Depression, quality of life, and body composition in patients with end-stage renal disease: a cohort study

Phase Angle as an Indicator of Depression in Maintenance Hemodialysis Patients

Introduction

Depression is a common psychiatric problem in maintenance hemodialysis (MHD) patients. Recent studies have begun to explore the relationship between body composition and depression. Phase angle (PhA), a core parameter for assessing body composition, has been observed to be associated with frailty and cognitive dysfunction. The aim of this study was to investigate the association between PhA and depression in MHD patients.

Methods

This multicenter, cross-sectional study included 843 MHD patients from seven dialysis centers in Shanghai, China. Depressive symptoms were evaluated using the Patient Health Questionnaire (PHQ-9), with a score of ≥10 indicating depression. PhA was measured by bioelectrical impedance analysis. Nutritional status was assessed by malnutrition inflammation score (MIS). Multivariable logistic regression models were used to investigate the association between PhA and depression. Restricted cubic spline (RCS) analysis was utilized to examine the association. Receiver operating characteristic curve was used to identify the cut-off value of PhA for depression.

Results

A total of 15.2% of patients (62.8% male, median age 66 years) had depression. Median PhA level (interquartile range) of depressed patients was 4.4° (3.9-4.9°) for males and 3.9° (3.2-4.7°) for females. There was a significant decrease in the prevalence of depression with increasing quartiles of PhA levels. In multivariable logistic regression analyses, after adjusting for age, sex, education level, spKt/V, dialysis vintage, Charlson comorbidity index, hemoglobin, and serum albumin, lower PhA levels (lowest quartile group) were significantly associated with depressive symptoms (adjusted odds ratio, 2.19; 95% confidence interval, 1.07 to 4.48), compared to higher PhA levels (highest quartile group). RCS analysis showed a relatively inverse linear association between PhA and depression. The optimal cut-off value of PhA for depression was 4.9° for males and 3.5° for females. Subgroup analyses validated the findings across patient characteristics, including age, sex, diabetes, education, and malnutrition.

Conclusion

Our findings indicated an inverse association between PhA and depressive symptoms in Chinese MHD patients, suggesting that PhA could serve as a valuable indicator for assessing the risk of depression in this population. Further studies are needed to explore the potential of PhA as a prognostic tool and its implications for intervention strategies.

Quality of life and functional capacity in depressive patients on hemodialysis: a systematic review and meta-analysis

Depression is a common disorder in patients with chronic kidney disease (CKD), and some data support its relationship with functional capacity and quality of life. However, to date, this has not been evaluated systematically or through meta-analysis. We sought to investigate the relationship of quality of life and functional capacity with depressive disorder in patients with CKD on hemodialysis. This systematic review considered studies published up to 2021 and included cross-sectional and cohort studies. PubMed, Embase, SPORTDiscus, Web of Science, and Cochrane (CENTRAL) databases were used to search for studies. The New Castle-Ottawa Quality Assessment scale was used to measure the quality of the studies. A total of 4,626 studies were found and, after applying the selection criteria, 16 studies (2,175 patients) remained for qualitative analysis and 10 for meta-analysis (1,484 patients). The physical component summary (MD=-6.563; 95%CI: -9.702 to -3.424) and mental component summary (MD=-18.760; 95%CI: -28.641 to -8.879) were lower in depressive patients, as in all Short Form Health Survey 36 (SF-36) domains. Only one study provided data regarding functional capacity, but it was not evaluated by the defined outcome measure. Twelve studies were classified as "moderate quality" (5 to 6 stars) and four were classified as "low-quality" (0 to 4 stars). This meta-analysis with CKD patients on hemodialysis showed a negative relationship between depression and quality of life, with worsening in all physical and mental domains of the SF-36 in depressed patients.

Frailty and chronic kidney disease: associations and implications

INTRODUCTION

Frailty and its association with chronic kidney disease (CKD) has been established previously. The present study examined this association further by studying the distribution of frailty among groups defined by different stages of the disease. It also identified associated health deficits and explored their association with estimated glomerular filtration rate (eGFR) and urine albumin creatinine ratio (UACR).

