The prevalence of depression and the association between depression and kidney function and health-related quality of life in elderly patients with chronic kidney disease: a multicenter cross-sectional study

Plasma brain-derived neurotrophic factor before hemodialysis reduces the risk of depression in patients with chronic renal failure

BACKGROUND

Neurotrophins are related with depressive disorders. Significant neurotrophins variations occur during renal replacement therapy, but whether peri-hemodialysis availability is associated with depression in patients with Chronic Kidney Disease (CKD) is yet unclear.

AIM

To determine dynamic concentrations of neurotrophins in the peri-hemodialysis range and their association with depressive symptoms in patients with CKD.

METHODS

Pre-, and post-hemodialysis plasma concentrations of brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF), as well as their plasma clearance rates, were determined (multiplexing) in patients with stage 5 CKD. Depressive symptoms, as assessed by the Beck Depression Inventory-II (BDI-II), were determined. Finally, the bioavailability of BDNF and NGF was related to the score of depressive symptoms.

RESULTS

Fifty-three patients were divided according to depressive symptoms. Pre-hemodialysis plasma BDNF was lower in patients with depressive disorder; whereas basal BDNF value >220 pg/mL independently reduced the risk for depressive disorder (Odds Ratio 0.23, p = 0.047) at uni- and multivariate analysis. Post-hemodialysis concentration and clearance rate of neurotrophins were not related with depressive symptoms.

CONCLUSION

Higher plasma BDNF before hemodialysis reduces the risk of mild depression in patients with CKD under renal replacement therapy.

Distressing symptoms and health-related quality of life in patients with chronic kidney disease

BACKGROUND

Chronic kidney disease (CKD) is an incapacitating illness associated with distressing symptoms (DS) that have negative impact on patients' health-related quality of life (HRQOL).

AIM

To assess the severity of DS and their relationships with HRQOL among patients with CKD in Jordan.

METHODS

A descriptive cross-sectional design was used. A convenience sampling approach was used to recruit the participants. Patients with CKD (n = 140) who visited the outpatient clinics in four hospitals in Amman between November 2021 and December 2021 were included.

RESULTS

The Edmonton Symptom Assessment System was used to measure the severity of the DS while the Short Form-36 tool was used to measure the HRQOL. Participants' mean age was 50.9 (SD = 15.14). Most of them were males (n = 92, 65.7%), married (n = 95, 67.9%), and unemployed (n = 93, 66.4%). The highest DS were tiredness (mean = 4.68, SD = 2.98) and worse well-being (mean = 3.69, SD = 2.43). The highest HRQOL mean score was for the bodily pain scale with a mean score of 68.50 out of 100 (SD = 32.02) followed by the emotional well-being scale with mean score of 67.60 (SD = 18.57).

CONCLUSION

Patients with CKD had suboptimal HRQOL, physically and mentally. They suffer from multiple DS that have a strong association with diminished HRQOL such as tiredness and depression. Therefore, healthcare providers should be equipped with the essential knowledge and skills to promote individualized strategies that focusing on symptom management.

Prediction of depressive disorder using machine learning approaches: findings from the NHANES

BACKGROUND

Depressive disorder, particularly major depressive disorder (MDD), significantly impact individuals and society. Traditional analysis methods often suffer from subjectivity and may not capture complex, non-linear relationships between risk factors. Machine learning (ML) offers a data-driven approach to predict and diagnose depression more accurately by analyzing large and complex datasets.

METHODS

This study utilized data from the National Health and Nutrition Examination Survey (NHANES) 2013-2014 to predict depression using six supervised ML models: Logistic Regression, Random Forest, Naive Bayes, Support Vector Machine (SVM), Extreme Gradient Boost (XGBoost), and Light Gradient Boosting Machine (LightGBM). Depression was assessed using the Patient Health Questionnaire (PHQ-9), with a score of 10 or higher indicating moderate to severe depression. The dataset was split into training and testing sets (80% and 20%, respectively), and model performance was evaluated using accuracy, sensitivity, specificity, precision, AUC, and F1 score. SHAP (SHapley Additive exPlanations) values were used to identify the critical risk factors and interpret the contributions of each feature to the prediction.

RESULTS

XGBoost was identified as the best-performing model, achieving the highest accuracy, sensitivity, specificity, precision, AUC, and F1 score. SHAP analysis highlighted the most significant predictors of depression: the ratio family income to poverty (PIR), sex, hypertension, serum cotinine and hydroxycotine, BMI, education level, glucose levels, age, marital status, and renal function (eGFR).

CONCLUSION

We developed ML models to predict depression and utilized SHAP for interpretation. This approach identifies key factors associated with depression, encompassing socioeconomic, demographic, and health-related aspects.

Insights into effective fatigue reducing interventions in kidney transplant candidates: a scoping review

BACKGROUND

Fatigue is a prevalent and debilitating symptom among kidney transplant candidates (KTCs), significantly affecting their quality of life and overall well-being. Its complexity necessitates a comprehensive approach to manage fatigue in this population.

