I.
BACKGROUND
Chronic
kidney disease is currently a worldwide health problem with increasing
prevalence and frequency, poor prognosis and high treatment costs [1]. According to 2018 data in the US,
about 37 million people (15% of the population) were diagnosed with chronic
kidney disease. Chronic kidney disease is common in the elderly ≥ 65
years old, accounting for 38% [2, 3]. The prevalence
of depression in the elderly population is reported to be 5%, whereas the
prevalence of depression in patients with end-stage chronic renal failure on
dialysis is much higher [4]. Depression in
elderly patients with end-stage chronic renal failure is associated with
increased rates of disability, hospitalization, and mortality [5]. In Vietnam, there have been no
studies on depression in this population. Therefore, we conducted this study to
investigate the rate of depression and related factors in elderly patients with
end-stage kidney disease (ESKD) on dialysis.
In
this study, we used the GDS-15 scale to assess depression. This is a shortened
version of the GDS-30 geriatric depression scale. This scale includes 15
questions instead of 30 questions as before. Both scales have high correlation
in diagnosing depression in the elderly [6]. The GDS15 scale
has been translated into many languages, including Vietnamese, with high
sensitivity and specificity [7].
II.
METHODS
2.1.
Study design
A descriptive, cross-sectional study design was conducted
among 93 patients diagnosed with ESKD and on hemodialysis. The prevalence of
depression among these patients and the factors that could potentially
influence an individual’s susceptibility to develop depressive symptoms were
investigated.
2.2. Participants
Patients ≥
60 years old diagnosed with end-stage kidney disease are undergoing dialysis at
the Department of Nephrology in Thong Nhat Hospital,
Ho Chi Minh City, from December 2020 to June 2021. The inclusion criteria were patients aged 60 years and older
diagnosed with ESKD under hemodialysis. Besides, we exclude patients under 60
years with severe dementia, mental disorders, and reduced hearing and vision
abilities affect the accuracy of information.
2.3.
Data collection
Patients were
interviewed directly using the GDS-15 questionnaire to evaluate depression. In
addition, the researcher will ask for additional information such as ADLs
(Activities of Daily Living), IADLs (Instrumental Activities of Daily Living), nutritional status, and
frailty. Depression: is a binary variable, assessed based on GDS-15. Score ≥
6: There is depression. In this scale, scores 6-7, 8-10 and 11-15 correspond
mild, moderate and severe depression. Frailty: is a binary variable, assessed
based on a scale clinical frailty score (CFS) [6].
2.4.
Data analysis
Data
were analyzed by SPSS Statistical software version 25.0. Descriptive statistics (median,
interquartile range, frequencies, and percentages) were used to describe the
quantitative and categorical variables. Multivariate regression analysis to
identify factors independently associated with depression. The difference is
considered statistically significant when p < 0.05.
III.
RESULTS
This
study enrolled 93 elderly patients who met the sampling conditions during the
study period. The average age is 75.3 ± 8.8 (years old), of which men account
for 51.6% and women account for 48.4%. Of the 93 patients participating in the
study, 40.9% decreased ADL; 84.9% decreased IADL; 43% depression according to
GDS15; 47.3% malnourished according to MNA-SF.
The
severity of depression based on GDS-15 is shown in Figure 1. Mild depression
accounts for 10.8%, moderate depression accounts for 14% and up to 18.3% of
patients have severe depression. The mean value of GDS-15 in our study with
median (quartile range) is 5 (3-10).
Our
study found a higher rate of frailty and malnutrition in the group of depressed
patients compared to the group without depression, this difference was
statistically significant with p values of 0.04 and 0.004,
respectively (Table 1).
%20Luong%20Huu%20Dang_files/image001.jpg)
Figure 1:
The severity of depression in patient ESKD on dialysis
|
Table
1:
Distribution of socio-demographic characteristics of the participants |
||||
|
|
Total (n=93) |
Non-depression (n=53) |
Depression (n=40) |
P |
|
Female |
45 (48.4) |
29 (54.7) |
16 (40) |
0.14 |
|
Age
(≥80) |
36 (38.7) |
17 (18.3) |
19 (47.5) |
0.14 |
|
High
education(a) |
59 (63.4) |
34 (36.6) |
25 (62.5) |
1.000 |
|
Live
alone |
3 (3.2) |
0 |
3 (7.5) |
0.076 |
|
Polypharmacy(b) |
68 (73.1) |
39 (73.6) |
29 (72.5) |
1.000 |
|
High
CCI(c) |
88 (94.6) |
50 (94.3) |
38 (95) |
1.000 |
|
Frailty(d) |
66 (70.9) |
33 (62.2) |
33 (82.5) |
0.04 |
|
History
of falls |
25 (26.9) |
12 (22.6) |
13 (32.5) |
0.348 |
|
Malnutrition(e) |
44 (47.3) |
18 (33.9) |
26 (65) |
0.004 |
(a): patient with
knowledge equivalent to high school level; (b): patient is being on
5 or more medicines; (c): CCI: Charlson Comorbidity
Index ≥4; (d): Frailty based on CFS Canada, frailty when CFS ≥4;
(e): malnutrition when MNA-SF ≤ 7
In table 2, we exammed characteristics of comorbidities in elderly
patients between the two subgroups of depression and non-depression. The highest
rate of comorbidities is hypertension, 100%; diabetes 69.9%; heart failure
58.1%; dyslipidemia 54.8% and coronary artery disease 61.3%.