METHODS

A cross-sectional survey was conducted on 90 non-dialysis dependent CKD Stage 1-4 patients, recruited in three stratified groups of 30 participants each based on the stage of disease. Frailty was assessed using Fried's frailty criteria and associated health deficits were recorded using a pre-determined list. Depression was screened using a 4-point depression scale.

RESULTS

21.1% of the participants were frail and 43.3% were pre-frail. The proportion of frailty in CKD groups A (Stages 1 and 2), B (Stage 3a), and C (Stages 3b and 4) was 10%, 13.3%, and 40%, respectively. The association of health deficits including co-morbidities, physical parameters, mental status, daily activities, etc. with UACR, eGFR, and CKD stages was not statistically significant. Nearly one in two frail participants was depressed compared with 14% among non-frail participants.

CONCLUSION

The skewed distribution of 21% frail subjects identified in our study indicates an association between frailty and advancing kidney disease. Frail individuals had a lower eGFR, higher UACR, were more likely to be depressed, and had higher count of health deficits and poorer performance on Barthel Index of Activities of Daily Living and WHOQOL. Early identification of depression would improve care in these patients.

A systematic review and meta-analysis of the evidence on inflammation in depressive illness and symptoms in chronic and end-stage kidney disease

BACKGROUND

Depression affects approximately 27% of adults with chronic kidney disease (CKD) and end-stage kidney failure (ESKF). Depression in this population is associated with impaired quality of life and increased mortality. The extent of inflammation and the impact on depression in CKD/ESKF is yet to be established. Through a systematic literature review and meta-analysis, we aim to understand the relationship between depression and inflammation in CKD/ESKF patients.

METHODS

We searched nine electronic databases for published studies until January 2022. Titles and abstracts were screened against inclusion and exclusion criteria. Data extraction and study quality assessment was carried out independently by two reviewers. A meta-analysis was carried out where appropriate; otherwise a narrative review of studies was completed.

RESULTS

Sixty studies met our inclusion criteria and entered the review (9481 patients included in meta-analysis). Meta-analysis of cross-sectional associations revealed significantly higher levels of pro-inflammatory biomarkers; C-reactive protein; Interleukin 6 (IL-6) and tumour necrosis factor-alpha in patients with depressive symptoms (DS) compared to patients without DS. Significantly lower levels of anti-inflammatory cytokine IL-10 were found in patients with DS compared to patients without DS. Considerable heterogeneity was detected in the analysis for most inflammatory markers.

CONCLUSION

We found evidence for an association of higher levels of pro-inflammatory and lower anti-inflammatory cytokines and DS in patients with CKD/ESKF. Clinical trials are needed to investigate whether anti-inflammatory therapies will be effective in the prevention and treatment of DS in these patients with multiple comorbidities.

Burden, depression and anxiety effects on family caregivers of patients with chronic kidney disease in Greece: a comparative study between dialysis modalities and kidney transplantation

INTRODUCTION

Burden of caregivers is a status that was identified as a consequence of daily care. Anxiety and depression are probably related to complex tasks interwined with the care of a family member suffering from chronic kidney disease (CKD).

PURPOSE

To examine the experienced burden, anxiety and depression of Greek caregivers of patients with End-Stage CKD on dialysis as well as kidney transplant recipients (TX) in relation to their demographic profile and to compare among the groups.

METHODS

A total of 396 participants (198 couples of patients and caregivers) were recruited. Structured interviews and self-completed questionnaires were obtained from patients undergoing dialysis modalities as well as TX (28 peritoneal dialysis patients, 137 hemodialysis patients, 33 TX) and their caregivers. Zarit Burden Interview, Beck Depression Inventory and the Generalized Anxiety Disorder-2 scales were used as screening tools.

RESULTS

The majority of caregivers were females (67.2%), with a median age of 58 years. Total burden was indicated as mild to moderate (Mdn = 36 (24-51)). Caregivers of haemodialysis (HD) patients showed the highest burden (Mdn = 40 (26-53)) followed by peritoneal dialysis(PD) (Mdn = 29 (25-51)) and TX group (Mdn = 28 (21-43)) (p = 0.022). Caregivers' depression and anxiety were related to the type of patients' treatment, as well. Caregivers of HD and PD patients reported significantly higher depression (Mdn = 11 (5-18)) and anxiety scores (Mdn = 3 (2-5)) in comparison to TX caregivers (Mdn = 6 (2-13) and Mdn = 2 (2-4)) (p = 0.045 and p = 0.04, respectively).