PURPOSE

To explore the effectiveness of nonpharmacological interventions in reducing fatigue in KTCs.

METHODS

Nonpharmacological interventions targeting fatigue in participants aged ≥18 years, who were either on the kidney transplantation waitlist or eligible candidates, were considered. A database search was conducted in PubMed, Embase, PsycINFO, CINAHL, and Web of Science. Results were reported in accordance with the guidelines provided by the Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocols extension for Scoping Reviews Checklist.

RESULTS

In total, 67 studies were included. Interventions were divided into manipulative and body-based practices, exercise, mind-body therapies, energy healing, and combined interventions. Thirty-eight studies (76%) demonstrated a significant effect on fatigue, with effect sizes ranging from 0.43 to 4.85. Reflexology, massage therapy, progressive muscle relaxation, and acupressure combined with massage therapy showed the strongest significant intervention effects on fatigue and had the strongest study quality. However, the overall study quality was weak, particularly concerning confounding control, blinding procedures, and withdrawals and dropouts.

CONCLUSIONS

Manipulative and body-based interventions showed the strongest significant effects on fatigue with the highest study quality. These interventions underscore the multifactorial nature of fatigue by targeting both its physical and psychological dimensions. Future high-quality research is needed to determine the optimal strategy for managing fatigue in KTCs.

Association Between Depressive Symptoms and Comorbidities Among Elderly Diabetic Individuals in China

BACKGROUND

Diabetic individuals are at an increased risk of mental illness and comorbidities. However, the precise association between depressive symptoms and comorbidity remains uncertain. Our study aimed to investigate this relationship among elderly Chinese diabetic patients.

METHODS

Data from the China Health and Retirement Longitudinal Study (CHARLS) in 2020 were utilized for the cross-sectional analysis. Depressive status was defined as the dependent variable, while the presence, number, and type of comorbidities served as independent variables. Logistic regression analyses were performed, adjusting for potential demographic factors, and health status and functioning factors.

RESULTS

Our findings indicate that diabetic patients with complications are more likely to experience depression. With the exception for dyslipidemia (OR = 1.195, 95% CI: 0.969, 1.475), individuals with hypertension, heart disease, stroke, kidney disease, memory-related disease, or arthritis/rheumatism were prone to develop depressive status in the fully adjusted model. After adjusting for covariates, diabetic patients with memory-related diseases exhibited the most pronounced association with depressive symptoms (OR = 2.673, 95% CI: 1.882, 3.797). Furthermore, an increasing number of depression-related comorbidities strengthened the association (p < 0.05). Sensitivity analysis revealed that there were no significant differences stratified by gender or marital status (p < 0.05).

CONCLUSIONS

In the elderly diabetic population in China, the presence, number, and type of comorbidities were independently associated with depressive symptoms. Diabetic patients with memory-related diseases displayed the highest likelihood of experiencing depressive status. These findings underscore the importance of implementing effective strategies for multimorbidity management in diabetic patients.

Depression and Quality of Life in Patients With Chronic Kidney Disease: A Mediation Analysis of Handgrip Strength and Demoralization

BACKGROUND

Chronic kidney disease (CKD) is a progressive disease impacting the physical function and mental health of sufferers. Depression is known to negatively impact quality of life, whereas handgrip strength and demoralization are important factors affecting physical and mental health. Lower handgrip strength has been associated with sarcopenia and higher risk of hospitalization in patients and higher workloads for nurse caregivers. Few studies have investigated the complex relations among these factors in patients with CKD.

PURPOSE

This study was designed to investigate the mediating effects of grip strength and demoralization on the relationship between depression and quality of life in patients with CKD.

METHODS

Two hundred fifty patients with CKD comprised the study sample. The hypotheses were tested using the PROCESS macro.

RESULTS

Depression was found to be negatively associated with handgrip strength and quality of life but positively associated with demoralization. The results indicate that both handgrip strength and demoralization mediate the association between depression and quality of life. Moreover, the results of multiple mediation model analysis showed handgrip strength and demoralization both play important roles in the link between depression and quality of life.

CONCLUSIONS

The results of this study indicate that handgrip strength and demoralization mediate the relationship between depression and quality of life in patients with CKD. Thus, increasing handgrip strength and decreasing demoralization levels may mitigate the impact of depression on quality of life. Therefore, nurses should better appreciate the importance of handgrip strength for patients with CKD and evaluate handgrip strength. Nurses should also develop physical and mental interventions to increase handgrip strength and decrease demoralization.

