Hemodiyaliz ve periton diyalizi hastalarında yaşam kalitesi ve depresyonun karşılaştırılması

Abstract

Giriş: Kronik böbrek hastalığı (KBH), yüksek morbidite ve mortalite ile ilişkili küresel bir sağlık sorunudur. Depresyon, özellikle majör depresif bozukluk (MDB), diyaliz hastalarında yaygın olarak görülmekte ve tedaviye uyumsuzluk, malnütrisyon ve artan mortalite gibi olumsuz sonuçlarla ilişkilendirilmektedir. Bu çalışma, hemodiyaliz (HD) ve periton diyaliz (PD) hastalarında depresyon ve yaşam kalitesini değerlendirerek optimal diyaliz yöntemi seçimine rehberlik etmeyi amaçlamaktadır. Materyal ve Metotlar: Bu çalışmaya, Akdeniz Üniversitesi Nefroloji Kliniği'nde tedavi gören 143 diyaliz hastası dahil edilmiştir. Bunlardan 44 HD ve 34 PD hastası 6 aylık takibi tamamlamıştır. Yaşam kalitesi WHOQOL-BREF ölçeği ile, depresyon düzeyleri ise Beck Depresyon Ölçeği (BDÖ) kullanılarak değerlendirilmiştir. Bulgular: HD grubundaki kadınların ortalama yaşı (9,7 yıl), erkeklere (11 yıl) göre daha düşük bulunmuştur (p=0,049). Hemoglobin düzeylerinde cinsiyetler arasında anlamlı fark saptanmıştır (p=0,024). Yüksek eğitim düzeyi, daha düşük depresyon skorları ile ilişkilendirilmiştir (üniversite mezunları: 11 puan; ilk/orta öğretim: 19 puan). Fiziksel sağlık skorları, psikolojik sağlık (r=0,46), sosyal ilişkiler (r=0,50) ve depresyon (r=-0,47) ile korelasyon göstermiştir. Psikolojik sağlık skorları ise sosyal ilişkiler (r=0,44) ve depresyon (r=-0,53) ile ilişkili bulunmuştur. Diyaliz süresi ile yaşam kalitesi veya depresyon skorları arasında anlamlı bir ilişki saptanmamıştır. Sonuç: HD ve PD hastaları arasında yaşam kalitesi veya depresyon düzeyleri açısından anlamlı bir fark gözlenmemiştir. Orta ve şiddetli depresyonu olan hastaların tüm yaşam kalitesi alanlarında daha düşük skorlar aldığı belirlenmiştir. Daha yüksek fiziksel sağlık ve sosyal ilişki skorları ile genç yaş, daha düşük depresyon ile ilişkilendirilmiştir. Diyaliz hastalarında depresyon ve yaşam kalitesinin düzenli izlenmesi, zamanında psikiyatrik müdahale ve tedavi sonuçlarının iyileştirilmesi için kritik öneme sahiptir.

Keywords

• Hemodiyaliz
• Periton Diyalizi
• Depresyon
• Yaşam Kalitesi
• WHOQOL-BREF
• Beck Depresyon Ölçeği

A comparison of quality of life and depression in hemodialysis and peritoneal dialysis patients

Abstract

Aims: Chronic kidney disease (CKD) is a global public health problem and characterized by a progressive loss of kidney function over time, leading to complications such as anemia, mineral and bone disorders, cardiovascular disease, and decreased quality of life (QoL). Depression is a common comorbidity in CKD patients. The aim of our study was to compare demographic and clinical data, QoL scales and depression scores in patients treated with hemodialysis (HD) and peritoneal dialysis (PD). Methods: This prospective study included 143 dialysis patients from Akdeniz University Nephrology Clinic. Of these, 44 HD and 34 PD patients completed the 6-month follow-up. QoL was assessed using the WHOQOL-BREF scale, and depression levels were measured using the Beck Depression Scale (BDS). A comparative analysis was conducted of demographic, laboratory and clinical characteristics in relation to KRT, gender and depression levels. Results: Female patients were significantly younger than males (42 vs. 55 years, p=0.019) and had higher depression scores (19 vs. 13, p=0.031). PD patients demonstrated significantly higher hemoglobin levels compared to HD patients (10.95 vs. 10.2 g/dl, p=0.008). A trend toward higher phosphorus levels was observed in PD patients (5.1 vs. 4.5 mg/dl, p=0.050). No significant differences were found in age, gender, calcium, albumin, CRP, vitamin D levels, KRT duration, or QoL measures between the HD and PD groups. Phosphorus levels were also higher in the moderate/severe depression group than the mild depression group (5.2 vs. 4.3 mg/dl, p=0.036). Individuals who completed primary or secondary education but did not attend university had higher depression scores (19 points) compared to university graduates (11 points). Conclusion: This study demonstrates that women on dialysis have higher depression scores than men. Higher levels of education were associated with improved QoL and reduced depression, reflecting better disease management. Serum phosphate levels were elevated in moderate to severe depression groups. Furthermore, higher hemoglobin levels in PD patients compared to HD patients suggest that dialysis modality may affect anemia and QoL.

