Depressive Symptomatology in Children and Adolescents with Chronic Renal Insufficiency Undergoing Chronic Dialysis

Abstract

This paper presents a descriptive study, using the Birleson Scale to determine the frequency of depressive symptomatology in children and adolescents with chronic renal insufficiency (CRI) undergoing hemodialysis (HD) and chronic peritoneal dialysis (CPD). There were 67 patients (40 female and 27 male) with a mean age of 14.76 ± 2.71 years, duration of illness ≥3 months, 43 (64.18%) patients with CPD and 24 (35.82%) undergoing HD. The frequency of high occurrence, low occurrence, and absence of depressive symptomatology was 10.45% (n = 7), 43.28% (n = 29), and 46.27% (n = 31), respectively; all of the seven (100%) patients with high occurrence of depressive symptomatology were female (P = 0.04), and none of these (0%) had a friend to confide in (P = 0.03). Depressive symptomatology in patients with CPD was associated with a lower weekly K t/V compared to those without depressive symptomatology (2.15 ± 0.68 versus 2.52 ± 0.65; P = 0.01). There was no association with patient age, caregiver, time and dialysis type, anemia, bone disease, nutritional or financial status, origin, schooling, or employment.

Depressive Symptoms in Children with Chronic Kidney Disease

“…A study done in Peru assessing depressive symptoms in children on dialysis did not find an association between depressive symptoms and demographic factors. 8 A study of pre-dialysis and dialysis pediatric CKD patients in Egypt also failed to find any associations with demographic or clinical factors. 10 Unfortunately, given their single center designs and small sample sizes, these findings may be reflective of inadequate power as opposed to a true lack of association and the possibility that there are other predictors of depression remains.…”

“…This does not differ from the prevalence cited in the general adolescent population (7.5%) 7 and is substantially less than that identified in other pediatric CKD studies in which up to 35% of subjects were reported to suffer from depression. 6,8–12 One explanation for this unexpected finding may be that because CKiD is a large, rigorous, multicenter study requiring long term yearly follow-up, the children in this study come from a select group of patients with families that have the means to take the extra time to participate in the protracted time commitment of the study. Such a committed and organized family unit is likely protective against depression and may be the reason that depression was less prevalent in CKiD than in other smaller studies evaluating depression in CKD.…”

“…Compared with prior decades, children with CKD are experiencing improved survival but the adversities related to their underlying condition predispose them to the development of depression. Compared with a 12 month prevalence of depression of 7.5% in adolescents in the general population, 7 prior studies assessing depression in pediatric CKD 6,8–12 have found a point prevalence of 10–35%, with variations according to the specific populations studied (transplant versus dialysis versus pre-end stage renal disease and young children versus adolescents) and methods used to define depression.…”

Psychosocial support for children and families requiring renal replacement therapy

“…Recently developed QoL questionnaires are easy to complete by patients and may act as a focus for early or longitudinal assessments [19,20]. There is increasing recognition of depression as being a major mortality risk in adult renal patients and depression may be more frequent than we have recognised in paediatric patients also [43].…”

Anxiety in Children and Adolescents with Chronic Kidney Disease - Multicenter National Study Results

“…Psychiatric disorders may develop as a response to being ill or in the hospital, to a threatening environment, as a result of genetic and psychosocial factors or may be secondary to metabolic disturbances related to the specific medical illness, or as a combination of all these factors [3,4,5,6] Psychiatric disorders can increase the severity of the preexisting physical illness by, among other ways, disturbing cardiac and nervous system, decreasing immune function or modulating nutritional conditions [7,8]. They can also influence patient compliance [9].…”