Fatigue and depression and sleep problems among hemodialysis patients in a tertiary care center

Abstract

High prevalence of sleep problems, fatigue and depression are reported in maintenance hemodialysis (MHD) patients. To assess fatigue, depression, sleep problems and their co-relates among MHD patients in a tertiary care center in India, we studied 47 patients on MHD for >3 months. Patients demographic, medical and co-morbidity profile were recorded. Pittsburgh Sleep Quality Index (poor sleeper if score >5) and Epworth Sleepiness Scale (EPSS, abnormal daytime sleepiness if score >13) were used to assess sleep abnormalities and quality. Beck Depression Inventory (BDI) was used to screen for depression. Depression was classified on BDI scores as mild-moderate (score 11-30) and severe (score >30). Fatigue Severity Scale was used to assess fatigue (score ≥36 indicates fatigue). The correlations of these parameters among themselves and with social and demographic parameters were also analyzed. The mean age of the study population was 37.1 ± 13.1 (range 19-65 years) years, with 89.3% being males. The majority (68.1%) of the MHD patients was poor sleepers, but only five (10.6%) patients had borderline or abnormal daytime sleepiness. Of the patients, 44.7% reported fatigue and (72.3%) had depression (mild to moderate in 59.7% and severe in 12.6%). Fatigue scores were found to be significantly associated with lesser frequency of dialysis (P < 0.05). There was higher daytime sleepiness in patients who were working (mean EPSS score 6.2 ± 3.7) than who were unemployed (mean EPSS score 3.9 ± 2.7). Depression was found to be higher in those who were paying for the treatment themselves (mean BDI score 20 ± 11.8) as compared with those who were getting medical expenditure reimbursed (mean BDI score 12.9 ± 8.8). Fatigue positively correlated with that of daytime sleepiness (P = 0.02), poor nighttime sleep (P = 0.02) and depression (P=0.006). In the present study, there was no correlation (P <0.05) found between daytime and night time sleep and depression. We found a high prevalence of fatigue, depression and poor sleep quality in our MHD patients. These abnormalities are closely related to each other and to the socioeconomic and demographic profiles of the population.

The Effect of the Physical and Mental Exercises During Hemodialysis on Fatigue: a Controlled Clinical Trial

“…Fatigue is a frequent symptom shared by all patients on long-term dialysis ( 15 ). Joshwa et al reported fatigue in 75% of the patients on hemodialysis ( 24 ); in the current study, 65.2% of the patients had experienced fatigue.…”

“…The validity and reliability of FSS was previously proved in a study by Zakerimoghadam ( 23 ). FSS includes nine questions rated from one to seven ( 24 ). The total score indicating the fatigue measure was calculated by dividing the sum of all scores by nine.…”

Development and effect of a rational‐emotive‐behaviour‐therapy‐based self‐management programme for early renal dialysis patients

“…For this condition, in the postsurvey, the experimental group showed a large decrease, but at the follow-up survey, a slight increase was evident; meanwhile, the control group showed a gradual decrease in both the postsurvey and the follow-up surveys. In a previous study of patients on renal dialysis for 3 months or longer, 72.3% of the patients were found to have depression, with 12.6% of the patients experiencing severe depression (Joshwa et al, 2012); meanwhile, in another study, 19.3% of 400 renal dialysis patients were found to have depressive symptoms (Araujo et al, 2012). This signifies that active nursing interventions are required to reduce depression in early renal dialysis patients.…”

“…For renal dialysis patients, both mental and physical symptoms generally occur simultaneously, with depression, fatigue and sleep disorders being the most common psychopathological issues reported (Joshwa, Khakha, & Mahajan, 2012;O'Sullivan & McCarthy, 2009). In addition, as renal dialysis has important short-and long-term influences on patients' health outcomes, such as causing malnutrition, decreases in albumin levels, anaemia, and bone disease, it is necessary to understand the potential influences these factors can have on patients' health, and provide appropriate, individualised nursing (Beto, 2010).…”

The outcomes of stress exposure in hemodialysis patients

“…Many researches confirmed the high prevalence rate of depression in patients with CRF as the most common psychiatric diagnoses due to many social problems or mental stresses, which are associated with high rates of morbidity and mortality. Joshwa et al stated that the depression prevalence among these patients is 72% in India, 12% of whom suffer from severe depression (22) and in Iran the prevalence is 79% (23). Depression symptoms in chronic dialysis patients are more prevalent than other chronic diseases.…”