Depression in Cardiac Patients Is a Major Cardiovascular Event Risk Factor: A 12-Month Observational Study

Background: Depression is a known factor in poor cardiovascular outcomes but is often underassessed in cardiac units. This study evaluates the impact of depression on cardiovascular outcomes in patients undergoing cardiac interventions. Methods: The study included 133 patients who underwent uncomplicated procedures for degenerative aortic valve stenosis (n = 40), acute coronary syndrome (n = 29), or chronic coronary artery disease (n = 64). Depression was assessed using the Beck Depression Inventory (BDI) and Hamilton Depression Rating Scale (HAM-D). The primary endpoint was a major adverse cardiac and cerebrovascular event (MACCE). Patients were followed up for 12 months. Cox proportional hazards analysis was used to identify MACCE risk factors. Results: Depression was more frequently screened by HAM-D than BDI (42.9% vs. 30.8%, p < 0.001). During follow-up, 26 (19.5%) MACCEs occurred. In univariate analysis, risk factors included BDI score ≥ 11, HAM-D score ≥ 8, diabetes on insulin, anticoagulant use, atrial fibrillation, and serum creatinine level ≥ 130 µmol/L. Depression in the BDI increased the risk of the MACCE 3.6-fold (95%CI: 1.64-8.0, p = 0.001), whereas in the HAM-D, it increased the risk 4.9-fold (95%CI: 1.97-12.24, p < 0.001). Multivariate analysis showed HAM-D score ≥ 8 as the strongest predictor of MACCE (HR: 3.08, 95%CI: 1.18-8.08). Conclusions: Depression is a common finding in cardiovascular patients, and it is a strong risk factor for one-year cardiovascular mortality and adverse event risk. Therefore, we believe that common guidelines should be elaborated between relevant psychiatry and cardiology scientific societies.

Prevalence and Risk Factors of Fatigue in Adults with Stage 3 and 4 CKD: Findings from the National Health and Nutrition Examination Survey, 2007-2012

Key Points

Fatigue is a common symptom experienced by adults with CKD. Physiological, sociodemographic, psychological, and behavioral factors are associated with fatigue.

Background

Fatigue is a devastating symptom experienced by adults with CKD, but less is known about the prevalence of fatigue and factors associated with fatigue in a general population of adults with CKD. Therefore, we examined the prevalence of fatigue and identified factors associated with fatigue among a national cohort of US adults with CKD.

Methods

We utilized cross-sectional data from 1079 adults from the National Health and Nutrition Examination Survey 2007–2012 and included participants aged 18 years and older with stage 3 and 4 CKD (eGFR between 15 and 60 ml/min per 1.73 m2) who had available data evaluating fatigue. Unadjusted and adjusted logistic regression models were used to evaluate the odds of having fatigue in the context of physiological, sociodemographic, psychological, and behavioral factors.

Results

We estimated that 48% of those with CKD had fatigue. Among the risk factors examined, those with the strongest evidence of association in multivariable analyses were female sex (odds ratio [OR], 1.49; 95% confidence interval [CI], 1.02 to 2.17), pain (OR, 2.49; 95% CI, 1.57 to 3.93), poor mental health (OR, 1.97; 95% CI, 1.05 to 3.72), anxiety (OR, 1.95; 95% CI, 1.14 to 3.34), and depressive symptoms (OR, 2.58; 95% CI, 1.17 to 5.66).

Conclusions

Fatigue is a common symptom experienced by adults with CKD in the United States. Physiological, sociodemographic, psychological, and behavioral factors are associated with fatigue, with psychological factors being most strongly associated with fatigue. Future work is needed to identify interventions to mitigate fatigue and risk factors of fatigue in adults with CKD.

Comprehensive geriatric assessment of older patients with renal disease: a cross-sectional survey

Multidimensional health function impairments are common in older patients with chronic kidney disease (CKD). The purpose of this study was to explore whether the risk or severity of geriatric syndrome increased with a decline in renal function. This survey was conducted for CKD patients aged  ≥ 60 years and hospitalized at West China Hospital of Sichuan University (Center of Gerontology and Geriatrics, Nephrology, and Endocrinology) and Chengdu Kangfu Kidney Disease Hospital from September 01, 2013 to June 30, 2014. Patients underwent multidimensional individualized assessments by trained doctors. Logistic regression analysis found that the risk of assisted walking (P = 0.001) and urinary incontinence (P = 0.039) increased with a decline in renal function. Regression analysis revealed that the scores of activities of daily living (P = 0.024), nutritional status (P = 0.000), total social support (P = 0.014), and objective support (P = 0.000) decreased with a decline in renal function.

Comparison of chronic kidney disease progression and associated complications between geriatric and non-geriatric groups

