INTRODUCTION:

End Stage Renal Disease (ESRD) patients worldwide, who regularly receive Renal Replacement Therapy (RRT) in the form of dialysis. People with depression will have 85% more chance of developing renal failure. The etiology of compound depression in ESRD is dynamic complicated by both neurocognitive and somatic features. Depression is often unrecognized, reflecting a lack of routine psychological evaluation among this patient population. The consequences of unidentified depression among dialysis patients are significant.²

Pathology2:

Depression is the most common psychopathological condition among patients with end-stage renal disease (ESRD), yet it is still under-recognized and misdiagnosed. Depression reduces quality of life and has a negative clinical impact upon sufferers with chronic illness, including ESRD.

METHODOLOGY:

Diagnostic and Statistical Manual of mental disorders was used as a diagnostic tool. Major Depressive Disorder was graded as minimal, mild, moderate and severe by Beck Depression Inventory. Exclusion criteria included refusal to participate in the psychiatric interview, patients who were diagnosed with psychiatric disorders other than MDD and patients with prior history of any psychiatric illness.

Depression screening tools in dialysis patients^3,6:

Depression is the most common psychiatric disorder in long-term dialysis patients and is a risk factor for morbidity and mortality. An efficient and valid method of diagnosing depression might facilitate recognition and treatment. We surveyed patients who had received dialysis for at least 90 days .We excluded patients with dementia, delirium, or a history of major psychiatric disorders other than depression. Of 62 enrolled subjects, 16 were diagnosed with a depressive disorder, including 12 patients (19%) with major depression, 3 patients with dysthymia, and 1 patient with minor depression. Optimal BDI and PHQ-9 cutoff values for depressive disorders combined was 16 or greater and 10 or greater, respectively. Sensitivities were 91% and 92%, specificities were 86% and 92%, positive predictive values were 59% and 71%, and negative predictive values were both 98%, with kappa values of 0.65 and 0.75, respectively. The difference between the 2 receiver operating characteristic curves was not statistically significant.¹¹

Our results validate the PHQ-9 and revalidate the BDI against a gold-standard measure for depressive disorders in the dialysis population. Both tools performed equally well. Because depression is prevalent, readily diagnosed, and associated with poor outcomes, screening by means of short and valid measurement tools may lead to better diagnosis and treatment of this modifiable risk factor. This may lead to improved clinical outcomes in dialysis patients⁶.

Psychological Factor¹³:

The study showed that the use of psychological intervention based on cognitive- behavioral therapy was an effective method of decreasing the severity of depressive symptoms in hemodialyzed patients.

Mechanisms by which depression associates with adverse outcome¹¹:

Depression can increase inflammation, which in turn can accelerate atherosclerosis and potentially lead to cardiovascular events. Depression is also implicated in the modulation of vascular tone by altering serotonin levels and autonomic nervous system function, increasing platelet aggregation, altering cortisol and norepinephrine production, all of which can lead to cardiovascular events and stroke. Depression is associated with dialysis shift, psychological and social factors.Depressive disorder is the most frequently described psychiatric condition in patients with End-Stage Renal Disease (ESRD). Prevalence can be as high as 100%. Depression predicts subsequent rapid decline in kidney function, in new onset clinically severe kidney disease (or end-stage renal disease), and hospitalizations that are complicated by acute kidney injury. Substance abuse, alcoholism and suicidal tendency are common in depressive illness. Moreover, they are likely to be non- complaint with regular dialysis, fluid replacement etc.

The impact on quality of life of dialysis patients⁴:

In order to improve the functioning of hemodialysis patients in a manner most similar to healthy persons, the renal replacement therapy should consider patients’ individual needs and expectations, i.e., guarantee flexible hours of work or study and of receiving dialysis. In addition, patients treated with hemodialysis should receive psychological care, in particular those demonstrating emotional problems, in order to achieve better results in therapy and improve their QoL.

To evaluate the presence of the relationship between depression and proinflammatory cytokine levels in hemodialysis (HD) patients.^7,9,12

The study included 40 HD patients and 20 healthy controls. All participants were evaluated for the presence of depression using the structured clinical interview based on criteria defined by Diagnostic and statistical manual mental disorders. The severity of depressive symptoms was assessed using the Beck Depression Inventory, the Hamilton Depression Rating Scale, and the Hamilton Anxiety Rating Scale. The depressive patients received antidepressants for 8 weeks. Blood samples were taken at baseline and after 8 weeks of antidepressant treatment for interleukin-1.

A total of 9 (22.5%) of the 40 HD patients had depression. IL-1, IL-6, and TNF-α levels were significantly higher in HD patients compared with that in the control group, but were not significantly different between HD patients with and without depression. In the depressive patients, we observed no significant difference in proinflammatory cytokine levels after antidepressant treatment. The psychometric measurements in depressive patients decreased significantly after antidepressant treatment.

We observed that depression is a common psychiatric disorder and has no significant effect on pro inflammatory cytokine levels in HD patients; no important improvement in cytokine levels was observed after antidepressant therapy.

Quality of life in peritoneal dialysis patients⁸:

Quality of life (QoL) is increasingly well recognized as an important measure of treatment outcome. The aim of this study was to determine which key factors affect QoL, which aspects of QoL change over time, and if measurements of QoL were associated with clinical outcome in our peritoneal dialysis (PD) population.

Psychological impact of haemodialysis patient¹⁸:

Depression, anxiety, and stress were highly prevalent in patients undergoing hemodialysis; all three had a strong relationship with the patients' level of spiritual well-being. In other words, patients with higher levels of spiritual well-being showed lower psychological symptoms.