CONCLUSION

Caregivers of TX patients appeared to have less burden, depression and anxiety levels compared with caregivers of patients on dialysis modalities. Caregivers' burden is significantly associated with anxiety, depressive symptoms, gender, duration of caregiving, educational level, financial status and caregivers' age.

Body Composition Parameters Correlate to Depression Symptom Levels in Patients Treated with Hemodialysis and Peritoneal Dialysis

The aim of this study was to investigate the determinants of depression and nutritional status and their associations in patients treated with hemodialysis (HD) and peritoneal dialysis (PD) and the differences according to the type of treatment. There were fifty-three patients treated with maintenance HD and twenty patients treated with PD enrolled in this cross-sectional study. Body composition, anthropometric parameters, and clinical and laboratory parameters were collected for each participant. Depression was assessed with the Beck Depression Inventory II (BDI-II) and risk of malnutrition with the Malnutrition Inflammation Score (MIS). The results suggest a positive association between the level of depression and the percentage of fat mass and obesity parameters in PD and HD participants. Muscle mass and fat-free mass in HD, phase angle (PhA), and serum albumin levels in PD were negatively associated with the value of BDI-II. Participants treated with HD were found to have higher levels of pessimism and loss of interest in sex compared with PD. There is a need to integrate multidisciplinary psychological and nutritional assessment into the usual care of dialysis patients.

Anxiety-depression levels and coping strategies among renal transplant waitlisted and non-waitlisted hemodialysis patients

Background/Aim: Although hemodialysis provides prolonged survival, patients face major challenges, including conflicts about life decisions, limited physical, mental, and lifestyle activities, psychological distress, high prevalence of anxiety and depression symptoms, and compromised health-related quality of life. This study aimed to compare anxiety-depression levels and coping strategies between renal transplant waitlisted and non-waitlisted hemodialysis patients. Methods: A total of 75 hemodialysis patients were enrolled in this case-control analytical study, including renal transplant waitlisted (n = 35) and non-waitlisted (n = 40) patients. Patients were asked to fill out a questionnaire including socio-demographic characteristics, duration of hemodialysis, the Hospital Anxiety and Depression Scale, and the Ways of Coping Questionnaire. Comparative analyses were performed via Student's t-test and Pearson Correlation test. Results: The mean age was 57.1 (15.3) years; 56% were males, and being under hemodialysis treatment was 7.3 (5.9) years. Waitlisted and non-waitlisted patients were matched. Overall, 28 patients (37.3%) had anxiety, and 34 patients (45.3%) had depression. There was no significant difference between the two groups regarding depression scores. Anxiety was more common among non-waitlisted than waitlisted patients (P = 0.043). The fatalistic approach was the most common coping strategy applied, and there was a significant negative correlation between anxiety scores and the problem-solving approach (P = 0.034) and a significant positive correlation between depression scores and the helplessness approach (r = 0.234, P = 0.043). Conclusion: Both waitlisted and non-waitlisted hemodialysis patients have significantly higher levels of depression, with anxiety being higher in non-waitlisted patients. Since coping strategies differed concerning anxiety and depression but not transplant candidacy, psychiatric evaluation and counseling would be essential in hemodialysis patients to control the stressors.

Correlations among lean tissue index, physical activity, clinical parameters, diet quality, and nutritional status in patients receiving haemodialyses

INTRODUCTION

Poor diet quality and malnutrition accelerate protein and energy depletion. This can result in a diminished lean tissue index (LTI) and an inability to perform daily activities, both of which increase the risk of falls and affect the quality of life.

OBJECTIVE

This study investigated the correlations among LTI, physical activity (PA), clinical parameters, diet quality, and nutritional status.

METHODS

A cross-sectional study design was employed. Participants in stable conditions receiving haemodialyses were enroled. LTI was measured using a body composition monitor. Three-day dietary records and demographic and clinical parameters were collected.

