Prevalência de sintomas depressivos em pacientes com doença renal crônica em hemodiálise

Introduction: Chronic Pancreatitis (CP) is a fibroinflammatory condition with debilitating symptoms affecting 35-50% of individuals worldwide. Quality of life is severely affected in patient with CP and they are likely to suffer from mental health disorders, including depression. We conducted a systematic review and meta-analysis assessing the prevalence of Depression in patients with CP. Methods: Multiple electronic databases including PubMed, MEDLINE (OVID), PsycINFO, Cochrane Library, Embase, Scopus and Web of Science were searched from inception to June 2022 to identify manuscripts reporting the prevalence of Depression (diagnosed clinically or with a validated scale without language restriction) among patients with Chronic Pancreatitis of any etiology. Case series, reports, editorials, and reviews were excluded. Two independent reviewers extracted data. Disagreements were resolved by a third author. The pooled prevalence was calculated using a random effects model. Heterogeneity was assessed by the inconsistency index (I2). Results: Among 3647 articles identified, 58 studies were identified for full text review, and ultimately nine studies were deemed eligible for inclusion with perfect agreement (kappa=1.0). Five of them were cross-sectional studies, whereas the rest were cohorts. A total of 87136 patients were included in the studies (Table). CP was determined with previous historical diagnosis, the M-ANNHEIM criteria and the presence of a clinical, radiologic and/or endosonographic features. Depression was diagnosed clinically and using Center for Epidemiological Studies 10-item Depression Scale (CESD), Beck Depression Inventory (BDI) and Hospital Anxiety and Depression Scale (HADS). Depression prevalence in patients with CP varied from 11%-70% among the studies. The pooled prevalence of Depression in CP patients was 39% (95% CI 0.26-0.53) (Figure). Four studies included healthy controls with lower prevalences of Depression. Conclusion: Depression among patients with CP deserves a call-to-action due to its medical implications and worsening quality of life. Chronic pain and malabsorption symptoms could predispose to the development of Depression. Our findings raise awareness of the importance of screening patients with chronic pancreatitis for mental health disorders and provide support. Further well-designed clinical trials would be necessary to test tentative therapeutic measures seeking the reduction of symptoms for this specific group of patients.Figure 1.: Forest plot of the prevalence of Depression in patients with Chronic Pancreatitis Table 1. - Baseline characteristics of included studies Study Design Country Duration of follow up or data collection Study Population Chronic Pancreatitis (N) Etiology of Chronic Pancreatitis Diagnosis of Chronic Pancreatitis Depression (N) Depression Diagnosis Cutoff for Depression Controls (N) Type of Controls Depression in Chronic Pancreatitis (%) Depression in Controls (%) Alkhayyat (2021) Retrospective cohort analysis USA 2014 -2019 Patients with diagnosis of CP 67,260 Any etiology Previous diagnosis (chart review) 31477 Clinical NA 30,209,550 Matched healthy controls 47% 14.7% Balliet (2012) Cross-sectional USA NA Patients with nonalcohol-related CP 692 Nonalcohol-related Previous diagnosis (chart review) 360 Center for Epidemiological Studies Depression Scale scores ≥ 10 NA NA 52% NA Chen (2018) Retrospective cohort Taiwan 2000-2010 Patients with newly diagnosed CP 17,733 Any etiology Previous diagnosis (chart review) 1, 898 Clinical NA 35,466 Matched healthy controls 11% 0.9% Szalewska (2016) Cross-sectional Poland NA Patients with CP exacerbation 30 Any etiology Previous diagnosis (chart review) 21 Beck Depression Inventory scores >10 NA NA 70% NA Olesen (2021) Cross-sectional USA and Denmark 2016-2021 Patients with diagnosis of CP 184 Any etiology M-ANNHEIM criteria: (Cambridge III or IV or pancreatic calcifications on cross-sectional imaging) 71 Hospital Anxiety and Depression Scale scores >7 NA NA 39% NA Phillips (2020) Cross-sectional USA and Denmark NA Patients with diagnosis of CP 171 Any etiology M-ANNHEIM criteria: (Cambridge III or IV or pancreatic calcifications on cross-sectional imaging) 66 Hospital Anxiety and Depression Scale scores >7 NA NA 39% NA Shah (2022) Cross-sectional USA 2016- 2021 Patients with CP with and without chronic opioid use 442 Any etiology Presence of a clinical and radiologic (CT or MRCP) and/or endosonographic features 145 Clinical NA NA NA 33% NA Singh (2021) Prospective cohort study India 2013-2014 Patients with Idiopathic CP, with/without diabetes, and >18 years of age 66 Idiopathic CP with/without Diabetes Previous diagnosis based on United European Gastroenterology Guidelines 19 Hospital Anxiety and Depression Scale (HADS) scores >7 152 Matched healthy controls 29% 1% Sarkar (2022) Prospective observational study India NA Patients between 18-60yrs with documented CP who visited the Pancreas Clinic 558 Any etiology 1. Pancreatic calcifications on imaging.2. Pancreatic ductal changes on MRCP or ERCP per Cambridge criteria3. Ductal and parenchymal changes on EUS per Rosemont criteria 261 Beck Depression Inventory II scores >13 67 Matched healthy relatives or caregivers 47% 7.5%

