Abstract
Context: Depression is a highly prevalent and debilitating mental disorder, particularly among patients under hemodialysis, who are more susceptible to depression due to their complex treatment regimens, dietary limitations, side effects of medications and fear of disease outcomes. This systematic review and meta-analysis explored the prevalence of depression in Iranian hemodialysis patients. Evidence Acquisitions: In this systematic review and meta-analysis, search was done in national and international databases, including SID, MagIran, Google Scholar, Web of Science, Medline (via PubMed), and Scopus from inception to March 2018. Key search terms included hemodialysis, renal replacement therapy, dialysis, end-stage renal disease, renal failure, depression and Iran along with all their possible combinations. Data were combined for metaanalysis using random effects model. Heterogeneity between studies was analyzed by I2 test, and data were analyzed by STATA (version 12) software. Results: The included 24 articles had a sample size of 2941 participants; the overall prevalence of depression in hemodialysis patients in Iran was 56.8% (95% CI: 50.5-63). The results of the univariate meta-regression analysis showed no significant correlation between prevalence of depression and methodological quality of articles (P=0.524), duration of hemodialysis (P=0.885), publication year (P=0.116), mean age of participants (P=0.224) and sample size (P=0.194). Conclusions: More than half of the hemodialysis patients in Iran suffer from depression. Given the overlap of depression symptoms with uremia in this group of patients, it is necessary to identify depression in these patients for early management and interventions.
Highlights
Implication for health policy/practice/research/medical education: Depression is common in patients undergoing hemodialysis, with an estimated prevalence of 56.8%
Evidence Acquisitions This study was a systematic review and meta-analysis, of studies reporting the prevalence of depression in hemodialysis patients in Iran, published in Persian or English in national and international journals, from inception to March 2018
In cases where the prevalence of depression was compared between hemodialysis and kidneytransplant patients, the data of hemodialysis patients were extracted from the articles
Summary
Implication for health policy/practice/research/medical education: Depression is common in patients undergoing hemodialysis, with an estimated prevalence of 56.8%. Diagnosis of depression in this patient group is essential since depression is reported to be associated with poor quality of life, increased re-hospitalization, cardiovascular diseases, malnutrition [6] and importantly, non-compliance with treatment [9] in hemodialysis patients. This study aimed to estimate the true prevalence of depression in hemodialysis patients in Iran using systematic search of literature. This is crucial because any strategy to prevent and mange depression in this group of patients requires accurate estimation of the size of the problem; appropriate allocation of healthcare resources. The required data, including title, first author, publication year, study location, sample size, type of questionnaire, mean age, mean duration of dialysis and prevalence of depression were extracted from the articles. Each item is given a score of 0 to 3; with a higher score indicating a higher methodological quality [14,15,16]
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