemployed, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33 (39.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27 (39.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrevious Kidney Biopsy, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22 (26.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (8.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbid Conditions, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38 (53.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36 (46.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.509\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiabetes Mellitus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25 (69.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18 (73.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.725\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDyslipidemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17 (26.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19 (21.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.520\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChronic Kidney Disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35 (43.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22 (32.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.262\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSystemic Lupus Erythematosus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18 (22.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19 (28.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.505\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of Antihypertensive Drugs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 [1\u0026ndash;3.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 [1\u0026ndash;3.8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.714\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eBeta Blocker Use, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18 (77.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14 (78.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eReceive antihypertensive medication\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69 (85.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55 (83.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.937\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSystolic BP, mmHg\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e135 [126\u0026ndash;153]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e140 [128\u0026ndash;151]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.383\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiastolic BP, mmHg\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e81 [71\u0026ndash;79]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e83 [72\u0026ndash;93]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.587\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePulse Rate, per Minute\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80 [70\u0026ndash;93]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80 [71\u0026ndash;92]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.940\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eIndication for Kidney Biopsy, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.525\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAcute Nephritis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22 (27.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15 (22.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNephrotic Syndrome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48 (59.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42 (61.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNon-Nephrotic Range Proteinuria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (9.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (7.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (3.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (8.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eBlood Urea Nitrogen, mg/dL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30 [19\u0026ndash;51]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21 [15\u0026ndash;30]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSerum Creatinine, mg/dL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.85 [0.88\u0026ndash;4.25]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.15 [0.85\u0026ndash;2.43]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.031\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eeGFR, ml/min/1.73 m\u0026sup2;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43.7 [12.9\u0026ndash;91.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55.2 [25.8\u0026ndash;85.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.231\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHemoglobin, g/dL\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.2 [8.7\u0026ndash;12.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.4 [8.9\u0026ndash;13.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.256\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003eData are presented as median [interquartile range] or number (percent).\u003cbr\u003eAbbreviations: BMI, body mass index; BP, blood pressure; eGFR, estimated glomerular filtration rate; STAI, State-Trait Anxiety Inventory.\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003e\u003cbr\u003eImpact of anxiety on hemodynamic parameter\u003c/h2\u003e\n \u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e presents the mixed-effects model results evaluating the impact of anxiety on hemodynamic parameters. For SBP, the model estimated an increase of 4.29 mmHg from baseline to pre‐biopsy (95% CI \u0026minus;\u0026thinsp;1.66 to 10.22, p\u0026thinsp;=\u0026thinsp;0.159), which was not statistically significant (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003eA). Similarly, the main effect of anxiety on SBP was \u0026minus;\u0026thinsp;2.16 mmHg (95% CI \u0026minus;\u0026thinsp;9.35 to 5.02, p\u0026thinsp;=\u0026thinsp;0.562), and the interaction between time and anxiety was also non-significant (\u0026minus;\u0026thinsp;1.48 mmHg, 95% CI \u0026minus;\u0026thinsp;9.37 to 6.44, p\u0026thinsp;=\u0026thinsp;0.715).