The course of chronic itch in hemodialysis patients: results of a 4-year follow-up study of GEHIS (German Epidemiological Hemodialysis Itch Study).

BackgroundTo determine the prevalence of depressive symptoms and to explore related factors of depressive symptoms in hemodialysis (HD) patients in northern China.MethodsWe used a cross-sectional research design to recruit 227 chronic kidney disease (CKD) patients who were undergoing HD treatment in northern China during December, 2012 to March, 2013. The Chinese edition of the Center for Epidemiologic Studies Depression (CES-D) was used to measure depressive symptoms. Information on quality of life (QOL), activities of daily living (ADL), social support status, coping style, self-efficacy, ego resiliency and demographic characteristics was all collected by face to face interview. Multivariate logistic regression analysis was used to explore related factors of depressive symptoms.ResultsThe prevalence of depressive symptoms among HD patients was 29.1%. Patients with a lower mood have worse ADL and QOL than patients with better mood. Patients with a lower mood have got less social support than patients with better mood, including both family support and outside family support. For coping style, patients with a lower mood were more inclined to choose “acceptance-resignation” coping style than patients with better mood, while the result is opposite in “avoidance” coping style. And patients with a better mood have better self-efficacy and ego resiliency than patients with lower mood. Multivariate logistic regression analyses revealed that ADL (OR = 1.124, p = 0.002), family support (OR = 0.867, p = 0.021), “acceptance-resignation” coping style (OR = 1.228, p = 0.022), and ego resiliency (OR = 0.944, p = 0.021) were associated with low mood independently.ConclusionsThe prevalence of depressive symptoms is high in CKD patients on HD in northern China. activities of daily living, family support, “acceptance-resignation” coping style and ego resiliency were independently associated with depressive symptoms.

Satisfaction with care in peritoneal dialysis patients

Prevalence of Depression in Patients With Chest Pain and Non-Obstructive Coronary Artery Disease

IntroductionChronic Pancreatitis (CP) is a fibroinflammatory condition with debilitating symptoms. Quality of life is severely affected in patients with CP and they are likely to suffer from mental health disorders, including depression. We conducted a systematic review and meta-analysis assessing the prevalence of depressive symptoms and depression in patients with CP. MethodsMEDLINE (OVID), PsycINFO, Cochrane Library, Embase, CINAHL Complete, Scopus and Web of Science were searched until July 2022 to identify manuscripts reporting the prevalence of depressive symptoms and depression (diagnosed clinically or with a validated scale without language restriction) in patients with Chronic Pancreatitis. The pooled prevalence was calculated using a random effects model. Heterogeneity was assessed by the inconsistency index (I2). ResultsAmong 3647 articles identified, 58 studies were identified for full text review, and ultimately nine studies were included. A total of 87,136 patients were included in the studies. Depression was diagnosed clinically or symptoms were identified using validated scales including Center for Epidemiological Studies 10-item Depression Scale (CESD), Beck Depression Inventory (BDI) and Hospital Anxiety and Depression Scale (HADS). The overall prevalence of depression in patients with chronic pancreatitis was 36.2% (95%CI: 18.8–55.7). In the stratified analysis, depression prevalence according to the clinical diagnosis, BDI and HADS was 30.10%, 48.17% and 36.61%, respectively. ConclusionThe high prevalence of depression among patients with CP deserves a call-to-action due to its medical implications and worsening quality of life. Our findings raise awareness of the importance of screening patients with CP for mental health disorders. Further well-designed studies are needed to further characterize these findings.

