Loss of appendicular muscle mass in haemodialysis patients is associated with increased self-reported depression, anxiety and lower general health scores.

Abstract

Previous reports have suggested an association between depression and nutritional status. To investigate whether there is an association with loss of muscle mass (sarcopenia), we screened HD patients for depression. We screened for depressive symptoms using the Beck Depression Inventory-II (BDI-II), Hospital Anxiety and Depression Scale (HADS), and general health using the short form 36 (SF36), and additionally measured appendicular lean mass post-dialysis with segmental bioimpedance. We studied 113 patients, 84 (74.3%) male, mean age 64.9 ± 14.9 years, median duration of haemodialysis 27.0 (15.7-61.0) months, body mass index post-dialysis 25.2 (22.8-28.6) kg/m2, appendicular lean mass (ALM) index 6.98 (6.22-8.10) kg/m2. BDI-II 11 (4-17), HADS 10 (5-16.5), and SF36 average 43.3(36.6-48.4). Lower ALM index was associated with greater BDI-II and HADS depression scores (r = 0.29, p = 0.008; r = 0.27, p = 0.012) respectively, whereas higher ALM index was associated with increased SF36 physical functioning and general health (r = 0.34, p = 0.001; r = 0.26, p = 0.019), respectively on univariate analysis. On logistic regression, lower ALM index was independently associated with high HADS cut off ≥8 (standardised β-0.31, p = 0.007). There were no associations with weight, body mass index or fat index. Greater extracellular water both pre- and post-dialysis was associated with reduced SF36 physical functioning (r = -0.24, p = 0.011, r = -0.22, p = 0.26), respectively. We report an association between ALM index measured by segmental bioimpedance and increased self-reported depression, anxiety and decreased general health. Whether treatment programs designed to improve muscle mass, can lead to reduced levels of depression, and anxiety and improved perceived general health, remains to be determined.