Screening of depression in chronic kidney disease patients undergoing haemodialysis.
Abstract and Figures
Background: Depression is a common psychiatric disorder among chronic kidney disease (CKD) patients, and it has affected the morbidity & mortality rate of CKD patients. This study aims to determine the frequency and severity of depression in CKD patients on hemodialysis. Methodology: This cross-sectional study was conducted at the Department of Nephrology, Abbasi Shaheed Hospital, Karachi. A total of 251 patients of age between 18-60 years admitted with End-Stage Renal Disease ESRD and getting maintenance haemodialysis were included. Patients diagnosed with psychiatric, neurological illnesses and taking antidepressants were excluded from the study. Demographic and clinical characteristics of CKD patients were obtained on the structured questionnaire, and the Hospital Anxiety and Depression Scale (HADS) was utilized. Results: Of the total, 127 (50.6%) were males, and 124 (49.4%) were females, with a mean age of 53.94 ± 14.67 years. Approximately 65% of ESRD patients were suffering from depression. Among these, the patients who were receiving maintenance dialysis were suffering from a mild form of depression (33.1%) (HADS 5-9), 22.3% had moderate depression (HADS 10-14), and 9.6% had severe depression (HADS>15). Moreover, a significant difference has been observed between age and creatinine levels. Conclusion: Around 10% of the patients had severe depression, which enhances the attention towards it. Multicenter studies should be conducted across Pakistan to identify the extent of the problem.
Figures - uploaded by Sher Wali Khan
Author content
All figure content in this area was uploaded by Sher Wali Khan
Content may be subject to copyright.
ResearchGate has not been able to resolve any citations for this publication.
Objective: To measure the frequency of depression and its risk factors in patients under going hemodialysis. Methodology: It is a cross-sectional prospective study conducted at Hemodialysis unit of Shalamar Hospital and Shaikh Zayed Hospital, Lahore from 1 st January 2006 to 30 th April 2006. All patients getting regular hemodialysis for more than three months were included. Beck's Depression Inventory-II (BDI-II; adapted in Urdu) was administered on all the patients who were able to read or understand it. Blood sample were drawn at the same time for routine hematological, biochemical parameters and viral markers (Anti HCV and HbsAg). Diagnosis was made as per Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM IV) for correlation of psychological variables with clinical, hematological and biochemical parameters. Results: Eighty nine patients were enrolled which included fifty two (58.4%) were male and seventy seven (86.5%) were married. Major causes of renal failure were diabetes, hypertension and chronic glomerulonephrotis. Duration of dialysis was from 03 to 49 months with mean of 19.64 ± 11.7 months. Severity of depression was categorized in to mild, moderate and severe on the basis of BDI score. Majority of the patients fifty (56.1%) were moderately to severely depressed and there was no gender difference in the prevalence of depression. Conclusions: Majority of patients undergoing hemodialysis were depressed. Major risk factors for depression were marital status, illiteracy, number of children, socioeconomic factors, gender, hypertension and hypoalbuminemia. Patients with anemia, hyponatremia and hyperkalemia had suicidal tendency. Patients with hepatitis C and disturbed liver function have strong correlation with psychological parameters.
Introduction
Pneumonia of unknown cause was detected on 30 December 2019 in China. It was categorized as an outbreak and named as COVID-19 by the World Health Organization. The pandemic affects all people, but patient groups such as hemodialysis (HD) patients have been particularly affected. We do not know if refugees suffered more during the outbreak. In this study, we compared depressive symptom frequency between Syrian refugee HD patients and Turkish ones.
Methods
The study had a single-center, cross-sectional design. Demographic and clinical data were
collected retrospectively from patients’ files containing details about past medical history,
demographic variables and laboratory values. Validated Turkish and Arabic forms of Beck
Depression Inventory (BDI) were used to assess depressive symptoms. BDI scores were
compared according to nationality, demographic features and clinical data. A BDI score
more than 14 was accepted as suspicion of depression.
Results
119 patients were enrolled in the study. After the exclusion of 22 patients, 75 Turkish and 22 Syrian patients were included for further analysis. The median BDI (interquartile range)
score for Turkish and Syrian patients were 12 (7–23) and 19.5 (12.7–25.2), respectively (p = 0.03). Suspicion of depression was present at 42.7% of Turkish, and 72.7% of Syrian HD
patients (p = 0.013). Regarding all patients, phosphorus level, Kt/V, and nationality were significantly different between patients with and without suspicion of depression (p = 0.023,0.039, 0.013, respectively).
Conclusion
Syrian patients had higher BDI scores and more depressive symptoms than Turkish
patients. Additional national measures for better integration and more mental support to SyrianHD patients are needed.
Background:
Health system planning requires careful assessment of chronic kidney disease (CKD) epidemiology, but data for morbidity and mortality of this disease are scarce or non-existent in many countries. We estimated the global, regional, and national burden of CKD, as well as the burden of cardiovascular disease and gout attributable to impaired kidney function, for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017. We use the term CKD to refer to the morbidity and mortality that can be directly attributed to all stages of CKD, and we use the term impaired kidney function to refer to the additional risk of CKD from cardiovascular disease and gout.
