ABSTRACT
Chronic kidney disease (CKD) patients are at high risk of depressive disorders because of considerable psychological stress due to physical and social changes brought on by disease. The aim of this study is to assess the prevalence of depression in patients with CKD and the factors affecting it at a public tertiary care hospital. This cross-sectional study was carried out at the renal clinic of a tertiary care hospital. Data on 612 patients diagnosed with CKD from September 2014 to April 2016 was obtained. Nine-item Patient Health Questionnaire from PRIME-MD was used to assess the depression. Of all the patients, 55.9% had no depression. Mild depression was found to affect 28.4% of the patients followed by moderate depression, moderately severe, and severe depression (11.8%, 3.8%, and 0.8%, respectively). According to multiple logistic regression, the occurrence of depression was significantly higher with age below 60 years [odds ratio (OR) 1.6, 0.8-2.7; P<0.05], male gender (OR 1.3, 0.9-3.1; P<0.05), no treatment funding (OR 2.6, 1.2-4.5; P<0.05), education less than grade 12 (OR1.3, 1.3-3.2; P<0.05), monthly income ≤INR 20,000 (OR 1.6, 1.1-3.6; P<0.05), CKD stage V (OR 1.3, 1.02.9; P <0.05), Patients on hemodialysis (hD) (OR 2.6, 1.2-4.5; P<0.05), comorbidities ≥3 (OR 1.7, 1.1-2.9; P<0.05), overweight (OR 2.5, 1.3-2.9; P<0.05), and duration of CKD >2 (OR 2.2, 1.3-4.3; P<0.05). About 44% of the patients were found to have depression. Patients' age, gender, body mass index, treatment funding, education status, income, CKD duration and stage, HD status, and comorbidities were found to be significant factors affecting depression.
Subject(s)
Affect , Depression/epidemiology , Hospitals, Public , Inpatients/psychology , Renal Insufficiency, Chronic/epidemiology , Tertiary Care Centers , Adult , Age Factors , Comorbidity , Cross-Sectional Studies , Depression/diagnosis , Depression/psychology , Educational Status , Female , Health Status , Humans , Income , India/epidemiology , Male , Middle Aged , Patient Admission , Prevalence , Renal Dialysis , Renal Insufficiency, Chronic/diagnosis , Renal Insufficiency, Chronic/psychology , Renal Insufficiency, Chronic/therapy , Risk Assessment , Risk Factors , Severity of Illness Index , Sex Factors , Social Determinants of HealthABSTRACT
BACKGROUND: Chronic kidney disease (CKD) has a high morbidity and mortality in developing countries. And this burden is also increasing rapidly in India. Unaffordability due to high cost of medication and hemodialysis remains one of the major barriers in the successful treatment of CKD. OBJECTIVES: To determine the direct cost involved in treating CKD at an outpatient department of a public tertiary care hospital. METHODS: This cross-sectional study was carried out at a public tertiary care hospital. Patients diagnosed with CKD by a physician were included in the study after obtaining a written informed consent. All the relevant data were collected on a predesigned case record form. RESULTS: The results are based on data obtained from 150 patients. The average age of the patients was 55.7 ± 10.1 years. The average number of drugs per prescription was found to be 6.5 ± 1.7. The annual average costs of treatment for patients on medication only and for patients on hemodialysis plus medication were Rs 25,836 (US $386) and Rs 2,13,144 (US $3181), respectively (Rs = Indian rupee). Treatment cost was found to be statistically significantly higher in patients on hemodialysis, treatment support by employer, patients with a smoking habit, patients with comorbidities, and patients with end-stage renal disease. Calcium tablets, vitamin D sachets, iron supplements, torsemide, and amlodipine were the top five medications prescribed. CONCLUSIONS: Reimbursement, patient's dialysis status, habits, and comorbidities were found to have a significant effect on the direct cost of treatment.
