ABSTRACT
Depression is the most common psychiatric illness in patients with end stage renal disease [ESRD], and has been associated with increased risk of death, cardiovascular events and hospitalization in a substantial proportion of patients. Impaired quality of life [QoL] has been reported in dialysis patients and is a marker of poor outcome. We aimed to assess the prevalence of depression and quality of life status among chronic hemodialysis patients. We explored the relationship between depressive symptoms and poor QoL on the one hand and sociodemographic profile, dialysis adequacy, serum chemistry, malnutrition-inflammation score [MIS] and symptom burden on the other hand. 60 chronic hemodialysis patients participated in the study between June and August 2007. They were on thrice weekly dialysis at the Kasr El-Aini Nephrology and Dialysis centre, Cairo University Hospital. Clinical and socio-demographic data were obtained and their case records were reviewed to obtain laboratory results including haemoglobin, urea reduction ratio, serum albumin, calcium, phosphorus, creatinine and total iron binding capacity. We used the Beck Depression Inventory [BDI] to assess the severity of depression, and SF-36 questionnaire to assess quality of life in the study group. MIS was used to assess the extent of malnutrition and inflammation complex and total symptom burden was evaluated using dialysis symptom Index [DSI]. Mean age was 46.13 +/- 16.55 years, with a range of 22-77 years. 20 patients [33.33%] had BDI score >/= 15. Two patients [3.33%] had QoL total score less than 50, 8 patients [13.33%] had scores in the range of 50-60, 30 patients [50%] had a score range of 60-70, 12 patients [20%] had scores of 70-80, 8 patients [13.3%] had a score range 80-90. Employment was found to significantly affect BDI scores; all patients with BDI scores >/= 15 were unemployed. The mean BDI score of unemployed patients was significantly higher than employed patients [13.03 +/- 6.27 Vs. 8.50 +/- 3.51, p=0.03]. Widowed had significantly higher BDI and lower F-36 scores compared to single, married and divorced patients [p<0.05]. DSI and MIS showed significant positive correlations with BDI scores [p<0.05] and significant negative correlations with F-36 scores [p<0.05]. Neither age, BMI, DIS, MIS, dialysis adequacy, haemoglobin, blood urea and serum creatinine, calcium, phosphate and albumin were predictable of BDI scores on regression analysis [p>0.05]. Our results showed high prevalence of depressive symptoms among the study group that was linked to poor quality of life, total symptom burden and malnutrition inflammation complex. We propose the routine use of simple screening tools such as BDI, F-36 form, and MIS to identify vulnerable patients at higher risk for poor outcome, increased hospitalization and death