P1023depression Is a Major Determinant of Health-Related Quality of Life in Patients With Diabetic Kidney Disease

Abstract

Background and Aims Poor health-related quality of life (HRQOL) is associated with increased cardiovascular risk and mortality in patients with kidney disease. Therefore, it is critical to identify and modify clinical contributors of poor HRQOL. This study examined modifiable factors associated with poor HRQOL in patients with diabetic kidney disease (DKD) focusing on depression, anxiety, sleep quality, and physical activity. Method Between April 2017 and March 2018, 141 adults (aged ≥18 years) with DKD were recruited in single tertiary hospital. HRQOL was assessed at baseline with the Short Form 36 of life Health Survey Question (SF-36) questionnaire. Poor HRQOL was defined as a score below the median value at baseline. Depression and anxiety were assessed with the Hospital Anxiety and Depression Scale. Sleep quality and physical activity were measured using Korean version of the Pittsburgh Sleep Quality Index and International Physical Activity Questionnaire respectively. Results The age was 65 [57-72] years old, and 73% (n=103) of participants were men. Prevalence of anxiety and depression were 8% (n=11) and 17% (n=24) respectively. Forty-eight (34%) subjects corresponded to poor sleepers and 40 (28%) subjects showed low physical activity. SF-36 scores were decreased with advanced CKD stages (stage 3, 79 [71-82]; stage 4, 71 [56-82]; stage 5, 70 [57-82]; p = 0.029 for trend) progressively. Anxiety, depression, and poor sleep quality were negatively correlated with SF-36 scores (p < 0.05). eGFR and physical activity were positively correlated with HRQOL scores (p < 0.05). In multivariable logistic analysis, depression scores were associated poor HRQOL independently of age, sex, comorbidity, eGFR, anemia, sleep quality, anxiety and physical activity (odds ratio per 1-score increment, 1.51; 95% confidence interval, 1.27-1.80, p < 0.001). Conclusion In patients with DKD, depression was a major determinant of poor HRQOL among the modifiable clinical factors such as anxiety and sleep. Active surveillance of depression and psychosocial intervention should be considered to improve the well-being of these patients.