DISCUSSION:

Neurocognitive, physical symptoms and the severity of MDD are measured in our study. Depression increases the risk of chronic diseases such as diabetes, chronic heart disease, and heart failure with their accompanying complex medical regimen and polypharmacy. Other pathways include poor adherence to medical regimen and other adverse health behaviors such as smoking and alcohol overuse. and possibly medical errors leading to Acute Kidney Injury (AKI).

RESULTS⁵:

Alport syndrome, Epilepsy, Kidney TB, Antral gastritis, Acute Respiratory Failure. Obstructive sleep apnea, Ischemic Heart Disease. Acute Suppurative Otitis Media. Electrolyte imbalance, Chronic Glomerulonephritis. Hyperkalemia, hyperparathyroidism, Coronary Artery Bypass Graft. Cholelithiasis, Hypoalbuminemia, Hypokalemia, Hypothyroidism Urinary tract infection, Asthma, Diabetic retinopathy, Fracture, Xerotic dermatitis, Eczema, Pulmonary Tuberculosis (PTB). Hemorrhoids, Sepis, Stroke, Facial palsy, Thyroidectomy, Benign Enlargement of Prostate (BEP). The most frequent comorbid condition was Diabetes and Hypertension

CONCLUSION¹:

Prevalence of MDD among CKD and ESRD patients propels the vicious cycle where dialysis treatment is undermined and the patients’ overall health outcomes are compromised. Treatment of the physical ailments become more challenging when it is compounded with mental disorders such as MDD. Lack of education, shortage of overall government health funding, stigma of mental health conditions and scarcity of desired resources, especially in developing countries such as Bangladesh, means that issue of MDD goes seemingly unaddressed, which further enhances the complexity of the issue. Thus, depressive disorder deserves more attention in context to the management of dialysis patients. Improvement of dialysis treatment outcome relies on utilization of a multifaceted intervention approach that encompasses social, political, biological and cultural models of health to address the proper diagnosis and treatment of depressive disorder.

REFERENCES:

1. Kimmel PL, Weihs K, Peterson RA (1993) Survival in hemodialysis patients: The role of depression J Am Soc Nephrol 4: 12-27.

2. Levenson JL, Glocheski S (1991) Psychological factors aﬀecting end-stage renal disease: A review. Psychosomatics 32: 382-389.

3. Watnick S, Wang PL, Demadura T, Ganzini L (2005) Validation of 2 depression screening tools in dialysis patients. Am J kidney Dis 46: 919-924.

4. Killingworth A, Van Den Akker O (1996) The quality of life of renal dialysis patients: Trying to find the missing measurement. Int J Nurs Stud 33: 107-120.

5. Stein MB, Cox BJ, Afifi TO, Belik SL, Sareen J (2006) Does co-morbid depressive illness magnify the impact of chronic physical illness? A population-based perspective. Psychological Medicine 36: 587-596.

6. Lopes AA, Albert JM, Young EW, Satayathum S, Pisoni RL, et al. (2004) Screening for depression in hemodialysis patients: Associations with diagnosis, treatment, and outcomes in the DOPPS. Kidney Int 66: 2047-2053.

7. Cilan H, Oguzhan N, Unal A, Turan T, Koc AN, et al. (2012) Relationship between depression and proinflammatory cytokine levels in hemodialysis patients. Ren Fail 34: 275-278.

8. Steele TE, Baltimore D, Finkelstein SH, Juergensen P, Kliger AS, et al. (1996) Quality of life in peritoneal dialysis patients. J Nerv Ment Dis 184: 368-374.

9. Beck AT, Steer RA, Brown GK (1996) Beck depression inventory-II.

10. Wuerth DB, Finkelstein SH, Schwetz O, Carey H, Kliger AS, et al. (2002) Patients’ descriptions of specific factors leading to modality selection of chronic peritoneal dialysis or hemodialysis. Perit Dial Int 22: 184-190.

11. Lambert MJ, Hatch DR, Kingston MD, Edwards BC (1986) Zung, beck, and hamilton rating scales as measures of treatment outcome: A meta-analytic comparison. J Consult Clin Psychol 54: 54-59.

12. Snaith RP, Taylor CM (1985) Rating scales for depression and anxiety: A current perspective. Br J Clin Pharmacol 19: 17S-20S.

13. Kimmel PL (2001) Psychosocial factors in dialysis patients. Kidney Int 59: 1599-1613.

14. Kimmel PL, Thamer M, Richard CM, Ray NF (1998) Psychiatric illness in patients with end-stage renal disease. Am J Med 105: 214-221.

15. Kop WJ, Seliger SL, Fink JC, Katz R, Odden MC, et al. (2011) Longitudinal association of depressive symptoms with rapid kidney function decline and adverse clinical renal disease outcomes. Clin J Am Soc Nephrol 6: 834-844.

16. Armaly Z, Farah J, Jabbour A, Bisharat B, Abd-El Qader A, et al. (2012) Major depressive disorders in chronic hemodialysis patients in Nazareth: Identification and assessment. Neuropsychiatr Dis Treat 8: 329-338.

17. Kimmel PL, Peterson RA (2006) Depression in patients with end-stage renal disease treated with dialysis: Has the time to treat arrived? Clin J Am Soc Nephrol 1: 349-352.

18. Wang LJ, Chen CK (2012) The psychological impact of hemodialysis on patients with chronic renal failure. Renal failure- The facts 217-236.

Received on 22.09.2022 Modified on 23.02.2023

Int. J. Nur. Edu. and Research. 2023; 11(2):161-164.

DOI: 10.52711/2454-2660.2023.00036

Pathology2:

Depression is the most common psychopathological condition among patients with end-stage renal disease (ESRD), yet it is still under-recognized and misdiagnosed. Depression reduces quality of life and has a negative clinical impact upon sufferers with chronic illness, including ESRD.

METHODOLOGY:

Depression screening tools in dialysis patients3,6:

Psychological Factor13: