Depression as a Potential Explanation for Gender Differences in Health-Related Quality of Life among Patients on Maintenance Hemodialysis

Abstract

Background/Aims: The reasons for lower health-related quality of life (HRQOL) scores in women compared to men on maintenance hemodialysis (MHD) are unknown. We investigated whether depression accounts for gender differences in HRQOL. Methods: Cross-sectional study of 868 (40.9% women) Brazilian MHD patients (PROHEMO Study). We used the Kidney Disease Quality of Life Short Form to assess HRQOL and the Center for Epidemiological Studies Depression (CES-D) scale (scores from 0–60) to assess depression with scores ≧18 indicating high depression probability. Results: Higher depression scores were associated with lower HRQOL in both sexes. Women had higher depression scores; 51.8% of women versus 38.2% of men (p < 0.001) had CES-D scores ≧18. Women scored lower on all 9 assessed HRQOL scales. The female-to-male differences in HRQOL were slightly reduced with inclusion of Kt/V and comorbidities in regression models. Substantial additional reductions in female-to-male differences in all HRQOL scales were observed after including depression scores in the models, by 50.9% for symptoms/problems related to renal failure, by 71.6% for mental health and by 87.1% for energy/vitality. Conclusions: Lower HRQOL among women was largely explained by depression symptoms. Results support greater emphasis on treating depression to improve HRQOL in MHD patients, particularly women.

Higher Ultrafiltration Rate Is Associated with Longer Dialysis Recovery Time in Patients Undergoing Conventional Hemodialysis

“…As the model included adjustment for patient's weight, these associations were independent of the gender and race weight differences. The association of race [27,28,29,30,31] and gender [32,33,34,35] with QOL in HD patients have long been noted. These may be secondary to spiritual beliefs [28], social factors [31,] psychological factors [29,34,35], how different genders or ethnic groups perceive their health level, or to different health expectations [30].…”

Depression and Mortality in End-Stage Renal Disease

“…In the general population, women are believed to have higher rates of depression and present for treatment more frequently [71]. This gender disparity in prevalence of depression was also evident in a sample of Brazilian hemodialysis patients, in which a greater percentage of women (51.8%) than men (38.2%) were found to meet criteria for depression (cutoff >18 on CES-D) [72]. Similarly, data from the Dialysis Outcomes and Practice Patterns Study (DOPPS), a large-scale, prospective, observational study of American and international hemodialysis patients, indicated that a higher percentage of the depressed patients were female [60].…”

Gender Differences in Chronic Kidney Disease: Underpinnings and Therapeutic Implications

“…These differences may translate into systemic stress, increased risk and further poor compliance, all likely increasing death hazards. Supporting this, women undergoing hemodialysis have been reported to experience a higher prevalence of depressive symptoms and anxiety traits [101,102] .…”