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eMixed-Effects Model Results for Hemodynamic Parameters\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"7\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSBP, mmHg\u003c/p\u003e\n \u003cp\u003e(95% CI) \u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDBP, mmHg\u003c/p\u003e\n \u003cp\u003e(95% CI) \u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePulse rate, bpm\u003c/p\u003e\n \u003cp\u003e(95% CI) \u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTime\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.29\u003c/p\u003e\n \u003cp\u003e(\u0026minus;\u0026thinsp;1.66 to 10.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.159\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.45\u003c/p\u003e\n \u003cp\u003e(1.47 to 9.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;0.42\u003c/p\u003e\n \u003cp\u003e(\u0026minus;\u0026thinsp;5.21 to 4.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.863\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnxiety\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;2.16\u003c/p\u003e\n \u003cp\u003e(\u0026minus;\u0026thinsp;9.35 to 5.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.562\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;3.04\u003c/p\u003e\n \u003cp\u003e(\u0026minus;\u0026thinsp;7.72 to 1.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.212\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;1.55\u003c/p\u003e\n \u003cp\u003e(\u0026minus;\u0026thinsp;7.02 to 3.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.584\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTime x Anxiety\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;1.48\u003c/p\u003e\n \u003cp\u003e(\u0026minus;\u0026thinsp;9.37 to 6.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.715\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026minus;3.23\u003c/p\u003e\n \u003cp\u003e(\u0026minus;\u0026thinsp;8.52 to 2.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.235\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003cp\u003e(\u0026minus;\u0026thinsp;6.21 to 6.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.958\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cem\u003eNote:\u003c/em\u003e Values are presented as the estimated effect (with 95% confidence intervals) and corresponding p values.\u003c/p\u003e\n \u003cp\u003eAbbreviations:\u0026nbsp;SBP, systolic blood pressure; DBP, diastolic blood pressure; bpm, beats per minute.\u003c/p\u003e\n \u003cp\u003e\u003csup\u003e\u0026dagger;\u0026nbsp;\u003c/sup\u003eMixed‐Effects Model Results for blood pressure are adjusted for age, sex, BMI, serum creatinine, and number of antihypertensive drugs.\u003c/p\u003e\n \u003cp\u003e\u003csup\u003e\u0026Dagger;\u0026nbsp;\u003c/sup\u003eMixed‐Effects Model Results for pulse rate are adjusted for age, sex, BMI, serum creatinine, and beta-blocker use.\u003c/p\u003e\n \u003cp\u003eIn contrast, DBP significantly increased over time, rising 5.45 mmHg (95% CI 1.47 to 9.43, p\u0026thinsp;=\u0026thinsp;0.008) from baseline to pre-biopsy (Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003eB). However, neither the main effect of anxiety nor the time-by-anxiety interaction reached statistical significance for DBP. Similarly, no significant effects were observed for pulse rate for time, anxiety, or their interaction.\u003c/p\u003e\n \u003cp\u003eIn the subgroup analysis, the main effect of anxiety did not significantly alter blood pressure. Specifically, the effect of anxiety was associated with a \u0026minus;\u0026thinsp;2.4 mmHg difference in SBP (95% CI: \u0026minus;9.6 to 4.8, p\u0026thinsp;=\u0026thinsp;0.523) and a \u0026minus;\u0026thinsp;3.1 mmHg difference in DBP (95% CI: \u0026minus;7.8 to 1.6, p\u0026thinsp;=\u0026thinsp;0.208). Similarly, no significant effect of anxiety was observed on pulse rate (\u0026minus;\u0026thinsp;1.4 bpm difference; 95% CI: \u0026minus;6.9 to 4.2, p\u0026thinsp;=\u0026thinsp;0.639).\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eFactors associated with anxiety\u003c/h3\u003e\n\u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e summarizes the factors related to anxiety among the study participants. Univariate analysis indicated that demographic factors such as female sex, age, and BMI were not significantly associated with anxiety. Similarly, clinical factors, including hypertension, diabetes mellitus, and dyslipidemia, demonstrated no significant associations. In contrast, marital status was significantly associated with anxiety, with married patients showing lower odds (OR 0.44, 95% CI 0.20\u0026ndash;0.92, p\u0026thinsp;=\u0026thinsp;0.033) compared to single patients. Furthermore, a history of previous kidney biopsy was significantly linked to higher odds of anxiety (OR 3.73, 95% CI 1.49\u0026ndash;10.69, p\u0026thinsp;=\u0026thinsp;0.008), and increased serum creatinine levels were also significantly correlated with anxiety (OR 1.24, 95% CI 1.06\u0026ndash;1.50, p\u0026thinsp;=\u0026thinsp;0.014).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eFactors associated with anxiety among the study patients: Univariate and Multivariate Analysis\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"7\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eUnivariate analysis\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eMultivariate analysis\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOdds ratio\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOdds ratio\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.41\u0026ndash;1.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.453\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.43\u0026ndash;1.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.812\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.97\u0026ndash;1.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.299\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.97\u0026ndash;1.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.499\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI (kg/m\u0026sup2;)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.94\u0026ndash;1.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.799\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHypertension\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.40\u0026ndash;1.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.409\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiabetes mellitus\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.60\u0026ndash;2.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.594\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDyslipidemia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.34\u0026ndash;1.