Hemodiyaliz Hastalarında Depresyon ve Yaşam Kalitesi ile İlişkili Faktörler

Year 2022, Volume: 5 Issue: 2, 92 - 100, 31.08.2022

Engin Onan , Saime Paydas , Bülent Kaya , Tuba Korkmaz , Ahmet Gazi Mustan , Merve Sungur Özgünen , Farid Mohamad Hamad , Ertan Kara

https://doi.org/10.36516/jocass.1100261

Abstract

Amaç: Depresyon hemodiyaliz hastalarını etkileyen en yaygın psikiyatrik bozukluktur ve bozulmuş yaşam kalitesi ile ilişkili olduğu düşünülmektedir. Bu çalışmada Çukurova Üniversitesinde hemodiyalize giren hastalarda depresyon ile yaşam kalitesi ve demografik faktörler arasındaki ilişki araştırılmıştır.
Yöntem: Çukurova üniversitesinde diyalize girmekte olan elli (n: 50) hemodiyaliz hastasına depresyon, yaşam kalitesi (quality of life, QoL) ve demografik veriler arasındaki ilişkiyi değerlendirmek için kısa form 36 (SF-36) ve Beck depresyon envanteri (BDI) anketleri uygulandı. BDI ve SF-36 skorları ile yıllık biyokimyasal ve demografik veriler arasındaki ilişki değerlendirildi.
Bulgular: Hastaların yaş ortalaması 56.4 ± 16.4 yıl, ortalama HD süresi 57.11 ± 39.09 ay idi. Depresyon insidansı (BDI> 14 olarak belirlendiğinde) % 36 idi. Yaş, hemoglobin, ferritin, vücut kitle indeksi (VKİ) ve Kt/v değerleri QoL skorları ile anlamlı olarak korele bulundu (hepsi için p <0.05). Ancak QoL skorları diyaliz süresi, serum albümin, C reaktif protein, kalsiyum, fosfor ve parathormon değerleri ile ilişkili değildi. Hemoglobin için hedef seviyede olma, hasta yaşının kırkbeşin altında olması, ideal vücut ağırlığında olma hali ise yüksek sosyal fonksiyon skoru (SF-36 alt analizi) ile anlamlı ölçüde ilişkiliydi (p <0.05).
Sonuç: Bu çalışmada hemodiyaliz hasta grubunda depresyon sıklığı % 36 olarak bulunmuş ve bu durumun kötü yaşam kalitesi skorları ile ilişkili olduğu gösterilmiştir. İlginç olarak iyi diyalizin bir göstergesi olan Kt/v’nin ve hastaların biyokimyasal parametrelerinin QoL ile ilişkisi bulunmamıştır. Ferritinin yüksek olması negatif olarak (>800 mg/dL); hemoglobinin> 11 g/dL’nin üzerinde olması, ideal vücut ağırlığında olmak (VKİ 18-25 kg/m2) ve 18-45 yaş aralığında olmak pozitif olarak bazı SF-36 skorlarıyla ilişkili bulunmuştur. Bu çalışma hemodiyaliz hastalarının iyilik hallerini sağlamak için nefrolog ve psikiyatrların birlikte çalışması gerektiğini vurgulamaktadır.

Keywords

Yaşam kalitesi, depresyon, hemodiyaliz

Depression and Quality of Life Related Factors in Hemodialysis Patients

Abstract

Objective: Depression is the most common psychiatric disorder affecting patients on hemodialysis (HD) and has been associated with impaired Quality of Life (QoL). This study aimed to investigate the prevalence of depression and the relationship between depression, QoL, and demographic factors in HD patients.

Methods: Short form 36 (SF–36) and Beck's depression inventory (BDI) were employed to assess the relationship between depression, QoL and demographics in 50 hemodialysis patients. The relationship between scores of BDI and SF–36, and annual biochemical and demographic data were then evaluated.

Results: Mean age of the patients was 56.4 ±16.4 years and the mean HD duration was 57.11 ±39.09 months. The incidence of depression (BDI>14) was 36%. Age, hemoglobin, ferritin, body mass index (BMI), and Kt/V values were observed to be significantly correlated with the QoL scores (p<0.05 for all). These scores, however, were not related to dialysis duration, serum albumin, CRP, calcium, phosphorus, and parathormone values. The target level for hemoglobin, age <45 years, and ideal body weight were associated with high SF–36 social functioning score (p<0.05).