There is no consensus on the physiologic decline in estimated glomerular filtration rate (GFR) due to geriatric conditions related with the aging or chronic kidney disease (CKD) itself. In this study, we aimed to compare the CKD progression and associated complications in a large sample of geriatric and non-geriatric patients. The data of in 506 patients at age between 30 to 90 years and diagnosed with CKD at stage 2 and above (15 mL/min/1.73 m2 ≤ eGFR < 90 mL/min/1.73 m2) were collected retrospectively and compared among geriatric (>65 years old) and non-geriatric individuals. The rate of hypertension was higher in geriatrics compared to non-geriatrics (96.6% vs 91.9%, P = .04). Among laboratory findings, only PTH level was significantly lower and HCO3 concentration was higher in geriatrics compared to non-geriatrics (P = .02, P < .001, respectively). There was no significant difference in last measured eGFR (P = .99) while that measured 4 years ago was lower in geriatrics compared to that of non-geriatrics (P < .001). eGFR change was smaller in geriatrics compared to non-geriatrics (P < .001), and rate of progressive renal disease among non-geriatric group (39%) was found to be significantly higher than in the geriatrics (17.2%) (P < .001). The prevalence of hyperkalemia was lower in geriatrics at stage 3a (P = .02); prevalence of hyperparathyroidism was lower in those at stage 3b (P = .02) and lastly the acidosis was observed significantly lower in geriatric patients at stage 3a, 3b, and 4 compared to the non-geriatrics at corresponding stages (P < .001, P = .03, and P = .04, respectively). The eGFR change was significantly smaller in geriatrics at stage 3b and 4 (P < .001 and P = .04, respectively) while the rate of progressed renal disease was lower in geriatrics at stage 3a and 3b (21.1% vs 9.9%, P = .03 and 41.2% vs 11.1%, P < .001, respectively). eGFR change in 4-year period and the rates of progressive renal disease are higher in the non-geriatrics and also the prevalence of secondary complications of CKD, such as hyperparathyroidism, acidosis, and hyperkalemia, are higher in non-geriatrics. This may reflect that decline of GFR in geriatric individuals is at least partially related to physiological aging rather than kidney disease. Therefore, devising age related CKD definitions might be appropriate.

[Neurocognitive disorders in chronic kidney disease]

Neurocognitive disorders (NCD) are common in patients with chronic kidney disease (CKD). It is essential to identify and characterize these disorders at an early stage, so as to be able to offer appropriate treatment. In a chronic disease such as CKD, the patient's involvement in decision-making is a major challenge, given the prospects for suppletive treatment: hemodialysis, peritoneal dialysis, kidney transplantation or non-dialytic drug therapy. Many factors are associated with the development and progression of NCD in patients with CKD, and a variety of conditions can influence the outcome of cognitive assessment in these patients.

Patient delay in chronic kidney disease: A qualitative study

This study aimed to investigate the reasons for patient delay in chronic kidney disease (CKD) and provide a scientific basis for implementing effective interventions. With the adoption of the phenomenological method in qualitative research, semi-structured, face-to-face interviews were conducted with 14 cases, and the Colaizzi seven-step analysis method was used to analyze the interview data and refine the themes. A total of 4 themes were obtained, namely, a cognitive explanation of illness, negative psychological emotions, socioeconomic levels, and limited medical resources. The current status of patient delay in chronic kidney disease is serious, and there are various reasons for it. Health management departments and healthcare providers at all levels should pay attention to this situation and provide targeted supportive interventions and health education to help patients establish the correct awareness of medical consultation and effectively improve their quality of survival.

Age-varying relationships between family support and depressive symptoms in Chinese community-dwelling older adults

BACKGROUND

Adequate family support is an important factor in reducing the risk of depressive symptoms in older adults. We aimed to explore the age-varying relationships of family support and depressive symptoms in community-dwelling older adults.

METHODS

A total of 22,163 person-waves of older adults aged 60 to 85 years from the China Health and Retirement Longitudinal Survey were included. Depressive symptoms were assessed by the Center for Epidemiological Studies Depression Scale. Family support was divided into instrumental family support and emotional family support. A Time-Varying Effects Model was utilized to analyze the age-varying relationships.

RESULTS

There were age-varying relationships between family support and depressive symptoms in community-dwelling older adults. Around age 70 was an important turning point of age. In instrumental family support, access to living care can reduce the risk of depressive symptoms in almost all age groups. At least medium-level financial support was required to be protective against depressive symptoms, and high-level financial support was necessary after age 70. In emotional family support, meeting children with high frequency was significantly associated with a lower risk of depressive symptoms before age 70. Contacting children with low or medium frequency added the risk of depressive symptoms before age 70.

LIMITATIONS

Limited sample size of participants aged 80 years and above, lack of assessment for expectations of family support.

CONCLUSIONS

Providing the appropriate type and intensity of family support for older adults at a suitable age was encouraged. Future research should further verify and explicate the age-varying relationships longitudinally.

Frailty and Age-Associated Assessments Associated with Chronic Kidney Disease and Transplantation Outcomes

Background. Frailty is often defined as a decrease in physiological reserve and has been shown to be correlated with adverse health outcomes and mortality in the general population. This condition is highly prevalent in the chronic kidney disease (CKD) patient population as well as in kidney transplant (KT) recipients. Other age-associated changes include sarcopenia, nutrition, cognition, and depression. In assessing the contributions of these components to patient outcomes and their prevalence in the CKD and KT patient population, it can be determined how such variables may be associated with frailty and the extent to which they may impact the adverse outcomes an individual may experience. Objectives. We sought to perform a systematic literature review to review published data on frailty and associated age-associated syndromes in CKD and KT patients. Results. Over 80 references pertinent to frailty, sarcopenia, nutrition, cognition, or depression in patients with CKD or KT were identified. Systematic review was performed to evaluate the data supporting the use of the following approaches: Fried Frailty, Short Physical Performance Battery, Frailty Index, Sarcopenia Index, CT scan quantification of muscle mass, health-related quality of life, and assessment tools for nutrition, cognition, and depression. Conclusion. This report represents a comprehensive review of previously published research articles on this topic. The intersectionality between all these components in contributing to the patient’s clinical status suggests a need for a multifaceted approach to developing comprehensive care and treatment for the CKD and KT population to improve outcomes before and after transplantation.

