EVALUATION OF DEPRESSION SYMPTOMS IN HEMODIALYSIS AND PERITONEAL DIALYSIS PATIENTS

Öz

Objective: The therapies implemented in the treatment of chronic kidney failure are Hemodialysis, Peritoneal dialysis and transplantation. Depression is the most commonly observed psychological disorder in this patient group. The purpose of this study is screening depression in hemodialysis and peritoneal dialysis patients, comparing the patient groups and the evaluation of associated socio-demographic characteristics. Material and Methods: The study population involved 63 chronic kidney failure patients 48 of whom were on hemodialysis and 15 were on peritoneal dialysis. Sociodemographic characteristics, medical history, and psychiatric history of the patients were recorded. The Beck Depression Inventory form was used to screen for depression symptoms. Student’s t test, Mann-Whitney U test, chi-square test were used to analyze the data and Spearman correlation was used to evaluate the relationship between variables, and the significance level was taken as 0.05. Results: There was no statistically significant difference between the groups (hemodialysis group and peritoneal dialysis group) in terms of age, gender, marital status, educational status, and employment status (p>0.05). There was not a significant difference between the groups in terms of dialysis durations. There was a statistically significant difference between the groups in terms of depression scores (p<0.05). The depression scores in hemodialysis group were found to be significantly higher compared to the peritoneal dialysis group. Conclusion: In our study, the depression level was higher in the hemodialysis group than in the peritoneal dialysis group. Frequently seen psychological problems, especially depression, in dialysis patients decrease the functionality of the patients and disrupt the compliance with the treatment, which is more clear in hemodialysis patients. This study revealed that hemodialysis patients have a higher tendency to psychological problems such as depression compared to patients undergoing peritoneal dialysis.

Anahtar Kelimeler

• End-stage renal failure
• hemodialysis
• peritoneal dialysis
• depression

Hemodiyaliz ve Periton Diyalizi Hastalarında Depresyon Belirtilerinin Değerlendirilmesi

Öz

Amaç: Kronik böbrek yetmezliği tedavisinde uygulanan tedaviler hemodiyaliz, periton diyalizi ve transplantasyondur. Depresyon bu hasta grubunda en sık görülen psikolojik rahatsızlıktır. Bu çalışmanın amacı hemodiyaliz ve periton diyalizi hastalarında depresyonun taranması, hasta gruplarının karşılaştırılması ve ilişkili sosyo-demografik özelliklerin değerlendirilmesidir. Gereç ve Yöntemler: Çalışmaya 48'i hemodiyaliz, 15'i periton diyalizi olmak üzere 63 kronik böbrek yetmezliği hastası dâhil edildi. Hastaların sosyodemografik özellikleri, tıbbi öyküleri ve psikiyatrik öyküleri kaydedildi. Depresyon belirtilerini taramak amacıyla Beck Depresyon Envanteri formu kullanıldı. Verilerin analizinde student's t testi, Mann-Whitney U testi, ki-kare testi, değişkenler arasındaki ilişkinin değerlendirilmesinde Spearman korelasyonu kullanıldı ve anlamlılık düzeyi 0.05 olarak alındı. Bulgular: Gruplar (hemodiyaliz grubu ve periton diyalizi grubu) arasında yaş, cinsiyet, medeni durum, eğitim durumu ve çalışma durumu açısından istatistiksel olarak anlamlı fark yoktu (p>0.05). Diyaliz süreleri açısından gruplar arasında anlamlı fark yoktu. Depresyon puanları açısından gruplar arasında istatistiksel olarak anlamlı fark saptandı (p<0.05). Hemodiyaliz grubunda depresyon skorlarının periton diyalizi grubuna göre anlamlı derecede yüksek olduğu görüldü. Sonuç: Çalışmamızda hemodiyaliz grubunda depresyon düzeyi periton diyalizi grubuna göre daha yüksekti. Diyaliz hastalarında sıklıkla görülen başta depresyon olmak üzere psikolojik sorunlar hastaların işlevselliğini azaltmakta ve tedaviye uyumu bozmaktadır ki bu durum hemodiyaliz hastalarında daha belirgindir. Bu çalışma, hemodiyaliz hastalarının periton diyalizi geçiren hastalara göre depresyon gibi psikolojik sorunlara daha fazla yatkınlık gösterdiğini ortaya koydu.

Anahtar Kelimeler

• Son dönem böbrek yetmezliği
• hemodiyaliz
• periton diyalizi
• depresyon

Kaynakça

1. Stevens PE, Levin A. Kidney Disease: Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group Members. Evaluation and management of chronic kidney disease: Synopsis of the kidney disease: Improving global outcomes 2012 clinical practice guideline. Ann Intern Med. 2013;158(11):825- 830.
2. Süleymanlar G, Ateş K, Seyahi N. Registry of the nephrology, dialysis and transplantation in Turkey. Published by the Turkish Society of Nephrology, 2018.
3. O’Donnell K, Chung JY. The diagnosis of major depression in end-stage renal disease. Psychother Psychosom. 1997;66(1):38-43.
4. Martiny C, Silva AC de O, Neto JPS, Nardi AE. Psychiatric disorders in patients with end‐stage renal disease. J of Renal Care. 2012;38(3):131-137.
5. Hawamdeh S, Almari AM, Almutairi AS, Dator WLT. Determinants and prevalence of depression in patients with chronic renal disease, and their care givers. Int J Nephrol Renovasc Dis. 2017;10:183-189.
6. Guenzani D, Buoli M, Carnevali GS, et al. Is there an association between severity of illness and psychiatric symptoms in patients with chronic renal failure? Psychol Health Med. 2018;23(8):970-979.
7. Lopes AA, Bragg J, Young E, et al. Depression as a predictor of mortality and hospitalization among hemodialysis patients in the United States and Europe. Kidney Int. 2002;62(1):199-207.
8. Lew SQ, Piraino B. Quality of life and psychological issues in peritoneal dialysis patients. Semin Dial. 2005;18(2):119-123.

