Abstract
Abstract Background and Aims The reported prevalence of depression is around 20-30% among dialysis patients according to the literature. Previous studies have shown a strong negative correlation between depression and kidney disease related quality of life (KDQOL) scores in ESRD patients. In this study we examined the relationship between depression and KDQOL scores of a racially diverse cohort of elderly haemodialysis (HD) patients. Additionally we investigated the predictors of depression among this cohort. Method Prevalent HD patients aged 65 years and above who were dialyzing in our institution were included in this cross-sectional study. The Geriatric depression scale (GDS-15) and KDQOL-SFTM version 1.3 were the instruments used to derive depression and KDQOL domain scores respectively. The predictor variable was depression status based on a cut-off of 5 and patients were categorized into 2 groups – depression (Yes)-GDS≥5 and depression (No)–GDS<5. The impact of socio-demographic factors and lab parameters was compared using chi square test for categorical variables and Independent T test/Mann Whitney U test for continuous variables. The 3 main KDQOL domains – physical composite summary (PCS) score, mental composite summary (MCS) score and Kidney disease composite summary (KDCS) score were compared using Independent T test among the depression status groups. Multivariate logistic regression was used to determine the predictors of depression among this elderly HD cohort. Results A total of 1034 elderly HD patients (mean age 72.1±5.6 years, 55.9% male, 65.7% Chinese, 65.8% diabetic and mean vintage of 5.8±5.6 years) were included in the study. The prevalence of depression was 18.1% among this elderly HD cohort. The patients with depressive symptoms were predominantly non-ambulant, with high medical dependency and increased hospital admissions in the past year compared to the non-depressed group. There were no statistically significant differences in the age, race, gender, diabetic status and dialysis vintage between the groups with and without depression. The group with depression had significantly lower PCS, MCS and KDCS domain scores compared to the group without depression (p<0.001). Mobility status was identified as an independent predictor of depression - ambulant patients were 53% (OR-0.47, 95%CI 0.31-0.70, p<0.001) less likely to be depressed compared to non-ambulant HD patients (p<0.001). Mean scores for KDQOL dimensions like sleep and social support were significantly lower among patients with depression (p<0.001). Conclusion Elderly haemodialysis patients with depression had significantly lower mean health related quality of life scores compared to patients without depression. Mobility status was an important predictor of depression among our elderly cohort. Regular screening and management of depression should be part of the routine care of the elderly HD patients so as to improve their quality of life and dialysis outcomes.
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