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.403\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ereference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.20\u0026ndash;0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.23\u0026ndash;1.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.252\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIlliterate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ereference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eElementary School\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.15\u0026ndash;11.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.793\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh School\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.12\u0026ndash;9.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.934\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBachelor\u0026rsquo;s Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.15\u0026ndash;13.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.744\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMaster\u0026rsquo;s Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.09\u0026ndash;69.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.661\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmployment status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ereference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.52\u0026ndash;1.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.995\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrevious kidney biopsy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.49\u0026ndash;10.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.64\u0026ndash;12.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eIndication of kidney biopy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ereference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAcute nephritis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.67\u0026ndash;15.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.169\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNephrotic syndrome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.57\u0026ndash;11.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.263\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHematuria or non-nephrotic range proteinuria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.57\u0026ndash;21.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSerum creatinine (mg/dL)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.06\u0026ndash;1.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.07\u0026ndash;1.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eUrine protein creatinine ratio\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.99\u0026ndash;1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.930\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003eAbbreviations: BMI, body mass index; OPD, outpatient department.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eAfter adjusting for potential confounders, multivariate analysis confirmed that serum creatinine remained a significant predictor of anxiety (OR 1.29, 95% CI 1.07\u0026ndash;1.59, p\u0026thinsp;=\u0026thinsp;0.012). A history of previous kidney biopsy was independently associated with anxiety (OR 4.28, 95% CI 1.64\u0026ndash;12.72, p\u0026thinsp;=\u0026thinsp;0.004). However, marital status showed no association with anxiety.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur prospective cohort study shows a high prevalence of preprocedural anxiety among patients undergoing kidney biopsy, with 55% of respondents meeting the threshold for clinically significant anxiety. Notably, anxiety did not significantly affect overall hemodynamic parameters; however, DBP increased notably from the OPD visit to immediately before the kidney biopsy. Additionally, multivariate analysis identified higher serum creatinine levels and a history of previous kidney biopsy as significant factors associated with anxiety.\u003c/p\u003e \u003cp\u003eTo our knowledge, no prospective cohort study has evaluated the prevalence of anxiety in patients undergoing kidney biopsy. A previous randomized trial conducted in Italy examined the effect of music therapy on anxiety in this population, including a total of 80 patients\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e. Notably, all participants in that study had STAI-Y1 scores exceeding 40, measured 30 minutes before the kidney biopsy procedure. The difference in prevalence between our study and the previous study may be attributed to several factors, including differences in the timing of anxiety evaluation\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e,\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e, socioeconomic status\u003csup\u003e\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e, the patient\u0026rsquo;s country of origin\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e, doctor-patient communication\u003csup\u003e\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e, social support\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e, and clinical practices (e.g., the information provided about the procedure and its associated risks)\u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe physiological response to anxiety involves heightened sympathetic nervous system (SNS) activity coupled with reduced parasympathetic nervous system (PNS) activity\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e. Overactivation of the SNS can result in adverse effects such as arterial and venous constriction, increased myocardial stimulation, and bronchoconstriction\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e. In contrast, the PNS facilitates relaxation by triggering the release of acetylcholine through the vagus nerve, which in turn helps modulate heart function\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e. Based on this physiological response and previous studies showing that preoperative anxiety is associated with higher blood pressure in patients awaiting surgery\u003csup\u003e\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e, we speculate that anxiety may play an essential role in elevating blood pressure before kidney biopsy. Contrary to our speculation, our study shows that anxiety did not significantly impact physiological parameters during biopsy. This finding is consistent with a previous study of surgical patients\u003csup\u003e\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e,\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u003c/sup\u003e, although other studies have reported different results\u003csup\u003e\u003cspan additionalcitationids=\"CR46\" citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e\u003c/sup\u003e. Moreover, our subgroup analysis indicates that this absence of effect is not due to patients receiving antihypertensive medication. Several factors may explain these results. First, anxiety was assessed 24 hours before the biopsy, which may not capture the acute anxiety experienced immediately before or during the procedure. Studies have shown that anxiety levels are highest when assessed closer to the time of surgery\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e,\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e. Second, hemodynamic parameters were measured at only two-time points, potentially missing transient anxiety-related changes. Blood pressure varibility and heart rate variability may be a more precise measure for assessing autonomic nervous system activity associated with anxiety\u003csup\u003e\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e,\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u003c/sup\u003e. Third, the small sample size may have resulted in insufficient statistical power to detect clinically significant effects of anxiety. Additionally, anxiety may not be the sole factor influencing physiological responses; other psychological aspects\u0026mdash;such as depression, stress, personal attitudes, or personality traits\u0026mdash;may also play important roles.\u003c/p\u003e \u003cp\u003eAnxiety can acutely elevate blood pressure\u0026mdash;often referred to as white-coat hypertension\u0026mdash;which typically manifests as a spike in SBP\u003csup\u003e\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e\u003c/sup\u003e. In our study, although both SBP and DBP increased from the OPD visit to the pre-biopsy measurement, only DBP reached statistical significance. We cannot definitively explain this selective effect. One possibility is that our limited, two-point measurement (OPD vs. pre-biopsy) may have missed transient SBP spikes. As mentioned above, assessing blood pressure variability or heart rate variability may be a more suitable alternative for evaluating the effect of anxiety on hemodynamic parameters\u003csup\u003e\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e,\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eOnly a prior kidney biopsy and elevated serum creatinine are associated with anxiety. A past kidney biopsy may trigger anxiety for two reasons: first, patients might fear their ongoing abnormal kidney function necessitating another biopsy, and second, they may have had an unpleasant experience during the previous procedure\u003csup\u003e\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e\u003c/sup\u003e. Elevated serum creatinine is related to anxiety, as patients worry about their biopsy results and the potential implications for their long-term kidney health.\u003c/p\u003e \u003cp\u003eOur study results have several implications. First, our findings indicate that the prevalence of anxiety in patients undergoing kidney biopsy is high and comparable to that of patients undergoing surgery\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e\u003c/sup\u003e. However, this anxiety is often overlooked, possibly because there is limited data about anxiety in this specific population. Although clinical guidelines recommend that patients and their caregivers receive education and information about renal biopsies to alleviate anxiety\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e, there are no specific recommendations on how to assess or manage anxiety before a kidney biopsy. Second, the factors associated with anxiety in patients undergoing kidney biopsy may be distinct from those associated with other procedures. In many surgical procedures, a history of prior anesthesia or surgical exposure has been shown to reduce the risk of preoperative anxiety\u003csup\u003e\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e\u003c/sup\u003e. However, in the case of kidney biopsy, a history of a previous kidney biopsy appears to increase preprocedural anxiety. This suggests that the target population for interventions aimed at reducing preprocedural anxiety in kidney biopsy patients may differ from those in other procedures.\u003c/p\u003e \u003cp\u003eOur study has several limitations. First, we did not use objective evidence such as electrical skin potential\u003csup\u003e\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e\u003c/sup\u003e, urine catecholamines\u003csup\u003e\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e\u003c/sup\u003e, or plasma catecholamine\u003csup\u003e\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e\u003c/sup\u003e to measure anxiety levels. Instead, we relied solely on the STAI-Y1, which is inherently subjective and has not been specifically validated for patients undergoing kidney biopsy. However, the STAI-Y1 is the most widely used instrument in studies aiming to measure the severity of anxiety\u003csup\u003e\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e\u003c/sup\u003e. Future studies should consider supplementing the STAI-Y1 with additional validated instruments, such as the Amsterdam Preoperative Anxiety and Information Scale (APAIS)\u003csup\u003e\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u003c/sup\u003e or the Generalized Anxiety Disorder-7 (GAD-7) scale\u003csup\u003e\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e\u003c/sup\u003e, along with objective measures, to provide a more comprehensive assessment of anxiety. Second, the STAI-Y1 assessment was conducted 24 hours before the kidney biopsy, primarily capturing anticipatory anxiety rather than immediate fear. Fear, characterized by an acute response to an imminent threat, may have a stronger and more direct effect on hemodynamic parameters. Future studies should consider incorporating repeated assessments closer to the procedure to evaluate both anxiety and fear. Third, our study sample size is small, which may limit its statistical power to detect the clinical significance of anxiety in elevating blood pressure. Fourth, as an observational study, the relationship between prior kidney biopsy, elevated serum creatinine, and anxiety may be confounded rather than causal. Although we adjusted for variables such as sex, age, comorbidities, education, and laboratory measurements, we could not