Depression, Quality of Life and Malnutrition-Inflammation Scores in Hemodialysis Patients

Abstract

Background: Depression is the most common psychiatric illness in patients with end-stage renal disease (ESRD), and has been associated with increased risk of death, cardiovascular events and hospitalization in a substantial proportion of patients. Impaired quality of life (QoL) has been reported in dialysis patients and is a marker of poor outcome. We aimed to assess the prevalence of depression and QoL status among chronic hemodialysis patients. We explored the relationship between depressive symptoms and poor QoL on the one hand and sociodemographic profile, dialysis adequacy, serum chemistry, malnutrition-inflammation score (MIS) and symptom burden on the other hand. Patients and Methods: 60 chronic hemodialysis patients participated in the study between June and August 2007. They were on thrice-weekly dialysis at the Kasr El-Aini Nephrology and Dialysis Center, Cairo University Hospital. Clinical and sociodemographic data were obtained and their case records were reviewed to obtain laboratory results including hemoglobin, urea reduction ratio, serum albumin, calcium, phosphorus, creatinine and total iron-binding capacity. We used the Beck Depression Inventory (BDI) to assess the severity of depression, and the SF-36 questionnaire to assess QoL in the study group. MIS was used to assess the extent of malnutrition and inflammation complex and total symptom burden was evaluated using the dialysis symptom index (DSI). Results: Mean age was 46.13 ± 16.55 years, with a range of 22–77 years. 20 patients (33.33%) had a BDI score of ≧15. Two patients (3.33%) had a QoL total score of <50, 8 (13.33%) had scores in the range of 50–60, 30 (50%) had scores in the range of 60–70, 12 (20%) had scores of 70–80, and 8 patients (13.3%) had scores in the range of 80–90. Employment was found to significantly affect BDI scores; all patients with BDI scores ≧15 were unemployed. The mean BDI score of unemployed patients was significantly higher than employed patients (13.03 ± 6.27 vs. 8.50 ± 3.51, p = 0.03). Widowed patients had significantly higher BDI and lower F-36 scores compared to single, married and divorced patients (p < 0.05). DSI and MIS showed significant positive correlations with BDI scores (p < 0.05) and significant negative correlations with F-36 scores (p < 0.05). Conclusions: Our results showed a high prevalence of depressive symptoms among the study group that was linked to poor QoL, total symptom burden and malnutrition-inflammation complex.