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Depression is an important target of psychological assessment in patients with end-stage renal disease because it predicts their morbidity, mortality, and quality of life. We assessed the effectiveness of cognitive-behavioral therapy in chronic hemodialysis patients diagnosed with major depression by the Mini International Neuropsychiatric Interview (MINI). In a randomized trial conducted in Brazil, an intervention group of 41 patients was given 12 weekly sessions of cognitive-behavioral group therapy led by a trained psychologist over 3 months while a control group of 44 patients received the usual treatment offered in the dialysis unit. In both groups, the Beck Depression Inventory, the MINI, and the Kidney Disease and Quality of Life-Short Form questionnaires were administered at baseline, after 3 months of intervention or usual treatment, and after 9 months of follow-up. The intervention group had significant improvements, compared to the control group, in the average scores of the Beck Depression Inventory overall scale, MINI scores, and in quality-of-life dimensions that included the burden of renal disease, sleep, quality of social interaction, overall health, and the mental component summary. We conclude that cognitive-behavioral group therapy is an effective treatment of depression in chronic hemodialysis patients.

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AIM:To compare the dimensions of quality of life in the stages of chronic kidney disease and the influence of sociodemographic, clinical and laboratory data.INTRODUCTION:The information available on the quality of life of patients on conservative treatment and the relationship between the quality of life and glomerular filtration rate is limited.METHODS:155 patients in stages 1–5 of chronic kidney disease and 36 in hemodialysis were studied. Quality of life was rated by the Medical Outcomes Study Short Form 36-Item (SF-36) and functional status by the Karnofsky Performance Scale. Clinical, laboratory and sociodemographic variables were investigated.RESULTS:Quality of life decreased in all stages of kidney disease. A reduction in physical functioning, physical role functioning and in the physical component summary was observed progressively in the different stages of kidney disease. Individuals with higher educational level who were professionally active displayed higher physical component summary values, whereas men and those with a higher income presented better mental component summary values. Older patients performed worse on the physical component summary and better on the mental component summary. Hemoglobin levels correlated with higher physical component summary values and the Karnofsky scale. Three or more comorbidities had an impact on the physical dimension.CONCLUSION:Quality of life is decreased in renal patients in the early stages of disease. No association was detected between the stages of the disease and the quality of life. It was possible to establish sociodemographic, clinical and laboratory risk factors for a worse quality of life in this population.

The absolute number and the prevalence and incidence rates of patients on dialysis continue to rise steadily; the gross mortality rate remained stable. Regional inequities are evident in these rates.

During 2011-2014 the prevalence and incidence rates of patients on dialysis tended to increase, while the gross mortality rate remained stable. In 2014, diabetes was the primary renal disease in 42% of the new dialysis patients.

Introduction: Having national data on chronic dialysis is essential in treatment planning. Objective: To present data of the survey from the Brazilian Society of Nephrology on patients with chronic kidney disease on dialysis in July 2017. Methods: Data was collected from dialysis units in Brazil. The data collection was done using a questionnaire completed online by the dialysis units. Results: Two hundred and ninety-one centers (38.4%) answered the questionnaire. In July 2017, the estimated total number of dialysis patients was 126,583. National estimates of prevalence and incidence rates of dialysis patients per million population (pmp) were 610 (range: 473 in the North region and 710 in the Midwest) and 194, respectively. The incidence rate of new dialysis patients with diagnosis of diabetic nephropathy was 77 pmp. The annual gross mortality rate was 19.9%. Of the prevalent patients, 93.1% were on hemodialysis and 6.9% on peritoneal dialysis, with 31,226 (24%) on the waiting list for renal transplantation. Venous catheter was used as access in 22.6% of patients on hemodialysis. The prevalence rate of positive serology for hepatitis C continued with a tendency to decrease (3.3%). Conclusion: The absolute number of patients and rates of incidence and prevalence on dialysis continued to increase; the mortality rate tended to rise. There were obvious regional and state discrepancies in these rates.