account for other potential confounders, including negative previous experiences, health literacy, socioeconomic status, and psychological factors such as fear and depression. Fifth, we acknowledge the challenges in adhering to standardized blood pressure measurement protocols. As a result, this study relies on office blood pressure measurements, which may introduce some limitations in measurement reliability. Sixth, the exclusion of patients with psychiatric illnesses may limit the generalizability of our findings, as these conditions are prevalent and could influence both anxiety levels and hemodynamic parameters. By excluding these patients, we may have underestimated the true prevalence of anxiety and its impact on blood pressure in the broader population undergoing kidney biopsy. Seventh, the timing of hemodynamic measurements, which were taken at only two-time points, may have missed brief anxiety-related variations in blood pressure and heart rate. Continuous monitoring would provide a more comprehensive assessment of hemodynamic changes associated with anxiety. Finally, our study was conducted in a tertiary center in Thailand, a middle-income country, which may limit its generalizability to other settings. Despite these limitations, a key strength of our study is that it is the first prospective cohort study specifically designed to assess the prevalence of anxiety before kidney biopsy.\u003c/p\u003e \u003cp\u003eIn conclusion, this study highlights the high prevalence of preprocedural anxiety among patients undergoing kidney biopsy, with higher serum creatinine levels and a history of previous biopsies identified as key contributing factors. While anxiety did not significantly impact overall hemodynamic parameters, the observed increase in diastolic blood pressure from baseline to pre-biopsy suggests a potential physiological stress response. These findings underscore the need for structured preprocedural anxiety assessments. Future research should explore the potential link between anxiety and post-kidney biopsy bleeding complications.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u0026nbsp;\u003c/strong\u003eWe thank all the study teams and patients who participated in our study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u0026nbsp;\u003c/strong\u003eKC led the trial design, with contributions from SJ, KC, JW, TS, PM, SS, AC, and SP. SP and TS acquired, analyzed, and interpreted the data. SS and KC analyzed the data. KC, AC, SP, and TS designed and conceptualized the study, interpreted the data and critically revised the manuscript for important intellectual content. All authors have reviewed and approved the final version of the manuscript. All authors attest to the accuracy and completeness of the data and confirm that the study was conducted in accordance with the approved protocol.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement:\u0026nbsp;\u003c/strong\u003eThe deidentified individual participant data collected during the study and a data dictionary defining each field in the dataset will be made available to researchers who propose to use the data for individual patient data meta-analysis. Requests for data access can be directed to the corresponding author at [email protected]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e This study did not receive any external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eNajafian, B., Lusco, M. A., Alpers, C. 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The Amsterdam Preoperative Anxiety and Information Scale (APAIS). \u003cem\u003eAnesth Analg\u003c/em\u003e \u003cstrong\u003e82\u003c/strong\u003e, 445-451 (1996). https://doi.org:10.1097/00000539-199603000-00002\u003c/li\u003e\n \u003cli\u003eZigmond, A. S. \u0026amp; Snaith, R. P. The hospital anxiety and depression scale. \u003cem\u003eActa Psychiatr Scand\u003c/em\u003e \u003cstrong\u003e67\u003c/strong\u003e, 361-370 (1983). https://doi.org:10.1111/j.1600-0447.1983.tb09716.x\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"kidney biopsy, preprocedural anxiety, hemodynamic parameters, STAI-Y1","lastPublishedDoi":"10.21203/rs.3.rs-5963719/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5963719/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003ePreprocedural anxiety remains understudied in patients undergoing kidney biopsy despite its potential to impact hemodynamic stability and procedural outcomes. This study aimed to evaluate the prevalence of anxiety, its associated factors, and its effects on hemodynamic parameters in patients undergoing percutaneous kidney biopsy. A prospective observational study was conducted at a tertiary hospital in Thailand, enrolling 151 adult patients. Anxiety was assessed 24 hours before the procedure using the validated Thai State-Trait Anxiety Inventory Y1, with a score of 40 or higher indicating anxiety. Hemodynamic parameters, including blood pressure and pulse rate, were measured at baseline and 30 minutes before the biopsy. The prevalence of preprocedural anxiety was 55%, with 43.4% of anxious patients reporting very high anxiety. Anxiety status was not an independent predictor of hemodynamic changes. However, higher serum creatinine and a history of prior kidney biopsy were significantly associated with anxiety. This study highlights the high prevalence of preprocedural anxiety among patients undergoing kidney biopsy and underscores the need for structured preprocedural anxiety assessments in clinical practice. Although anxiety did not significantly alter hemodynamic parameters, future studies should explore its potential role in post-biopsy complications to optimize patient management and procedural safety.\u003c/p\u003e","manuscriptTitle":"Prevalence of Anxiety and Its Impact on Hemodynamic Parameters in Patients Undergoing Kidney Biopsy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-10 08:38:37","doi":"10.21203/rs.3.rs-5963719/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7fb75936-4ef8-4f6a-a75b-e02a6a22dd93","owner":[],"postedDate":"April 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":46900103,"name":"Health sciences/Nephrology/Kidney"},{"id":46900104,"name":"Health sciences/Risk factors"}],"tags":[],"updatedAt":"2025-04-23T07:54:24+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-10 08:38:37","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5963719","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5963719","identity":"rs-5963719","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}