Conclusion: The results of this study showed that the depressive symptoms were as high as 36% among the study group linked to poor QoL. Interestingly, annual mean values of Kt/V and the biochemical parameters were not related to BDI scores. Higher levels of ferritin (800) (negatively) and hemoglobin (>11 g/dL) / ideal BMI (18–25 kg/m2) / younger age (18–45 year) (positively) were related to some SF–36 scores. The study emphasizes that hemodialysis patients should also be evaluated for depression and QoL, to optimize clinical outcomes with the help of nephrologists and psychiatrist.

Keywords

Quality of life, depression, hemodialysis

References

• 1. Kimmel PL, Cukor D, Cohen SD, Peterson RA. Depression in end-stage renal disease patients: a critical review. Adv Chronic Kidney Dis. 2007;14 (4):328–34.
• 2. King-Wing Ma T, Kam-Tao Li P. Depression in dialysis patients. Nephrology (Carlton). 2016;21 (8):639–46.
• 3. Kimmel PL, Patel SS. Quality of life in patients with chronic kidney disease: focus on end-stage renal disease treated with hemodialysis. Semin Nephrol. 2006;26 (1):68–79.
• 4. Kimmel PL, Emont SL, Newmann JM, Danko H, Moss AH. ESRD patient quality of life: symptoms, spiritual beliefs, psychosocial factors, and ethnicity. Am J Kidney Dis. 2003;42 (4):713–21.
• 5. Hedayati SS, Yalamanchili V, Finkelstein FO. A practical approach to the treatment of depression in patients with chronic kidney disease and end-stage renal disease. Kidney Int. 2012;81 (3):247–55.
• 6. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4:561–71.
• 7. McHorney CA, Ware JE, Jr., Raczek AE. The MOS 36-Item Short-Form Health Survey (SF–36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care. 1993;31 (3):247–63.
• 8. Kimmel PL, Peterson RA, Weihs KL, Simmens SJ, Alleyne S, Cruz I, et al. Multiple measurements of depression predict mortality in a longitudinal study of chronic hemodialysis outpatients. Kidney Int. 2000;57 (5):2093–8.
• 9. Demiral Y, Ergor G, Unal B, Semin S, Akvardar Y, Kivircik B, et al. Normative data and discriminative properties of short form 36 (SF–36) in Turkish urban population. BMC Public Health. 2006;6:247.
• 10. Finkelstein FO, Finkelstein SH. Depression in chronic dialysis patients: assessment and treatment. Nephrol Dial Transplant. 2000;15 (12):1911–3.
• 11. Kimmel PL, Levy BL. Psychology and rehabilitation. In: Daugirdas JT, Blake PG, Todd SI. eds. Handbook of Dialysis. third ed. Baltimore, MD: LippincottWilliams &Wilkins; 2004:413–419.
• 12. Lopes AA, Bragg J, Young E, Goodkin D, Mapes D, Combe C, et al. Depression as a predictor of mortality and hospitalization among hemodialysis patients in the United States and Europe. Kidney Int. 2002;62 (1):199–207.
• 13. O'Donnell K, Chung JY. The diagnosis of major depression in end-stage renal disease. Psychother Psychosom. 1997;66 (1):38–43.
• 14. Smith MD, Hong BA, Robson AM. Diagnosis of depression in patients with end-stage renal disease. Comparative analysis. Am J Med. 1985;79 (2):160–6.
• 15. Son YJ, Choi KS, Park YR, Bae JS, Lee JB. Depression, symptoms and the quality of life in patients on hemodialysis for end-stage renal disease. Am J Nephrol. 2009;29 (1):36–42.
• 16. Drayer RA, Piraino B, Reynolds CF, third, Houck PR, Mazumdar S, Bernardini J, et al. Characteristics of depression in hemodialysis patients: symptoms, quality of life and mortality risk. Gen Hosp Psychiatry. 2006;28 (4):306–12.
• 17. Fukuhara S, Lopes AA, Bragg-Gresham JL, Kurokawa K, Mapes DL, Akizawa T, et al. Health-related quality of life among dialysis patients on three continents: the Dialysis Outcomes and Practice Patterns Study. Kidney Int. 2003;64 (5):1903–10.