|
Table
2:
The comorbidities in two subgroups of depression and non-depression |
||||
|
|
Total (n=93) |
Non-depression (n=53) |
Depression (n=40) |
p |
|
Hypertension |
93 (100) |
53 (100) |
40 (100) |
|
|
Chronic
coronary artery disease |
57 (61.3) |
32 (60.4) |
25 (62.5) |
1.000 |
|
Stroke |
26 (27.9) |
10 (18.9) |
16 (40) |
0.035 |
|
Chronic
heart failure |
54 (58.1) |
28 (52.8) |
26 (65) |
0.291 |
|
Diabetes |
65 (69.9) |
37 (69.8) |
28 (70) |
1.000 |
|
Cancer |
7 (7.5) |
1 (1.8) |
6 (15) |
0.04 |
|
Peripheral
artery disease |
4 (4.3) |
1 (1.9) |
3 (7.5) |
0.311 |
|
COPD |
11 (11.8) |
7 (13.2) |
4 (10) |
0.752 |
|
Dyslipidemia |
51 (54.8) |
30 (56.6) |
21 (52.5) |
0.834 |
|
Gastritis |
27 (29) |
14 (26.4) |
13 (32.5) |
0.645 |
In our study, the incidence of
cerebrovascular accident (40%) and the incidence of cancer (15%) in the group of
depressed patients were higher than in the group of non-depressed patients.
This difference was statistically significant with p values of
0.035 and 0.04, respectively (Table 2). After multivariate regression analysis,
only two comorbidities include stroke and cancer, were found to be associated
with depression in elderly patients with end-stage kidney disease undergoing
hemodialysis (Table 3).
|
Table 3:
Multivariate logistic regression analysis examining factors ssociated with depression |
|||
|
OR |
95%
CI |
p |
|
|
Age (≥80) |
2.21 |
0.66
– 7.39 |
0.196 |
|
High education |
0.80 |
0.29
– 2.21 |
0.680 |
|
Stroke |
4.01 |
1.20
– 13.38 |
0.024 |
|
Diabetes |
0.55 |
0.17
– 1.75 |
0.310 |
|
Cancer |
13.91 |
1.16
– 166.23 |
0.038 |
|
Frailty |
1.03 |
0.21
– 5.14 |
0.971 |
|
Malnutrition |
3.31 |
0.99
– 11.06 |
0.052 |
|
Polypharmacy |
0.59 |
0.19
– 1.81 |
0.359 |
IV.
DISCUSSION
Our
study found that the rate of depression in the elderly population with end-stage
kidney disease undergoing hemodialysis was quite high at 43%. The results of
this study are similar to the results of the study by author Nguyen Thanh Huan
when examining the rate of depression in elderly inpatients with cardiovascular
disease[8]. In some studies
on the rate of depression in other countries around the world, depending on the
study population and the scale used for assessment, this rate can range from
8-45% [9].
The
levels of depression in elderly patients with end-stage chronic kidney disease
on hemodialysis, severe depression accounted for the highest rate at 18.3%,
followed by moderate depression and finally mild depression with rates of 14%
and 10.8% respectively. Our study had lower results than the study of author
Saeed Zeb et al., the author recorded the highest rate of severe depression in
hemodialysis patients at 70%, the average rate of moderate depression was 65%,
the rate of mild depression was 31% [10].
Also
in this study, the author found factors related to moderate to severe
depression such as marital status, employment status, low income, female
gender, low education level. In our study, when analyzing univariate
regression, we recorded some factors related to depression such as frailty,
malnutrition, comorbidities of cerebrovascular accident and cancer. However,
after multivariate analysis, we only recorded cerebrovascular accident and
cancer as factors related to depression in elderly patients with end-stage
chronic kidney disease. In another study in Saudi Arabia, in 2022, author LuJain Sallam and colleagues
found a number of factors related to depression in patients with chronic kidney
failure undergoing dialysis 3 times/week, including female gender and low
education level. In addition, the author found that common symptoms related to
depression were fatigue and energy loss [11].
Our study was
conducted on a small sample size, so it is necessary to expand the sample size
to find out the classic factors that are really related to depression in
elderly patients with end-stage chronic kidney disease undergoing hemodialysis
V.
CONCLUSION
Depression
in elderly people with end-stage kidney disease undergoing hemodialysis is
high. Therefore, in addition to caring for the disease, medical staff also need
to pay attention to assessing the psychological aspects of patients to help
detect depression early in this special group. Recognize comorbidities related
to depression such as stroke and cancer, these are subjects with a higher risk
of depression.
Conflicts
of interest
The
authors declare no conflict of interest related to this research, authorship,
or publication of this article.
Ethical
considerations
This
study was approved by the Ethics Committee in Biomedical Research of the University
of Medicine and Pharmacy at Ho Chi Minh City (Approval No.
788/2020/HĐĐĐ-ĐHYD, dated November 2, 2020.