ObjectiveTo investigate the effectiveness of a guided internet-based self-help intervention for hemodialysis patients with depressive symptoms. MethodChronic hemodialysis patients from nine Dutch hospitals with a depression score on the Beck Depression Inventory – second edition (BDI-II) of ≥10, were cluster-randomized into a five modules guided internet-based self-help problem solving therapy intervention or a parallel care-as-usual control group. Clusters were based on hemodialysis shift. The primary outcome depression was measured with the BDI-II. Analysis was performed with linear mixed models. ResultsA total of 190 hemodialysis patients were cluster-randomized to the intervention (n = 89) or control group (n = 101). Post-intervention measurement was completed by 127 patients (67%) and more than half of the patients (54%) completed the intervention. No significant differences were found on the BDI-II score between the groups (mean difference − 0.1, 95%CI -3.0; 2.7, p = 0.94). Per protocol sensitivity analysis showed comparable results. No significant differences in secondary outcomes were observed between groups. ConclusionsGuided internet-based self-help problem solving therapy for hemodialysis patients with depressive symptoms does not seem to be effective in reducing these symptoms as compared to usual care. Future research should examine how to best design content and accessibility of an intervention for depressive symptoms in hemodialysis patients. Trial registrationDutch Trial Register: Trial NL6648 (NTR6834) (prospectively registered 13th November 2017).

A hemodialysis is a treatment option for patients with End-Stage Renal Disease (ESRD). However, patients undergoing hemodialysis three times per week may experience psychological issues, including depression, which are highly prevalent among patients. Unfortunately, most healthcare providers fail to recognize the symptoms of depression due to overlap with other somatic symptoms; thus, depression remains undiagnosed. This study aimed to estimate the prevalence of depression and compare the differences in depression symptoms according to the sociodemographic characteristics of patients with ESRD undergoing hemodialysis. A descriptive, cross-sectional study was conducted from August to October 2021 with a total of 132 hemodialysis patients using the Beck Depression Inventory (BDI II) questionnaire to examine symptoms of depression at multiple health centers in Jeddah. Descriptive statistics, Mann-Whitney U, Kruskal-Wallis, Post-hoc analysis using Conover tests were used for data analysis. The prevalence of depression in hemodialysis patients was 51.5%, 25.8%, 15.9%, and 6.8%, with minimal, mild, moderate, and severe symptoms, respectively. Depression exhibited a significant relationship with sex (p = 0.034), with females showing higher mean depression scores than males. Additionally, depression scores were statistically significant across the different levels of education (p = 0.019), with the mean depression scores significantly highest in subjects who had only primary school level of education. Furthermore, the most common symptoms associated with depression were found to be energy loss and fatigue. Depression prevalence was relatively low among patients with ESRD undergoing hemodialysis, and a loss of energy and fatigue were the most common symptoms correlated with depression. Hence, nurses should be trained on how to routinely use psychological screening scales among patients with ESRD undergoing hemodialysis.

Background and Aims The reported prevalence of depression in dialysis population ranges from 20-45%, which varies across regions. Limited data are available on association with co-morbidities, clinical symptoms and quality of life, especially from India. Present study was aimed to explore the prevalence of depression in patients on maintenance haemodialysis, quality of life and feasibility of group based cognitive behavioural therapy (CBT) in this set of patients. Method This is a single centre prospective study conducted at a tertiary care referral hospital, Bangalore, India, over the period of 22 months (Dec-2017 to Apr-2019). Patients aged >18 years and on maintenance haemodialysis for >6 months were included in the study. Any patients with known psychiatric illness or substance abuse were excluded. Beck depression inventory (BDI) score and quality of life by kidney disease quality of life short form-36 (KDQOL-SF) were used for diagnosis of depression. Group based CBT is offered to patients with mild to moderate depression. Results A total of 100 (85 males) patients were studied, the mean±SD age was 54.0±12.9 years (range, 23-76). Forty-six (46%) patients had depression (mean BDI score 35.04±10.8), out of whom, 8 (17.4%) had mild depression, 6 (13.1%) had moderate depression, 14 (30.4%) had severe depression and 18 (39.1%) people had extreme levels of depression. Females, unemployed and retired persons, low socioeconomic status and frequent dialysis related complications are more prone for depression. Age, dialysis vintage, duration from diagnosis to dialysis, associated co-morbid conditions, frequency of emergency dialysis requirement, hospitalization rates did not significantly differ in both groups. Low serum phosphate levels and high Kt/V values had association with depression, while haemoglobin, serum albumin and serum calcium levels did not have association with depression. We were unable to complete the group based CBT due to medical and social reasons. Conclusion Depression is common in haemodialysis patients, patients with depression had poor medication compliance and lower quality of life. Group based CBT is not feasible due to high attrition rates.

Prevalence of Depression and Anxiety in Patients with COPD: Relationship to Functional Capacity

Background: End-stage renal disease requires dialysis treatment, with haemodialysis and peritoneal dialysis being the two primary modalities. These treatments often lead to psychological distress, including depression and anxiety, which adversely affect patients' quality of life and treatment adherence. Although both dialysis modalities have been associated with mental health issues, limited research compares the prevalence of depression and anxiety between haemodialysis and peritoneal dialysis patients. Materials and Methods: This observational cross-sectional study, conducted at Nobel Medical College Teaching Hospital, Biratnagar, enrolled 129 dialysis patients. Ethical approval was obtained, and informed consent was acquired from participants. The beck depression inventory, beck anxiety inventory, and the hospital anxiety and depression scale were used to assess depression and anxiety levels. Data were analyzed using the Student’s t-test and chi-square tests, with a significance level set at p < 0.05. Results: Of the 129 patients, 27.27% of haemodialysis patients and 42.10% of peritoneal dialysis patients exhibited depression on the beck depression inventory. On the hospital anxiety and depression, 10.90% of haemodialysis patients and 21.05% of peritoneal dialysis patients showed depression symptoms. Anxiety was observed in 27.27% of haemodialysis patients and 10.52% of peritoneal dialysis patients according to the Beck Anxiety Inventory. The differences between groups were not statistically significant (p > 0.05). Conclusion: Depression and anxiety are prevalent among dialysis patients, with no significant difference in the prevalence rate between haemodialysis and peritoneal dialysis groups. This highlights the need for routine screening for mental health disorders in dialysis patients to improve their overall well-being. Tailored mental health interventions should be developed to address the psychological needs of dialysis patients.

Background: The loss of residual renal function (RRF) and subsequent urine volume among haemodialysis (HD) patients may influence affect. Although RRF has been associated with improved patient outcome, its relationship with depression symptomatology is unknown. Methods: 106 HD patients completed the Beck Depression Inventory (BDI). The BDI is a depression symptom screening tool, with a score of ≥16 indicating possible clinical depression. Clinical parameters, including RRF (urea clearance, KRU [ml/min]) and interdialytic urine volume, were averaged over the 3-month pre-assessment including the month of the BDI assessment. Results: BDI scores correlated negatively with KRU and interdialytic urine volume. Patients with a KRU <1 had significantly higher BDI scores compared to those with a KRU ≥1. In logistic regression, KRU significantly predicted a BDI score ≥16, after controlling for a range of clinical parameters including urea, dialysis vintage and treatment time. A history of depressive illness was the only other predictive factor. Conclusion: We have demonstrated an association between RRF and depression symptoms in HD patients. The perception of loss associated with low RRF and urine volume may increase depressive vulnerability. Longitudinal assessment is required in order to validate this finding and to determine causality.

Patients on hemodialysis therapy often experience a high burden of mental and physical health symptoms. We developed a guided internet-based self-help problem-solving therapy (IPST) targeted on practical daily life issues. While we did not find an effect for all patients, we hypothesized that an internet intervention might be effective in younger patients below 65years of age. In this post-hoc secondary subgroup analysis we divided our study population based on age to study the effect of our intervention on depressive- and dialysis-related symptoms. Chronic hemodialysis patients with a depression score on the Beck Depression Inventory (BDI-II) of ≥10, were randomized into a five modules guided IPST or a care-as-usual control group. The study population was stratified by age (< 65 and≥65years). The primary outcome was depressive symptoms (BDI-II). Secondary outcomes were anxiety (BAI), health-related quality of life (HRQoL) and dialysis related symptoms (DSI). Analyses were performed using linear mixed models. 122 out of 190 randomized patients completed post-intervention measurements. In 25 younger patients (age<65), a significant effect was found in reduction of BDI-II (-30%, p=0.04) and DSI (presence of symptoms: -27%, p=0.001; level of distress: -25%, p=0.03). No effect was seen on BAI or HRQoL. In the older population (n=29), no effect of the intervention was found on any outcomes. An easy to implement guided IPST showed a clinically relevant decrease in depressive symptoms and dialysis related physical symptoms in hemodialysis patients aged below 65years although results should be interpreted cautiously given the post-hoc design. Dutch Trial Register: Trial NL6648 (NTR6834) (prospectively registered 13th November 2017).

BACKGROUND AND AIMS Expanding complexity of the comorbid disorders is becoming increasingly common in patients treated with chronic haemodialysis (HD) related to technique improvements, better treatment options and resultant prolonged survival. This contributes to development of physical and emotional symptoms, which further affect patients’ health. We aimed to examine the symptom burden, symptom severity and prevalence of depression in patients treated with chronic HD. METHOD Three hundred and four chronic adult HD patients (58.9% males, 67.1% under 65 years of age, 15.7% with diabetes, time on dialysis 3—324 months) from five dialysis centrrs were enrolled in this cross-sectional study. All patients were under stable condition, without any severe acute comorbidities, and able to understand and fill-in the self-administered questionnaires. Standard laboratory parameters and Kt/V were measured in all patients. Presence and severity of physical and emotional symptoms were assessed by the 30-item Dialysis Symptom Index (DSI), while the presence of depression was assessed with Beck Depression Inventory (BDI). Other relevant demographic and clinical data were obtained from patients’ medical records. The results were analyzed with independent sample T-test, χ2 and ANOVA statistic. RESULTS The average BDI was 15.10 ± 11.04, the average symptom burden 15.49 ± 12.85 and the average symptom severity 23.38 ± 18.78. Nearly half of the patients (45.1%) had depressive symptoms (BDI ≥ 14). The demographic (sex, age, marital status, level of education, employment status, smoking habit), clinical (body mass index, comorbidities, dialysis vintage, shift and adequacy, type of membrane and vascular access) were not significantly associated with depression. Patients with depressive symptoms had significantly higher serum urea (24.5 ± 5.5 mmol/L versus 22.7 ± 5.4 mmol/L; P = 0.028) and creatinine (896.7 ± 196.2 umol/L versus 809.5 ± 206.4 umol/L; P = 0.003), but no significant difference in other standard laboratory measurements. Women, patients &amp;gt;65 and diabetic patients had significantly higher symptom burden than men, younger and non-diabetic patients (17.50 ± 12.88 versus 14.08 ± 11.68, P = 0.017; 18.65 ± 15.47 versus 13.94 ± 10.04, P = 0.002; 22.80 ± 18.75 versus 14.32 ± 10.39, P = 0.017, respectively), while diabetic and patients with inadequate dialysis had siginifcantly higher symptom severity (29.65 ± 21.69 versus 22.37 ± 18.26, P &amp;lt; 0.01 and 27.33 ± 20.70 versus 17.37 ± 14.62, P &amp;lt; 0.01, respectively). Depressive patients had significantly higher symptom burden (19.68 ± 13.29 versus 12.04 ± 10.20; P &amp;lt; 0.01) and symptom severity (31.92 ± 19.71 versus 16.37 ± 14.69; P &amp;lt; 0.01). The symptoms significantly more prevalent in depressive patients included constipation, nausea, diarrhoea, muscle cramps, restless legs, numbness/tingling in feet, lack of energy, bone/joint pain, dry mouth (all P &amp;lt; 0.001), shortness of breath (P = 0.036), dizziness (P = 0.048) and chest pain (P = 0.027). CONCLUSION These results highlight the need for routine surveillance of symptoms and emotional status in chronic HD patients.

Depression is common in haemodialysis (HD) patients and associated with poor outcomes. To evaluate whether depression symptoms predict survival and transplantation in a large sample of haemodialysis patients using cause-specific survival models. Survival data was collected between April 2013 and November 2015, as part of the screening phase of a multicentre randomised placebo-controlled trial of sertraline in HD patients. Depression was measured using the Beck Depression Inventory-II (BDI-II) and the Patient Health Questionnaire-9 (PHQ-9). Demographic and clinical data were collected via a self-report questionnaire and medical records. Competing risk survival analysis involved cause-specific and subdistribution hazard survival models. All models were adjusted for appropriate covariates including co-morbidity and C-reactive protein (CRP) in a subanalysis. Of 707 cases available for analysis, there were 148 deaths. The mean survival time was 787.5 days. Cumulative survival at 12 months was 88.5%. During the study follow-up period, there were 92 transplants. The cumulative transplant event rate at 12 months was 7.8%. In separate adjusted models, depression symptoms predicted mortality (BDI-II HR = 1.03 95% CI 1.01, 1.04; PHQ-9 HR = 1.04 95% CI 1.01, 1.06). With respect to screening cut-off scores, a PHQ-9 ≥ 10 was associated with mortality (HR = 1.51 95% CI 1.01, 2.19) but not a BDI-II ≥ 16. Depression symptoms were not associated with time to transplantation in either cause-specific or subdistribution model. Consistent with past findings in HD patients, depression symptoms predicted survival but were not associated with kidney transplantation. Suitable treatments for depression need further evaluation, and their impact upon quality of life and clinical outcomes determined. (ISRCTN06146268).