RESULTS

In total, 104 patients receiving haemodialyses were recruited (53.8% men, aged 57.7 ± 11.78 years; dialysis duration, 7.3 ± 6.04 years). LTI was not associated with diet quality; LTI was positively correlated with sex and negatively correlated with age, dialysis duration, and fat tissue index (FTI); and lean tissue index was positively correlated with PA. Among patients with a normal LTI, the odds ratio for low-FTI was 31.04 times higher than that for high-FTI. In total, 80.8% of the participants had poor diet quality, which was mainly attributed to their excessive intake of saturated fatty acids and insufficient fruit intake.

CONCLUSIONS

Although diet quality was unrelated to the LTI, the results indicated that most patients receiving haemodialyses had poor diet quality. Therefore, this topic merits further investigation.

Predictors of health-related quality of life in Koreans with cardiovascular disease

Objectives

Methods

Results

Conclusion

The effect of different measurement modalities in the association of lean mass with mortality: A systematic review and meta-analysis

OBJECTIVES

Lean mass is commonly measured by 3 modalities, dual energy X-ray absorptiometry (DXA), bioelectrical impedance analysis (BIA), and computerized tomography (CT). CT is considered the most accurate, while lean mass measured by DXA and BIA often consists of non-muscle compartment, and hence considered less accurate when compared with CT. It remains unclear if the association of lean mass with mortality would differ using different measurement modalities.

METHODS

A systematic review and meta-analysis of lean mass and mortality was conducted. The analysis was stratified by different measurement modalities and health conditions. Pooled hazard ratios were estimated using a random effects model.

RESULTS

This meta-analysis included 188 studies with 98 468 participants. Reduced lean mass measured by BIA, DXA, and CT, was associated with increased risk of mortality with a hazard ratio (HR) of 1.35 (95% CI, 1.21-1.49), 1.18 (95% CI, 1.06-1.30), and 1.44 (95% CI, 1.32-1.57), respectively. Similarly, low lean mass defined by BIA-, DXA-, and CT-measurement was associated with increased risk of mortality, with an HR of 1.81 (95% CI, 1.56-2.10), 1.44 (95% CI, 1.29-1.60), and 1.78 (95% CI, 1.64-1.93).

CONCLUSIONS

Reduced and low lean mass were robustly associated with increased mortality in studies using different measurement modalities.

Systematic review and meta-analysis of lean mass and mortality: Rationale and study description

Objectives

Muscle mass is one of the key components in defining sarcopenia and is known to be important for locomotion and body homeostasis. Lean mass is commonly used as a surrogate of muscle mass and has been shown to be associated with increased mortality. However, the relationship of lean mass with mortality may be affected by different clinical conditions, modalities used, cut-off point to define low or normal lean mass, and even types of cancer among cancer patients. Thus, we aim to perform a comprehensive meta-analysis of lean mass with mortality by considering all these factors.

Methods

Systematic search was done in PubMed, Cochrane Library and Embase for articles related to lean mass and mortality. Lean mass measured by dual X-ray absorptiometry, bioelectrical impedance analysis, and computerized tomography were included.

Results

The number of relevant studies has increased continuously since 2002. A total of 188 studies with 98 468 people were included in the meta-analysis. The association of lean mass with mortality was most studied in cancer patients, followed by people with renal diseases, liver diseases, elderly, people with cardiovascular disease, lung diseases, and other diseases. The meta-analysis can be further conducted in subgroups based on measurement modalities, site of measurements, definition of low lean mass adopted, and types of cancer for studies conducted in cancer patients.

Conclusions

This series of meta-analysis provided insight and evidence on the relationship between lean mass and mortality in all directions, which may be useful for further study and guideline development.