Gut microbiome and tissue metabolomics reveal the compatibility effects of Xiaoyaosan on depression based on "gut-liver-kidney" axis

BACKGROUND

Depression affects not only the central nervous system, but also the peripheral system. Xiaoyaosan (XYS), a classical traditional Chinese medicine (TCM) prescription, exhibits definite anti-depression effects demonstrated both clinically and experimentally. However, its compatibility has not been entirely revealed due partly to the complex compositions of herbs contained.

AIM

Based on the strategy of "Efficacy Group", this study aimed to reveal the compatibility of XYS from the perspective of "gut-liver-kidney" axis.

METHODS

Firstly, XYS was divided into two efficacy groups, i.e. Shugan (SG) and Jianpi (JP) groups. Classic behaviors of rats were measured to confirm the anti-depression effects of XYS and its two efficacy groups. On top of this, gut microbiota analysis and kidney metabolomics were performed by 16S rRNA sequencing and ¹H NMR, respectively.

RESULTS

We found that XYS and its efficacy groups significantly regulated the abnormalities of behaviors and kidney metabolism of depressed rats, as well as intestinal disorders, but to different degrees. The regulatory effects of XYS and its efficacy groups on behaviors and kidney metabolomics of depressed rats had the same order, i.e. XYS > SG > JP, while the order of regulating gut microbiota was XYS > JP > SG. Both XYS and its efficacy groups significantly ameliorated gut microbiota disturbed, especially significant modulation of Peptostreptococcaceae. XYS significantly regulated nine kidney metabolites, while SG and JP regulated four and five differential metabolites, respectively, indicating that the two efficacy groups synergistically exhibited anti-depression effects, consequently contributing to the overall anti-depression effects of XYS.

CONCLUSION

The current findings not only innovatively demonstrate the anti-depression effects and compatibility of XYS from the perspective of "gut-liver-kidney" axis, comprehensively using "Efficacy Group" strategy, macro behavioristics, metabolome and microbiome, and also provide a new perspective, strategy, and methodology for studying complex diseases and the compatibility of TCMs.

Combination Effect of Microcystins and Arsenic Exposures on CKD: A Case-Control Study in China

Evidence has shown that exposure to environmental pollutants such as microcystins (MCs), arsenic (As), and cadmium (Cd) can lead to the occurrence and development of chronic kidney disease (CKD). There is a synergistic effect between MCs and Cd. However, the combined effect of MCs and As exposures on CKD remains unclear. In Hunan province, China, 135 controls and 135 CKD cases were enrolled in a case-control study. Serum MCs, plasma As and Cd concentrations were measured for all participants. We investigated the association between MCs/As and CKD risk using conditional logistic regression. The additive model explored the interaction effect, and the Bayesian kernel machine regression (BKMR) models investigated the combined effects of MCs, As, and Cd on CKD. The results showed that MCs and As were significantly associated with CKD risk. Participants in the highest MCs concentration had a 4,81-fold increased risk of CKD compared to those in the lowest quartile (95% confidence interval [CI]: 1,96 to 11,81). The highest quartile of As concentrations corresponded to an adjusted odds ratio of 3.40 (95% CI: 1.51, 7.65) relative to the lowest quartile. MCs/As and CKD risk exhibited significant dose-response correlations (all p for trend < 0.01). In addition, a positive interaction effect of MCs and As on CKD was also reported. The CKD risk due to interaction was 2.34 times (95% CI: 0.14, 4.54) relative to the CKD risk without interaction, and the attributable proportion of CKD due to interaction among individuals with both exposures was 56% (95% CI: 0.22, 0.91). In the BKMR, the combined effect of MCs, As, and Cd was positively associated with CKD. In conclusion, both MCs and As are independent risk factors for CKD, exerting a synergistic effect between them. Combined exposure to MCs, As, and Cd can increase the risk of CKD.

The Association between Symptoms of Depression and Anxiety, Quality of Life, and Diabetic Kidney Disease among Chinese Adults: A Cross-Sectional Study