Methods:
The main data sources we used were published literature, vital registration systems, end-stage kidney disease registries, and household surveys. Estimates of CKD burden were produced using a Cause of Death Ensemble model and a Bayesian meta-regression analytical tool, and included incidence, prevalence, years lived with disability, mortality, years of life lost, and disability-adjusted life-years (DALYs). A comparative risk assessment approach was used to estimate the proportion of cardiovascular diseases and gout burden attributable to impaired kidney function.
Findings:
Globally, in 2017, 1·2 million (95% uncertainty interval [UI] 1·2 to 1·3) people died from CKD. The global all-age mortality rate from CKD increased 41·5% (95% UI 35·2 to 46·5) between 1990 and 2017, although there was no significant change in the age-standardised mortality rate (2·8%, -1·5 to 6·3). In 2017, 697·5 million (95% UI 649·2 to 752·0) cases of all-stage CKD were recorded, for a global prevalence of 9·1% (8·5 to 9·8). The global all-age prevalence of CKD increased 29·3% (95% UI 26·4 to 32·6) since 1990, whereas the age-standardised prevalence remained stable (1·2%, -1·1 to 3·5). CKD resulted in 35·8 million (95% UI 33·7 to 38·0) DALYs in 2017, with diabetic nephropathy accounting for almost a third of DALYs. Most of the burden of CKD was concentrated in the three lowest quintiles of Socio-demographic Index (SDI). In several regions, particularly Oceania, sub-Saharan Africa, and Latin America, the burden of CKD was much higher than expected for the level of development, whereas the disease burden in western, eastern, and central sub-Saharan Africa, east Asia, south Asia, central and eastern Europe, Australasia, and western Europe was lower than expected. 1·4 million (95% UI 1·2 to 1·6) cardiovascular disease-related deaths and 25·3 million (22·2 to 28·9) cardiovascular disease DALYs were attributable to impaired kidney function.
Interpretation:
Kidney disease has a major effect on global health, both as a direct cause of global morbidity and mortality and as an important risk factor for cardiovascular disease. CKD is largely preventable and treatable and deserves greater attention in global health policy decision making, particularly in locations with low and middle SDI.
Funding:
Bill & Melinda Gates Foundation.
Prevalence of depression in chronic kidney disease (CKD) is higher than in the general population and predicts a higher mortality risk. The aim of this study is to investigate the occurrence of depressive symptoms among individuals with CKD in conservative treatment and renal replacement therapy (hemodialysis).
Background: Chronic Renal Failure (CRF) is a public health problem that tends to take dimensions of epidemic and has serious impact on quality of patient's life. Aim: The aim of the present study was to review the literature and to explore the psychological impact of dialysis on the quality of life of people with chronic renal failure. Material - Method: Literature review based on studies and reviews derived from international (Medline, PubMed, Cinahl, Scopus) and Greek (Iatrotek) data bases concerning psychological problems of people with renal failure. The collection of data conducted from March to December 2012. Also, were used keywords such as haemodialysis, psychological factors, social status, economic status, renal failure, quality of life, as well as articles by the National Documentation Centre, which provided valid and documented data from global research and epidemiology. Results: According to the literature, Chronic Renal Failure is associated with long-term psychological effects on patients undergoing haemodialysis. A chronic illness, such as kidney failure, is a continuous process since these patients try to accept their new image and to adapt their lifestyle to dialysis treatment. Patients with kidney disease undergoing regular dialysis face difficulties in maintaining their employment, their social life, their financial flexibility and their limitation of liquids and foods. Conclusion: Complexity and chronic nature of the disease affect the quality of life of patients with CRF and their health and reduce their life expectancy. So, the role of the Nephrology Nurse is highly important for the implementation of effective nursing interventions and psychological support during their treatment.
We aim to investigate the extent to which depression and quality of life might be associated with decreased glomerular filtration rate (GFR) in a large hypertensive population in rural Northeast China.
A total of 5566 hypertensive participants aged 35 years and older were screened with a stratified cluster multistage sampling scheme in rural areas of Liaoning Province during 2012-2013. Decreased GFR was defined as estimated GFR <60 ml/min/1.73 m(2).
The overall prevalence of decreased GFR was 3.2%. In the multivariable regression model, participants with moderate or greater depression had a greater risk for having a decreased GFR (OR: 1.739, 95%CI: 1.004 to 3.014) after full adjustment. Every 1-point increase of all the domains in WHOQOL-BREF, except for physical and environment domains, was significantly related to a lower risk for decreased GFR adjusting for age, gender and race. However, after fully adjustment, only social relations remained significant (OR: 0.899, 95%CI: 0.820 to 0.985). Increasing in total scores of WHOQOL-BREF was a protective factor against decreased GFR after fully adjustment.
We found that moderate or greater depression and lower quality of life were associated with higher risks for developing decreased GFR. © 2015 S. Karger AG, Basel.
Introduction:
Patients with chronic kidney disease (CKD) who perform renal replacement therapy (RRT) are subject to a higher prevalence of mood disorders.
Objective:
The aim of this study is to compare the prevalence of anxiety and depression in patients on hemodialysis (HD) and peritoneal dialysis (PD), taking into account comorbidities that may contribute to this.
Methods:
The study was done in Ponta Grossa with CKD patients, using Beck Depression and Anxiety Inventory (BDI and BAI) and the Hospital Anxiety and Depression Scale (HADS).
Results:
We studied 155 patients, 128 in the HD group and 27 in PD. In the first, depression was found in 22.6% of patients in the BDI and 9.3% in HADS, and anxiety 25.7% in the BAI and 11.7% in the HADS. In the PD group, 29.6% of patients had depression in the BDI and 14.8% in HADS, and anxiety 11.1% in the BAI and none in HADS.
Conclusion:
The hemodialysis or peritoneal dialysis did not influence the prevalence of anxiety and depression in patients with CKD.
Introduction:
Affective disorders, particularly depression, are the commonest and probably the most important psychopathological complication of end stage renal disease (ESRD). Depression has the potential to alter adversely the medical outcome of ESRD patients and the psychological stress can affect patient's adherence to medication regimen. In Iraq as well as many other Arab countries, the true prevalence of depression among ESRD patients is unknown. The objective of this study was to determine the prevalence of depression among a cohort of Iraqi hemodialysis (HD) patients and relate it to their socio-demographic characteristics.
Methods:
We recruited patients from two HD centers in Baghdad, excluding patients with history of depression or other psychiatric disorders prior to the initiation of HD. The Arabic version of diagnostic and statistical manual of mental disorders fourth edition (DSM-IV) was used to diagnose depression. Beck's Depression Inventory was used to grade its severity. Clinical and laboratory data of the study group were documented and related to the diagnosis of depression.
Results:
Seventy-five Iraqi patients on maintenance HD were included in the study. Patients' duration on HD ranged from six months to five years. The prevalence of depression among this cohort of HD patients was 80%. The prevalence of severe, moderate and mild depression was 25%, 50% and 25% respectively. The mean depression score was 17.1. Female gender, unemployment, and marital status had statistically significant associations with depression.
Conclusion:
Depression is common in this group of Iraqi HD patients and its prevalence is comparable to the results of similar studies in other societies.
Depression is recognized as the most common psychiatric problem in patients with end-stage renal disease. Stress negatively affects the quality of life of not only the patients on hemodialysis but also their caregivers. The objective of this study was to measure and compare the frequency of depression in these patients and their attendants, and to assess the associated risk factors in both groups. A cross-sectional study was conducted at our hemodialysis unit from June to September 2009. A total of 180 patients and 180 caregivers were enrolled and the Beck's Depression Inventory (BDI-II) questionnaire was administered. Of the 360 respondents, 201 (55.8%) were males and 264 (73.3) were married. According to the BDI scoring, 135 (75%) of the patients and 60 (33.4%) of the attendants were found to be moderately to severely depressed. Marriage (OR 1.817), low income status (OR 1.757) and unemployment (OR 4.176) correlated with increased depression grade, while gender and education level did not. Anemia was the only co-morbidity showing positive association with depression scores in the patients' group (P = 0.023). We conclude that the majority of the patients undergoing dialysis were depressed and were twice more likely to be depressed than their caregivers. In both groups, marriage and unemployment were associated with increased depressive symptoms, while household income showed negative association with depression. Gender and education level were not related to the depression scores.
Depression is the most common psychiatric illness in patients with end-stage renal disease (ESRD). The reported prevalence of depression in dialysis population varied from 22.8% (interview-based diagnosis) to 39.3% (self- or clinician-administered rating scales). Such differences were attributed to the overlapping symptoms of uremia and depression. Systemic review and meta-analysis of observational studies showed that depression was a significant predictor of mortality in dialysis population. The optimal screening tool for depression in dialysis patients remains uncertain. The Beck Depression Inventory (BDI), Patient Health Questionnaire (PHQ) and Center for Epidemiologic Studies Depression Scale (CESD) have been validated for screening purpose. Patients who scored ≥14 using BDI should be referred to psychiatrist for early evaluation. Structured Clinical Interview for DSM disorders (SCID) remains the gold standard for diagnosis. Non-pharmacological treatment options include cognitive behavioral therapy and exercise training programs. Although frequent hemodialysis may have beneficial effects on patient' physical and mental well-being, it cannot and should not be viewed as a treatment of depression. Selective serotonin reuptake inhibitors (SSRIs) are generally effective and safe in ESRD patients, but most studies were small, non-randomized and uncontrolled. The European Renal Best Practice (ERBP) guideline suggests a trial of SSRI for 8 to 12 weeks in dialysis patients who have moderate major depression. The treatment effect should be re-evaluated after 12 weeks to avoid prolonging ineffective medication. This review will discuss the current understanding in the diagnosis and management of depression in dialysis patients.This article is protected by copyright. All rights reserved.