Association Between Serum Uric Acid and Depression in Patients with Chronic Kidney Disease not Requiring Kidney Dialysis: Cross-Sectional and Longitudinal Analyses

BACKGROUND Depression is the main problem of psycho-nephrology. We aimed to investigate clinical risk factors for depression in patients with non-dialysis chronic kidney disease (CKD). MATERIAL AND METHODS A non-dialysis CKD cohort study was conducted with 223 patients. Information on demographic and clinical parameters was collected at baseline. Beck Depression Inventory (BDI) and Pittsburgh Sleep Quality Index (PSQI) questionnaires were used to estimate depression and sleep quality in the patients. The questionnaires were repeated in 158 patients after 6 months. Logistic regression was performed to identify independent factors associated with depression and any longitudinal changes in BDI scores. RESULTS At baseline, 17 patients (7.72%) in the CKD cohort presented with depression. Multivariate logistic regression revealed that being female (odds ratio [OR] 0.319, 95% confidence interval [CI] 0.108 to 0.944, P=0.039) and having lower levels of serum uric acid (SUA) (OR 0.675, 95% CI 0.469 to 0.970, P=0.034) were independent risk factors for depression. A decrease in PSQI score (OR 0.873, 95% CI 0.777 to 0.981, P=0.022) and an increase in SUA level (OR 1.383, 95% CI 1.115 to 1.715, P=0.003) were independently associated with decline in BDI scores in the patients in the 6-month follow-up group. CONCLUSIONS Lower SUA levels and being female were independent risk factors for depression in non-dialysis CKD patients. Improving sleep quality and increasing SUA levels may relieve depression to some extent.

Exercise interventions improve depression and anxiety in chronic kidney disease patients: a systematic review and meta-analysis

PURPOSE

This systematic review examined the effects of exercise interventions on depression and anxiety in chronic kidney disease patients.

METHODS

Electronic searches were conducted between August 2019 and February 2020 at PubMed, MEDLINE, Web of Science, EBSCO, Scopus, LILACS, EMBASE, Physiotherapy Evidence Database, and Cochrane Library databases. Original clinical trial studies that examined the effects of exercise on depression and anxiety in chronic kidney disease patients, stages 3-5, were included. A total of eight studies were included in the systematic review after applying the eligibility criteria, and six studies used for the meta-analysis procedures.

RESULTS

The meta-analysis demonstrated statistical difference on depression in favour to exercise when compared to active control (SMD = - 0.66 [- 1.00, - 0.33], p < 0.0001) and passive control (MD = - 6.95 [- 8.76, - 5.14], p < 0.00001). Same results on anxiety demonstrated statistical difference between exercise and active control (SMD = - 0.78 [- 1.21, - 0.34], p = 0.0004).

CONCLUSION

From the current limited number and quality of published studies, exercise seems to be more effective than sedentary control and other active control groups for improving depression and anxiety symptoms in chronic kidney disease patients.

The screening score of Mini Nutritional Assessment (MNA) is a useful routine screening tool for malnutrition risk in patients on maintenance dialysis

PURPOSE

Malnutrition is prevalent in patients on dialysis and is associated with morbidity and mortality. Nutritional status can be assessed by a variety of biochemical and physical parameters or nutritional assessment scores. Most of these methods are expensive or cumbersome to use and are not suitable for routine repetitive follow-up in dialysis patients. The Mini Nutritional Assessment (MNA) has a short form screening set (MNA-SF), which would be suitable as a screening tool, but has not been validated yet in dialysis patients. We aimed to assess whether the MNA is an appropriate tool for identifying nutritional problems in dialysis patients.

METHOD

MNA, routine biochemistry, physical parameters, comorbidities were assessed in cross-sectional multicentric cohorts of hemodialysis and peritoneal dialysis patients with a longitudinal follow up of 2 years for mortality.

RESULTS

In this cohort of 216 patients, mortality was 27.3% at a follow up of 750±350 days. The mean MNA-SF score was 9.9±1.8, with 30.1%, 59.3% and 10.6% of patients categorized as having normal nutritional status, at risk for malnutrition and malnourished, respectively. The screening score was associated with mortality (HR 0.86, 95% CI 0.75-0.98 per point). With normal nutrition as reference, adjusted mortality was 2.50 (95% CI 1.16-5.37) and 3.89 (95% CI 1.48-10.13) for patients at risk for malnutrition and with malnutrition, respectively. After recalibrating the MNA full score for the specificity of some of its domains for dialysis patients, the MNA-SF had a good sensitivity and specificity for not being well nourished (0.95 and 0.63 respectively) in the full score, and a high negative predictive value (0.91).