Keywords

• Hemodialysis
• peritoneal dialysis
• depression
• quality of life
• WHOQOL-BREF
• Beck Depression Scale

References

1. Jha V, Garcia-Garcia G, Iseki K, et al. Chronic kidney disease: global dimension and perspectives. Lancet. 2013;382(9888):260-272. doi:10.1016/S0140-6736(13)60687-X
2. Webster AC, Nagler EV, Morton RL, Masson P. Chronic kidney disease. Lancet. 2017;389(10075):1238-1252. doi:10.1016/S0140-6736(16)32064-5
3. Palmer S, Vecchio M, Craig JC, et al. Prevalence of depression in chronic kidney disease: systematic review and meta-analysis of observational studies. Kidney Int. 2013;84(1):179-191. doi:10.1038/ki.2013.77
4. Molnar MZ, Streja E, Sumida K, et al. Pre-ESRD depression and post-ESRD mortality in patients with advanced CKD transitioning to dialysis. Clin J Am Soc Nephrol. 2017;12(9):1428-1437. doi:10.2215/CJN. 00570117
5. Tsai YC, Chiu YW, Hung CC, et al. Association of symptoms of depression with progression of CKD. Am J Kidney Dis. 2012;60(1):54-61. doi:10.1053/j.ajkd.2012.02.325
6. Zalai D, Szeifert L, Novak M. Psychological distress and depression in patients with chronic kidney disease. Semin Dial. 2012;25(4):428-438. doi:10.1111/j.1525-139X.2012.01100.x
7. Cukor D, Coplan J, Brown C, et al. Depression and anxiety in urban hemodialysis patients. Clin J Am Soc Nephrol. 2007;2(3):484-490. doi:10. 2215/CJN.00040107
8. Maes M, Berk M, Goehler L, et al. Depression and sickness behavior are Janus-faced responses to shared inflammatory pathways. BMC Med. 2012;10:66. doi:10.1186/1741-7015-10-66

9. Murtagh FE, Addington-Hall J, Higginson IJ. The prevalence of symptoms in end-stage renal disease: a systematic review. Adv Chronic Kidney Dis. 2007;14(1):82-99. doi:10.1053/j.ackd.2006.10.001
10. Purnell TS, Auguste P, Crews DC et al. Comparison of life participation activities among adults treated by hemodialysis, peritoneal dialysis, and kidney transplantation: a systematic review. Am J Kidney Dis. 2013;62(5):953-973. doi:10.1053/j.ajkd.2013.03.022
11. Kimmel PL, Patel SS. Quality of life in patients with chronic kidney disease: focus on end-stage renal disease treated with hemodialysis. Semin Nephrol. 2006;26(1):68-79. doi:10.1016/j.semnephrol.2005.06.015
12. Kimmel PL, Emont SL, Newmann JM, Danko H, Moss AH. ESRD patient quality of life: symptoms, spiritual beliefs, psychosocial factors, and ethnicity. Am J Kidney Dis. 2003;42(4):713-721. doi:10.1016/s0272-6386(03)00907-7
13. Eser E, Fidnner H, Fidaner C, Eser SY, Elbi H, Göker E. Psychometric properties of the WHOQOL-100 and WHOQOL-BREF. J Psychiatry Psychol Psychopharmacol (3P). 1999;7(2):23-40.
14. Hisli N. The validity and reliability of the Beck Depression Inventory for university students. J Psychol. 1989:7:3-13.
15. Sallam L, Alsharif F, Abaalalaa A, Alakeely R. Prevalence of depression in patients with end-stage renal disease undergoing hemodialysis in Saudi Arabia: a cross-sectional study. Belitung Nurs J. 2022;8(4):296-303. doi:10.33546/bnj.2080
16. Alkubati SA, Al-Sayaghi KM, Salameh B, et al. Prevalence of depression and its associated factors among hemodialysis patients in Hodeida City, Yemen. J Multidiscip Healthc. 2024;17:689-699. doi:10.2147/JMDH.S452935
17. Mosleh H, Alenezi M, Al Johani S, Alsani A, Fairaq G, Bedaiwi R. Prevalence and factors of anxiety and depression in chronic kidney disease patients undergoing hemodialysis: a cross-sectional single-center study in Saudi Arabia. Cureus. 2020;2(1):e6668. doi:10.7759/cureus.6668
18. Al- Jabi SW, Sous A, Jorf F, et al. Depression among end-stage renal disease patients undergoing hemodialysis: a cross-sectional study from Palestine. Renal Replacem Ther. 2021;7:12.
19. Al-Ali F, Elshirbeny M, Hamad A, et al. Prevalence of depression and sleep disorders in patients on dialysis: a cross-sectional study in Qatar. Int J Nephrol. 2021;2021:5533416. doi:10.1155/2021/5533416
20. Kuehner C. Why is depression more common among women than among men? Lancet Psychiatry. 2017;4(2):146-158. doi:10.1016/S2215-0366(16)30263-2
21. Call JB, Shafer K. Gendered manifestations of depression and help seeking among men. Am J Mens Health. 2018;12(1):41-51. doi:10.1177/1557988315623993
22. Othayq A, Aqeeli A. Prevalence of depression and associated factors among hemodialyzed patients in Jazan area, Saudi Arabia: a cross-sectional study. Ment Illn. 2020;12(1):1-5. doi:10.1108/MIJ-02-2020-0004
23. Shaman AM, Kowalski SR. Hyperphosphatemia management in patients with chronic kidney disease. Saudi Pharmaceutical J. 2016;24(4):494-505. doi:10.1016/j.jsps.2015.01.009
24. Forfang D, Edwards DP, Kalantar-Zadeh KK. The impact of phosphorus management today on quality of life: patient perspectives. Kidney Med. 2022;4(4):100437. doi:10.1016/j.xkme.2022.100437
25. Karl S, Young JB, Anand IS, et al. Treatment of anemia with darbepoetin alfa in systolic heart failure. N Engl J Med. 2013;368(13):1210-1219. doi:10.1056/NEJMoa1214865
26. Wang WN, Zhang WL, Sun T, Ma FZ, Su S, Xu ZG. Effect of peritoneal dialysis versus hemodialysis on renal anemia in renal in end-stage disease patients: a meta-analysis. Ren Fail. 2017:39(1):59-66. doi:10.1080/0886022X.2016.1244079