Depression in hemodialysis patients: the role of dialysis shift

Abstract

OBJECTIVE:Depression is the most important neuropsychiatric complication in chronic kidney disease because it reduces quality of life and increases mortality. Evidence demonstrating the association between dialysis shift and depression is lacking; thus, obtaining such evidence was the main objective of this study.METHOD:This cross-sectional study included patients attending a hemodialysis program. Depression was diagnosed using Beck's Depression Inventory. Excessive daytime sleepiness was evaluated using the Epworth Sleepiness Scale.RESULTS:A total of 96 patients were enrolled (55 males, age 48±14 years). Depression and excessive daytime sleepiness were observed in 42.7% and 49% of the patients, respectively. When comparing variables among the three dialysis shifts, there were no differences in age, dialysis vintage, employment status, excessive daytime sleepiness, hemoglobin, phosphorus levels, or albumin levels. Patients in the morning shift were more likely to live in rural areas (p<0.0001), although patients in rural areas did not have a higher prevalence of depression (p = 0.30). Patients with depression were more likely to be dialyzed during the morning shift (p = 0.008). Independent risk factors for depression were age (p<0.03), lower levels of hemoglobin (p<0.01) and phosphorus (p<0.01), and dialysis during the morning shift (p = 0.0009). The hospitalization risk of depressive patients was 4.5 times higher than that of nondepressive patients (p<0.008).CONCLUSION:These data suggest that depression is associated with dialysis shift, higher levels of phosphorus, and lower levels of hemoglobin. The results highlight the need for randomized trials to determine whether this association occurs by chance or whether circadian rhythm disorders may play a role.

Predictors of quality of life in patients with end-stage renal disease on hemodialysis

“…1 In addition, depression, a well-known condition to increase disease burden, was associated with morning shift dialysis, anemia, and phosphorus levels, which independently predicted the depression in ESRD population. 9 Other factors that seem to affect mental well-being are lower calcium levels and absence of diabetes mellitus. 3 Sleep quality in ESRD population is significantly related to phosphorus and albumin levels and body mass index.…”

The Level of Anxiety and Depression in Dialysis Patients Undertaking Regular Physical Exercise Training - a Preliminary Study

“…Additionally, the authors report that 12% to 52% of hemodialysis patients experience anxiety during dialysis [3,5]. Depressive disorders that occur as a result of complications of chronic kidney disease, and the anxiety that accompanies them, lower the quality of life of patients, but also according to studies increase their mortality [6][7][8][9].…”

Evaluation of subjective sleep quality in hemodialysis patients and its association with hemodialysis timing

“…In addition, intra-class correlation-coefficient (ICC) has been calculated at 0.85 with validity of 0.81 using Spearman-Brown prediction formula (30,31). In this study, reliability of BDI was confirmed using Cronbach's alpha (0.92).…”