CONCLUSION

The MNA-SF is independently associated with 2 year mortality in dialysis patients. It has a high negative predictive value for excluding being at risk or having malnutrition in the full score. Therefore, it can be advocated as a screening tool for nutritional status in dialysis patients.

A Systematic Review and Meta-Analysis of Depression and Protein-Energy Wasting in Kidney Disease

Introduction

Depression comorbid with chronic disease may be mediated by inflammation. We sought to characterize relationships between inflammatory biomarkers and depressive symptoms in patients with chronic kidney disease and end-stage kidney disease.

Methods

A systematic literature search was conducted by 2 authors up to March 19, 2019, for studies of patients with chronic kidney disease or end-stage kidney disease evaluating circulating inflammatory biomarkers associated with depression of chronic disease: albumin, C-reactive protein (CRP), high-sensitivity CRP, interleukin-6 (IL-6), tumor necrosis factor-α, and interleukin-1. Standardized mean differences in biomarkers between individuals with and without depression were computed and analyzed using mixed effects models. Correlations between biomarkers and the severity of depressive symptoms were computed.

Results

Thirty-four studies (5652 participants) compared biomarkers between depressed and nondepressed individuals. Individuals with depression had lower albumin levels (standardized mean difference, −0.37; 95% confidence interval [CI], −0.61 to −0.13), higher CRP levels (standardized mean difference, 0.76; 95% CI, 0.16–1.37), and higher IL-6 levels (standardized mean difference, 0.42; 95% CI, 0.21–0.63). Studies were heterogeneous for albumin, CRP, high-sensitivity CRP, and tumor necrosis factor-α. Twenty-three studies (3047 participants) investigated correlations between biomarkers and depressive symptoms. The severity of depressive symptoms correlated with albumin (Z = −0.25; 95% CI, −0.36 to −0.14), high-sensitivity CRP (Z = 0.28; 95% CI, 0.13–0.43), and IL-6 (Z = 0.34; 95% CI, 0.18–0.49). There was heterogeneity across studies of IL-6. Only 6 studies (321 participants) investigated the effect of antidepressant treatment on inflammatory biomarkers, which was insufficient to combine in meta-analysis.

Conclusion

Lower albumin and higher IL-6 were associated with both the presence and severity of depression, CRP with the presence of depression, and high-sensitivity CRP with the severity of depressive symptoms. The effect of interventions to lower inflammation in patients with kidney disease and depression deserves investigation.

Depression and anxiety among patients undergoing dialysis and kidney transplantation: a cross-sectional study

BACKGROUND

Depression and anxiety are the most prevalent psychological disorders among end-stage renal disease patients and are associated with various conditions that result in poorer health outcomes, e.g. reduced quality of life and survival. We aimed to investigate the prevalences of depression and anxiety among patients undergoing renal replacement therapy.

DESIGN AND SETTING

Cross-sectional study in Belo Horizonte, Brazil.

METHODS

Patients' depression and anxiety levels were assessed using the Beck Inventory. The independent variables were the 36-Item Short-Form Health Survey (SF-36), Charlson Comorbidity Index and Global Subjective Assessment, along with sociodemographic and clinical characteristics.

RESULTS

205 patients were included. Depression and anxiety symptoms were detected in 41.7% and 32.3% of dialysis patients and 13.3% and 20.3% of transplantation patients, respectively. Lower SF-36 mental summary scores were associated with depression among transplantation patients (odds ratio, OR: 0.923; 95% confidence interval, CI: 0.85-0.99; P = 0.03) and dialysis patients (OR: 0.882; 95% CI: 0.83-0.93; P ≤ 0.001). Physical component summary was associated with depression among dialysis patients (OR: 0.906; 95% CI: 0.85-0.96; P = 0.001). Loss of vascular access (OR: 3.672; 95% CI: 1.05-12.78; P = 0.04), comorbidities (OR: 1.578; 95% CI: 1.09-2.27; P = 0.01) and poorer SF-36 mental (OR: 0.928; 95% CI: 0.88-0.97; P = 0.002) and physical (OR: 0.943; 95% CI: 0.89-0.99; P = 0.03) summary scores were associated with anxiety among -dialysis patients.

