Frailty as an Independent Risk Factor for Depression in Patients With End-Stage Renal Disease: A Cross-Sectional Study.

Chun-Yi Chi,Jenq-Wen Huang,Chia-Ter Chao,Szu-Ying Lee

doi:10.3389/fmed.2022.799544

Abstract

BackgroundDepression confers substantial disease burden globally, especially among those with chronic kidney disease (CKD). The presence of depression significantly impairs one's quality of life. Risk factors for depression in patients with CKD remain under-appreciated, and whether frailty, a geriatric phenotype, constitutes a risk factor for depression in this population is unknown.MethodsWe prospectively enrolled patients with end-stage renal disease (ESRD) undergoing hemodialysis for >3 months from National Taiwan University Hospital Yunlin Branch between 2019 and 2021. Clinical, physical, functional, and performance parameters were recorded, followed by frailty/sarcopenia assessment. Depression was screened for using the Geriatric Depression Scale. We analyzed the independent relationship between frailty and depression in these patients, using multiple regression analyses.ResultsTotally 151 patients with ESRD were enrolled (mean 61.1 years, 66.9% male), among whom 16.6% had screening-identified depression. ESRD participants with depression did not differ from those without regarding most parameters except serum creatinine, functional indices, and sarcopenia/frailty status. We found that having greater frail severities was independently associated with a higher probability of depression; having FRAIL- (odds ratio [OR] 5.418) and SOF-based (OR 2.858) frailty independently correlated with a higher depression probability. A linear relation exists between a greater frail severity and the probability of depression. Using a more relaxed criterion for detecting depression, higher SOF scores remained significantly associated with an increased depression risk.ConclusionsIn patients with CKD, frailty independently correlated with a higher probability of having depression. Strategies aiming to attenuate frailty may be able to benefit those with depression simultaneously in this population.

Highlights

Depression, characterized by an emotional turbulence presenting with somatic, cognitive, and behavioral symptoms, is one of the common psychiatric disorders that affect billions of people and confer substantial disease burden globally [1]
Besides its effect on survival, depression poses a plethora of adverse influences in this population; depressed patients with chronic kidney disease (CKD) were found to have a higher incidence of muscle wasting and correlated with a greater degree of functional impairment, according to findings from the Dialysis Outcomes and Practice Patterns Study (DOPPS) [4, 5]
After accounting for variables with significant between-group differences in univariate analysis (Tables 1, 2), including serum creatinine, functional evaluation results (Karnofsky and instrumental activity of daily living (IADL) scores), SARC-F scores, frailty scores (EFS, FRAIL, and Study of Osteoporotic Fractures (SOF) scales), and Council of Nutrition Assessment Questionnaire (CNAQ) scores, we found that having a greater frail severity, including higher Edmonton frail scale (EFS) and SOF scores, was independently associated with a higher risk of developing potential depression (Table 3)

Summary

Introduction

Depression, characterized by an emotional turbulence presenting with somatic, cognitive, and behavioral symptoms, is one of the common psychiatric disorders that affect billions of people and confer substantial disease burden globally [1]. Depression exhibits an increased incidence in patients with chronic kidney disease (CKD) and especially those with endstage renal disease (ESRD), up to 20% to 40% depending upon countries and assessment tools [2]. Besides its effect on survival, depression poses a plethora of adverse influences in this population; depressed patients with CKD were found to have a higher incidence of muscle wasting and correlated with a greater degree of functional impairment, according to findings from the Dialysis Outcomes and Practice Patterns Study (DOPPS) [4, 5]. A recent Mendelian randomization study showed that genetic alleles intimately associated with depressive symptoms conferred a greater risk of carrying lower estimated glomerular filtration rates (eGFRs) [6]. Depression confers substantial disease burden globally, especially among those with chronic kidney disease (CKD). Risk factors for depression in patients with CKD remain under-appreciated, and whether frailty, a geriatric phenotype, constitutes a risk factor for depression in this population is unknown

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