9. Finkelstein FO, Finkelstein SH. Depression in chronic dialysis patients: Assessment and treatment. Nephrol Dial Transplant. 2000;15(12):1911-1913.
10. Esen B, Gökmen ES, Atay AE, et al. Evaluation of the frequency and related factors of depression and anxiety in patients with end stage renal disease receiving renal replacement therapies. Turk Neph Dial Transpl. 2015;24(3):270-277.
11. Kimmel PL, Weihs K, Peterson RA. Survival in hemodialysis patients: The role of depression. J Am Soc Nephrol. 1993;4(1):12-27.
12. Einwohner R, Bernardini J, Fried L, Piraino B. The effects of depressive affect on survival in peritoneal dialysis patients. Perit Dial Int. 2004;24(3):256-263.
13. Klaric D, Klaric V. Depression in end stage renal disease: Comparison between patients treated with hemodialysis and peritoneal dialysis. J Life Sci. 2012;6(5):582-586.
14. Farrokhi F, Abedi N, Beyene J, et al. Association between depression and mortality in patients receiving long-term dialysis: A systematic review and meta-analysis. Am J Kidney Dis. 2014;63(4)623-635.
15. deAlencar SBV, de Lima FM, Dias L do A, et al. Depression and quality of life in older adults on hemodialysis. Braz J Psychiatry. 2020;42(2):195-200.
16. 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.
17. Shirazian S, Grant CD, Aina O, et al. Depression in chronic kidney disease and end-stage renal disease: Similarities and differences in diagnosis, epidemiology, and management. Kidney Int Rep. 2017;2(1):94-107.
18. Beck AT, Ward CH, Mendelson M, et al. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4:561-571.
19. Hisli N. A study on the validity of Beck Depression Inventory. Psikoloji Derg. 1988;6:118-122.
20. Finkelstein FO, Wuerth D, Finkelstein SH. An approach to addressing depression in patients with chronic kidney disease. Blood Purif. 2010;29(2):121-124.
21. Hedayati SS, Bosworth HB, Briley LP, et al. Death or hospitalization of patients on chronic hemodialysis is associated with a physician-based diagnosis of depression. Kidney Int. 2008;74(7):930-936.
22. Halen NV, Cukor D, Constantiner M, Kimmel PL. Depression and mortality in end-stage renal disease. Curr Psychiatry Rep. 2012;14(1):36-44.
23. Balogun RA, Turgut F, Balogun SA, et al. Screening for depression in elderly hemodialysis patients. Nephron Clin Pract. 2011;118(2):72-77.
24. Kimmel PL, Peterson RA, Weihs KL, et al. Psychologic functioning, quality of life, and behavioral compliance in patients beginning hemodialysis. J Am Soc Nephrol. 1996;7(10):2152-2159.
25. Kimmel PL, Peterson RA, Weihs KL, et al. Multiple measurements of depression predict mortality in a longitudinal study of chronic hemodialysis outpatients. Kidney Int. 2000;57(5):2093-2098.
26. Steele TE, Wuerth D, Finkelstein SH, et al. Sexual experience of the chronic peritoneal dialysis patient. J Am Soc Nephrol. 1996;7(8):1165-1168.
27. Wuerth D, Finkelstein SH, Ciarcia J, et al. Identification and treatment of depression in a cohort of patients maintained on chronic peritoneal dialysis. Am J Kidney Dis. 2001;37(5):1011-1017.
28. Uglešić B, Ljutić D, Lasić D, et al. Depression and serum interleukin-6 levels in patients on dialysis. Psychiatr Danub. 2015;27(2):168-173.
29. Erengin N, Keçecioğlu N, Güven M, et al. Comparison of patients on hemodialysis and continuous ambulatory peritoneal dialysis in terms of depression, anxiety and disability. Turkish Nephrol Dialysis ant Transplant J. 1998;3:137-140.
30. Aldukhayel A. Prevalence of depressive symptoms among hemodialysis and peritoneal dialysis patients. Int J HealthSci (Quassim). 2015;9(1):9-16.
31. Kalender B, Dervisoglu E, Sengul E, et al. Depression, nutritional status, and serum cytokines in peritoneal dialysis patients: Is there a relationship? Perit Dial Int. 2007;27(5):593-595.
32. Fan L, Sarnak MJ, Tighiouart H, et al. Depression and all- cause mortality in hemodialysis patients. Am J Nephrol. 2014;40(1):12-18.
33. Drayer RA, Piraino B, Reynolds CF, et al. Characteristics of depression in hemodialysis patients: Symptoms, quality of life and mortality risk. Gen Hosp Psychiatry. 2006;28(4):306-312.
34. Chilcot J, Wellsted D, Da Silva-Gane M, Farrington K. Depression on dialysis. Nephron Clin Pract. 2008;108(4):256-264.
35. Debnath S, O’Connor J, Hura C, et al. Quality of life and depression among Mexican Americans on hemodialysis: A preliminary report. Ther Apher Dial. 2018;22(2):166-170.
36. Kimmel PL. Depression in patients with chronic renal disease: What we know and what we need to know. J Psychosom Res. 2002;53(4):951-956.
37. Kimmel PL, Peterson RA. Depression in end-stage renal disease patients treated with hemodialysis: Tools, correlates, outcomes, and needs. Semin Dial. 2005;18(2):91- 97.