Depression and anxiety are common comorbid symptoms among patients with diabetic kidney disease (DKD). Little is known about the influence of poor psychological conditions on the disease progression and quality of life (QOL) in DKD patients. This study aimed to investigate the prevalence of, and risk factors for, depression and anxiety in Chinese DKD patients, and to analyze their impact on the renal function, proteinuria, and QOL. A total of 620 adult patients with Type 2 diabetes and DKD being treated at a tertiary hospital in East China were recruited. Depression and anxiety symptoms were assessed by the Zung Self-Rating Depression Scale and Anxiety Scale. Among the DKD participants, 41.3% had symptoms of depression and 45.0% had anxiety symptoms. A poor education, physical inactivity, stroke, low serum albumin, CKD stage 3-4, macroalbuminuria, and a poor QOL were independent risk factors for depression in the DKD patients. Whereas a higher education, physical inactivity, diabetic retinopathy and neuropathy, low hemoglobin, CKD stage 3-4, and a poor QOL were risk factors for anxiety. Depression and anxiety scores among the DKD patients were negatively correlated with the eGFR and QOL scores. Moreover, depression and anxiety symptoms were independent risk factors for DKD patients with CKD stage 3-4 and a poor QOL. Our findings suggest a high prevalence of depression and anxiety among Chinese DKD patients, and the severity of psychological symptoms is closely linked to the deterioration of renal function and the QOL. The early screening and intervention of psychopathological disorders is thus strongly recommended for improving the QOL and clinical outcomes among DKD patients.

The big data era: The usefulness of folksonomy for natural language processing

BACKGROUND

A huge amount of clinical data is generated daily and it is usually filed in clinical reports as natural language. Data extraction and further analysis requires reading and manual review of each report, which is a time consuming process. With the aim to test folksonomy to quickly obtain and analyze the information contained in media reports we set up this study.

METHODS AND OBJECTIVES

We have used folksonomy to quickly obtain and analyze data from 1631 discharge clinical reports from the Nephrology Department of Hospital del Mar, without the need to create a structured database.

RESULTS

After posing some questions related to daily clinical practice (hypoglycaemic drugs used in diabetic patients, antihypertensive drugs and the use of renin angiotensin blockers during hospitalization in the nephrology department and data related to emotional environment of patients with chronic kidney disease) this tool has allowed the conversion of unstructured information in natural language into a structured pool of data for its further analysis.

CONCLUSIONS

Folksonomy allows the conversion of the information contained in clinical reports as natural language into a pool of structured data which can be further easily analyzed without the need for the classical manual review of the reports.

Prevelance of depression and anxiety with their effect on quality of life in chronic kidney disease patients

Chronic kidney disease is one of the most common chronic diseases globally. Many studies have shown it is strongly associated with increased social and psychological problems such as depression and anxiety which are considered as common psychiatric disorders that occur in patients with chronic kidney disease. We investigated the prevalence of depression, anxiety and perception of quality of life in a sample of chronic kidney disease patients at the Jordan University Hospital. We aimed to see any association of the mental health in these patients; mainly depression and anxiety with their quality of life and correlation to socio-demographics or laboratory and metabolic profile of this population. 103 chronic kidney disease patients were interviewed using a questionnaire in the Nephrology outpatient clinics of the Jordan University Hospital, the questionnaire included four sections, the first sections handled socio-demographic data. Also, it contains a brief Clinical and laboratory parameter of our patients. The second part consisted of the 9-item Patient Health Questionnaire (PHQ-9) that used to measure the severity of depression. The third part included the 7-item Generalized Anxiety Disorder (GAD-7) to evaluate the severity of anxiety, the fourth part assessed participants quality of life (QOL) using The World Health Organization Quality of Life, Short Form (WHOQOL-BREF) questionnaire. More than half of the participants have depression and anxiety with a percentage of 58.3% and 50.5%, respectively. There was a negative moderate to strong correlation between depression score and quality of life domains scores (p < 0.001).Only marital status had a significant relationship with depression (p < 0.001).Weak positive correlation between Glomerular Filtration Rate and anxiety score (p = 0.04),with significant positive correlation between lipid profile and anxiety score. There was a negative correlation between anxiety score and quality of life domains scores. Females had higher anxiety score than males (p = 0.27). Patients who do not work had a lower physical functioning score compared to others (p value = 0.024).Patients with higher serum Hemoglobin had higher physical and psychological scores. Anxiety, Depression are common among our chronic kidney disease patients, more interventions are needed to improve the mental health of our patients and their quality of life perception. This kind of study allows us to gain a deeper understanding regarding the effects of chronic kidney disease on psychosocial well-being of those patients, and helps health care providers to put depression, anxiety and Quality of life into consideration when treating patients.

Depression is a main determinant of health-related quality of life in patients with diabetic kidney disease

Low health-related quality of life (HRQOL) is associated with adverse outcomes in diabetic kidney disease (DKD) patients. We examined the modifiable factors associated with low HRQOL in these patients. We enrolled 141 DKD patients. HRQOL was assessed with the Short Form 36 (SF-36) questionnaire. Low HRQOL was defined as a score > one standard deviation below the mean. Depression and anxiety were assessed with the Hospital Anxiety and Depression Scale (HADS-D and HDAS-A, respectively). The patients’ median age was 65 years, and 73% were men. The prevalence rates of anxiety and depression were 8% (n = 11) and 17% (n = 24), respectively. Forty (28%) patients were identified as poor sleepers, and 40 (28%) had low physical activity levels. Anxiety, depression, and poor sleep quality were negatively correlated with SF-36 scores. Higher levels of physical activity and the estimated glomerular filtration rate (eGFR) were correlated with higher SF-36 scores, which indicated better health status. Higher depression scores (HADS-D scores) were associated with low HRQOL, independent of factors including age, sex, smoking status, comorbidities, eGFR, anemia, sleep quality, anxiety levels, and physical activity levels (odds ratio, 1.43; 95% confidence interval, 1.17–1.75). Among the clinical and psycho-physical factors, depression was a main determinant of low HRQOL in DKD patients.

Prospective bidirectional associations between depression and chronic kidney diseases

Previous studies had reported the mutual relation between depression and chronic kidney diseases (CKD). This study aimed to investigate potential bidirectional relationships between depression and CKD. Participants more than 45 years from the China Health and Retirement Longitudinal Study (CHARLS) were included in present study. In study I, we tended to assess the association between baseline depression with the risk of subsequent CKD. In study II, we aimed to examine whether the onset of CKD could predict the development of depression. Multivariate logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (95% CIs) in study I and study II, respectively. In study I, 301 (6.16%) respondents experienced CKD in participants without depression, and 233 (8.48%) respondents experienced CKD in participants with depression. Participants with depression had higher risk of developing CKD with the corresponding ORs (95% CIs) was 1.38(1.08-1.76). In study II, 1333 (22.29%) subjects in the non-CKD group and 97 (27.17%) in CKD group developed depressive symptoms. Individuals with CKD had higher risk of developing depression than those without CKD, with the multivariate ORs (95% CIs) was 1.48(1.23-1.78). Significant bidirectional relationships remained in both sensitivity and subgroup analyses. Findings demonstrate bidirectional relationships between depression and CKD. Individuals with depression were associated with increasing risk of CKD; in addition, CKD patients had higher risk of developing depression.

Association between frailty and depression among hemodialysis patients: a cross-sectional study

BACKGROUND

Frailty is consensually understood to be a clinical syndrome in which minimal stressors can lead to negative outcomes such as hospitalization, early institutionalization, falls, functional loss and death. Frailty is more prevalent among patients with chronic kidney disease (CKD), and those on dialysis are the frailest. Depression contributes towards putting patients with CKD into the frailty cycle.

OBJECTIVE

To assess frailty and its relationship with depression among patients with CKD undergoing hemodialysis.

DESIGN AND SETTING

Observational and quantitative cross-sectional study conducted in a renal therapy unit, located in the interior of the state of São Paulo, Brazil.

METHODS

This investigation took place in 2019, among 80 patients. The following instruments were applied: a sociodemographic, economic and health condition characterization and the Subjective Frailty Assessment (SFA) and Patient Health Questionnaire-9 (PHQ-9).

RESULTS

Among the patients, there was higher prevalence of females, individuals with a steady partner and retirees, and their mean age was 59.63 (± 15.14) years. There was high prevalence of physical frailty (73.8%) and depression (93.7%). Depression was associated with frailty, such that patients with depression were 9.8 times more likely to be frail than were patients without depression (odds ratio, OR = 9.80; 95% confidence interval, CI, 1.93-49.79).

CONCLUSION

Based on the proposed objective and the results achieved, it can be concluded that depression was associated with the presence of frailty among patients with CKD on hemodialysis.

The mediating effect of sleep quality and fatigue between depression and renal function in nondialysis chronic kidney disease: a cross-sectional study

BACKGROUND

Depressive symptoms, fatigue, and poor sleep quality are associated with renal function deterioration in patients with nondialysis chronic kidney disease (CKD-ND). This study was designed to examine whether fatigue and sleep quality are mediators of the association between depression and renal function.

METHODS

This study adopted a cross-sectional study design. Patients with CKD-ND aged 20 years or older were recruited by purposive sampling at a medical center in Central Taiwan from December 2020 to July 2021. Data were collected using the Emotional and Social Support Scale, Fatigue Scale, Beck Depression Inventory-II (BDI-II), and Pittsburgh Sleep Quality Index. Medical records were reviewed to obtain the estimated glomerular filtration rate (eGFR) for the next month. The relationships among variables were analyzed using structural equation modeling to assess the goodness-of-fit of the model. Then, the bootstrapping method was used to analyze the mediated effect.

RESULTS

Two hundred forty-two participants (mean age 70.5 years and 53% males) were included in the analysis. About 39% of the participants met the criteria for depressive symptoms in BDI-II, and 91% reported having sleep disturbances. Participants' degree of fatigue was not high (20.4 ± 13.3). The average eGFR was 25.45 mL/min/1.73 m ² (± 13.36). The results showed that fatigue, sleep quality, and eGFR were significantly correlated with depression. The total effect size was - 0.8304 (95% confidence interval [CI], - 0.9602 to - 0.7006), and the indirect effect size was - 0.1738 (95% CI, - 0.2812 to - 0.0651), which was a statistically significant difference, indicating that the model has a mediating effect. According to mediation analysis, fatigue and sleep quality had a significant indirect effect on the relationship between depression and renal function (95% CI, - 0.0587 to - 0.0039).

CONCLUSIONS

The findings suggest that fatigue and poor sleep quality may mediate the association between depression and renal function.