CONCLUSIONS

Depression and anxiety symptoms occurred more frequently among patients undergoing dialysis. Quality of life, comorbidities and loss of vascular access were associated factors.

Modality transition on renal replacement therapy and quality of life of patients: a 10-year follow-up cohort study

PURPOSE

Despite advance in renal replacement therapy (RRT), patients with chronic end-stage renal disease (ESRD) face various limitations, and renal transplantation (Tx) is the treatment that impacts most on quality of life (QoL). This study aimed to assess changes in QoL in a cohort of ESRD dialysis patients.

METHODS

Sociodemographic, clinical, nutritional, lifestyle, and QoL data were collected from 712 patients at baseline (time 1) and after 10 years of follow-up (time 2) for patients surviving. The QoL was assessed through the 36-Item Short Form Health Survey (SF-36) and the multiple linear regression model was used to analyze the factors associated with change in QoL.

RESULTS

A total of 205 survivors were assessed and distributed into three groups according to current RRT (Dialysis-Dialysis, Dialysis-Tx, and Dialysis-Tx-Dialysis). At time 1, only age was significantly different among groups; at time 2, transplant patients sustained greater social participation, job retention, and improvement in SF-36 scores. The factors associated with change in QoL were more time on dialysis interfering negatively on physical functioning (p = 0.002), role-physical limitations (p  = 0.002), general health (p  = 0.007), social functioning (p = 0.02), role-emotional (p = 0.003), and physical components ( p = 0.002); non-participation in social groups at times 1 and 2 reducing vitality (p = 0.02) scores; and having work at time 2, increasing vitality (p = 0.02) and mental health (p  = 0.02) scores.

CONCLUSIONS

QoL was shown to be dynamic throughout the years of RRT, transplantation being the treatment with more benefits to the ESRD. More time on dialysis and limited social and occupational routine were associated with a reduction in QoL.

Implementing an arts-based intervention for patients with end-stage kidney disease whilst receiving haemodialysis: a feasibility study protocol

BACKGROUND

End-stage kidney disease is a life-changing illness. Many patients require haemodialysis, a treatment that impacts profoundly on quality of life and mental health. Arts-based interventions have been used in other healthcare settings to improve mental health and quality of life; therefore, they may help address the impact of haemodialysis by improving these outcomes. However, there is a lack of evidence assessing their effectiveness in this population and few randomised controlled trials (RCTs) evaluating the effectiveness of complex arts-based interventions.

METHODS

The aims of this study are to establish the feasibility of a cluster RCT of an arts-based intervention for patients with end-stage kidney disease whilst receiving haemodialysis through a cluster randomised pilot study, explore the acceptability of the intervention with a process evaluation and explore the feasibility of an economic evaluation. The study will have three phases. The first phase consists of a cluster randomised pilot study to establish recruitment, participation and retention rates. This will involve the recruitment of 30 participants who will be randomly allocated through cluster randomisation according to shift pattern to experimental and control group. The second phase will be a qualitative process evaluation to establish the acceptability of the intervention within a clinical setting. This will involve semi-structured interviews with 13 patients and three focus groups with healthcare professionals. The third phase will be a feasibility economic evaluation to establish the best methods for data collection within a future cluster RCT.

DISCUSSION

Arts-based interventions have been shown to improve quality of life in healthcare settings, but there is a lack of evidence evaluating arts-based interventions for patients receiving haemodialysis. This study aims to assess the feasibility of a future cluster RCT assessing the impact of an arts-based intervention on the wellbeing and mental health of patients receiving haemodialysis and identify the key factors leading to successful implementation. The hope is this study will inform a trial that can influence future healthcare policy by providing robust evidence for arts-based interventions within the haemodialysis setting.

TRIAL REGISTRATION

The trial was prospectively registered on clinicaltrials.gov on 14/8/2018, registration number NCT03629496.

