Depression and Physical Frailty Have Additive Effect on the Nutritional Status and Clinical Outcome of Chinese Peritoneal Dialysis

Abstract

Background/Aims: Frailty and depression both contribute to malnutrition and adverse clinical outcome of peritoneal dialysis (PD) patients. However, their interaction is incompletely defined. Methods: We studied 178 adult Chinese PD patients. Physical frailty was assessed by a validated in-house questionnaire; depressive symptoms was screened by the Geriatric Depression Scale; nutritional status was determined by subjective global assessment (SGA) and malnutrition inflammation score (MIS). All patients were followed for up to 24 months for survival and hospitalization analysis. Results: There were 111 patients (62.4%) physically frail, amongst those 48 (43.2%) had depressive symptoms. Only 1 patient had depressive symptoms without frailty. There was an additive effect of depressive symptoms and physical frailty on nutritional status. For the groups with no frailty, frail but no depressive symptoms, and frail with depressive symptoms, serum albumin decreased in a stepwise manner (35.8 ± 5.6, 34.9 ± 4.4, and 32.9 ± 5.3 g/L, respectively, p=0.025); overall SGA score was 5.75 ± 0.61, 5.41 ± 0.59, and 5.04 ± 0.77, respectively (p< 0.0001), and MIS was 5.12 ± 2.30, 7.13 ± 3.22, and 9.48 ± 3.97, respectively (p< 0.0001). At 24 months, patient survival was 86.6%, 71.4%, and 62.5% for patients with no frailty, frail but no depressive symptoms, and frail with depressive symptoms, respective (p=0.001). The median number of hospital stay was 8.04 (inter-quartile range [IQR] 0.91 – 19.42), 14.05 (IQR 3.57 – 37.27), and 26.62 (IQR 10.65 – 61.18) days per year of follow up, respectively (p< 0.0001). Conclusion: Physical frailty and depressive symptoms are both common in Chinese PD patients, and they have additive adverse effect on the nutritional status and clinical outcome.

Family caregiver's burden and the social support for older patients undergoing peritoneal dialysis

“…In China, the majority of elderly patients suffering from depressive symptoms received no medical attention or treatment for these symptoms (Feng et al 2014); therefore, family caregivers play an important role in ensuring the mental health and wellbeing of patients by providing them with comfort and support. Meanwhile, elderly people on PD with depressive symptoms may display additional symptoms, such as cognitive impairment, sleep disturbance and frailty (Dong et al 2016; Szeto et al 2018), which could place further demands on caregivers. In addition, depressive symptoms in patients have been associated with their non‐adherence to dietary and medication regimes, particularly among the dialysis population (Khalil & Frazier 2010; Alosaimi et al 2016).…”

Depression does not predict clinical outcome of Chinese peritoneal Dialysis patients after adjusting for the degree of frailty

“…Iyasere et al [12] showed that patients on assisted PD had a higher prevalence of possible depression and higher Hospital Anxiety and Depression Scale (HADS) depression score than in-center hemodialysis patients, but their frailty scores were similar. Our previous study showed that around 40% frail PD patients had depressive symptoms, while depression was rare in PD patients without frailty [13]. More importantly, physical frailty and depressive symptoms had additive adverse effect on the nutritional status and clinical outcome [13].…”

Depression Does Not Predict Clinical Outcome of Chinese Peritoneal Dialysis Patients After Adjusting for the Degree of Frailty

“…However, most of the western studies focus on hemodialysis patients. A study in Korea [28] and in Hong Kong reported 75% and 43.2% [13] prevalence of depression respectively among the population undergoing CAPD. Such discrepancy could be explained by differences in in cohort size, characteristics of subjects, and the measurement tool for depression.…”

“…We used a validated Chinese questionnaire that consisted of 30 yes/no questions (Supplementary Figure 1) [6,13]. The questions involve assessment of subjective assessment of personal health, psychological state, physical state in terms of number of hospital or doctor visit and medication needs to be taken, body weight, need of assistance in different aspects of daily living and mobility.…”

“…Moreover, frailty and depression were both de ned as dichotomized entities in that study [13], so that the severity of either problem could not be considered. In the present study, we determined correlation between depression and frailty in prevalent Chinese PD patients, and explored their interaction on the peritonitis rate, hospitalization, and short-term mortality.…”