Depression and Symptom Burden in Patients on Chronic Haemodi
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.

304 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, 2 and ANOVA statistic.

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 >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 < 0.01 and 27.33 ± 20.70 versus 17.37 ± 14.62, P < 0.01, respectively).

Depressive patients had significantly higher symptom burden (19.68 ± 13.29 versus 12.04 ± 10.20; P < 0.01) and symptom severity (31.92 ± 19.71 versus 16.37 ± 14.69; P < 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 < 0.001), shortness of breath (P = 0.036), dizziness (P = 0.048) and chest pain (P = 0.027). These results highlight the need for routine surveillance of symptoms and emotional status in chronic HD patients.

Source: https://academic.oup.com/ndt/article/37/Supplement_3/gfac083.074/6578059
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