Implications of low muscle mass across the continuum of care: a narrative review

Abnormalities in body composition can occur at any body weight. Low muscle mass is a predictor of poor morbidity and mortality and occurs in several populations. This narrative review provides an overview of the importance of low muscle mass on health outcomes for patients in inpatient, outpatient and long-term care clinical settings. A one-year glimpse at publications that showcases the rapidly growing research of body composition in clinical settings is included. Low muscle mass is associated with outcomes such as higher surgical and post-operative complications, longer length of hospital stay, lower physical function, poorer quality of life and shorter survival. As such, the potential clinical benefits of preventing and reversing this condition are likely to impact patient outcomes and resource utilization/health care costs. Clinically viable tools to measure body composition are needed for routine screening and intervention. Future research studies should elucidate the effectiveness of multimodal interventions to counteract low muscle mass for optimal patient outcomes across the healthcare continuum. Key messages Low muscle mass is associated with several negative outcomes across the healthcare continuum. Techniques to identify and counteract low muscle mass in clinical settings are needed.

Factors associated with health-related quality of life in Koreans aged over 50 Years: the fourth and fifth Korea National Health and Nutrition Examination Survey

BACKGROUND

To evaluate and analyse the factors associated with health-related quality of life (HR-QoL) in the Korean population aged 50 years and older.

METHODS

We used data obtained from the fourth and fifth Korea National Health and Nutrition Examination Survey (KNHANES IV-V) 2007-2012, a national, cross-sectional health examination and survey, for which representative data on the health, nutritional status, and physical activities of the Korean general population are collected by the Korea Centres for Disease Control and Prevention (KCDC). The sampling protocol for the KNHANES was designed to involve a complex, stratified, multistage probability cluster survey of a representative sample of the noninstitutionalized civilian population in South Korea using a cross-sectional design. The association between HR-QoL and socio-economic factors and medical comorbidities in adults aged 50 years and older was investigated using data from the KNHANES IV-V from 2007 to 2012 (n = 17,937). The EuroQol 5-Dimension Questionnaire (EQ-5D) was used to evaluate HR-QoL, and the factors associated with HR-QoL were analysed after adjusting for socio-economic and demographic factors, anthropometric measurements and clinical comorbidities.

RESULTS

Health status declined with ageing, and low socio-economic status had negative associations with health status. Gender had no association with health status. Among chronic medical conditions, arthritis and depression had significant associations with health status in older people when stratified by age and gender (P < 0.05).

CONCLUSIONS

These findings suggest that older people may value the ability to perform daily activities, which may mean that it is necessary to pay more attention to the factors associated with musculoskeletal pain and emotional distress, as well as socio-economic status or chronic diseases.

TRIAL REGISTRATION

The Korea National Health and Nutrition Examination Survey (KNHNES) is not a clinical trial registry, but the national health survey conducted by the Government of the Republic of Korea, to gather information on health and nutritional status of Korean population, to plan public health services and health education programs, and to do statistical studies of the efficiency of public health services required for setting up welfare and healthcare policies.

The role of socio-demographic factors in depression and anxiety of patients on hemodialysis: an observational cross-sectional study

PURPOSE

Depression and anxiety have high prevalence in patients on hemodialysis and are strongly associated with socio-economic factors. The aim of this study was to evaluate the prevalence of depression and anxiety in hemodialyzed patients in Greece and its association with socio-demographic factors.

METHODS

Four hundred and fourteen (414) patients on hemodialysis (262 males and 152 females) from 24 dialysis centers in Greece participated in this observational cross-sectional study. Mean age was 63.54 (54.06-72.41), and mean time of dialysis treatment was 36 (16-72) months. Depression and anxiety were assessed by the state-trait anxiety inventory (STAI), the beck depression inventory (BDI) and the hospital anxiety and depression scale (HADS). Multinomial logistic regression was performed to estimate the factors being independently associated with anxiety and depression levels (HADS scale). Multiple linear regression was performed to estimate the factors being independently associated with BDI and STAI.

RESULTS

From a total of 414 participants, (29.4%, n = 122) had depression and 35.9% (n = 149) had anxiety. Depression and anxiety were significantly associated with females, low level of education, increased patients' age, retirement, poor financial situation, marital status and co-morbidities.

CONCLUSION

The overall study findings indicated a significant correlation between the levels of anxiety and depression in patients on hemodialysis. Patients with high levels of anxiety had higher levels of depression and those with high depression scores had higher anxiety scores.