Individual-level determinants of depressive symptoms and associated diseases history in Turkish persons aged 15 years and older: A population-based study

BACKGROUND

Depressive symptoms are associated with both long-lasting and short-term repetitive mood disorders and affect a person's ability to function and lead a rewarding life. In addition to predisposing genetic causes, other factors such as socioeconomic and demographic factors, and chronic diseases have also been reported to associate with depression. In this study, we analyzed the association between history of chronic diseases and presentation of depressive symptoms amongst Turkish individuals.

METHODS

We employed the 2019 Turkey health survey to analyze data of 11,993 individuals aged 15+ years. Depressive symptoms were assessed using the eight-item Patient Health Questionnaire (PHQ-8) coded with a binary measure, a score of <10 as less depressed and >10 as moderate-severely depressed. A number of sociodemographic characteristics were adjusted for in the analyses. Logistic regression models were used to test the association between chronic diseases and depressive symptoms in the study sample.

RESULTS

Our analysis revealed that 6.24% of the 11,993 participants had reported an episode of depressive symptoms. The prevalence of depressive symptoms in men was 1.85% and in women, it was 2.34 times higher. Participants who had previously reported experiencing coronary heart diseases (AOR = 7.79, 95% CI [4.96-12.23]), urinary incontinences (AOR = 7.90, 95% CI [4.93-12.66]), and liver cirrhosis (AOR = 7.50, 95% CI [4.90-10.42]) were approximately eight times likely to have depressive symptoms. Similarly, participants with Alzheimer's disease (AOR = 6.83, 95% CI [5.11-8.42]), kidney problems (AOR = 6.63, 95% CI [4.05-10.85]), and history of allergies (AOR = 6.35, 95% CI [4.28-9.23]) had approximately seven-fold odds of reporting episodes of depressive symptoms. The odds of presenting with depressive symptoms amongst participants aged ≥ 50 were higher than in individuals aged ≤ 49 years.

CONCLUSION

At individual level, gender and general health status were associated with increased odds of depression. Furthermore, a history of any of the chronic diseases, irrespective of age, was a positive predictor of depression in our study population. Our findings could help to serve as a reference for monitoring depression amongst individuals with chronic conditions, planning health resources and developing preventive and screening strategies targeting those exposed to predisposing factors.

Persistent Depressive Symptoms and the Changes in Serum Cystatin C Levels in the Elderly: A Longitudinal Cohort Study

BACKGROUND

The burden of depression in the elderly is increasing worldwide with global aging. However, there is still a lack of research on the relationship between depressive symptoms and the progression of renal function. Our aim is to evaluate the longitudinal association between baseline depressive symptoms and the changes in serum cystatin C levels over 10 years' follow-up period.

METHODS

We used longitudinal data from the Health and Retirement Study (HRS), an existing community based nationally representative aging cohort study which enrolled individuals over age 50 in the USA. Depressive symptoms were determined using an eight-item version of the Center for Epidemiologic Studies Depression Scale (CESD) at wave 7 (2004) and wave 8 (2006). Persistent depressive symptoms were defined as both CESD scores measured at waves 7 and 8 were ≥3; episodic depressive symptoms were defined as CESD scores ≥3 at wave 7 or wave 8. A linear mixed model was used to evaluate the correlation between baseline depressive symptoms and future changes in cystatin C levels.

RESULTS

The mean age of the 7,642 participants was 63.8 ± 10.8 years, and 60.9% were women. Among the participants, 1,240 (16.2%) had episodic depressive symptoms and 778 (10.2%) had persistent depressive symptoms. Compared with participants with no depressive symptoms at both waves, a significant increase in serum cystatin C levels was found among those with persistent depressive symptoms.

CONCLUSIONS

Our results showed that baseline persistent depressive symptoms were significantly associated with an increased rate of serum cystatin C levels. The level of serum cystatin C should be monitored in the elderly with persistent depressive symptoms.

Associations between depressive symptoms and disease progression in older patients with chronic kidney disease: results of the EQUAL study

Background

Depressive symptoms are associated with adverse clinical outcomes in patients with end-stage kidney disease; however, few small studies have examined this association in patients with earlier phases of chronic kidney disease (CKD). We studied associations between baseline depressive symptoms and clinical outcomes in older patients with advanced CKD and examined whether these associations differed depending on sex.

Methods

CKD patients (≥65 years; estimated glomerular filtration rate ≤20 mL/min/1.73 m²) were included from a European multicentre prospective cohort between 2012 and 2019. Depressive symptoms were measured by the five-item Mental Health Inventory (cut-off ≤70; 0–100 scale). Cox proportional hazard analysis was used to study associations between depressive symptoms and time to dialysis initiation, all-cause mortality and these outcomes combined. A joint model was used to study the association between depressive symptoms and kidney function over time. Analyses were adjusted for potential baseline confounders.

Results

Overall kidney function decline in 1326 patients was –0.12 mL/min/1.73 m²/month. A total of 515 patients showed depressive symptoms. No significant association was found between depressive symptoms and kidney function over time (P = 0.08). Unlike women, men with depressive symptoms had an increased mortality rate compared with those without symptoms [adjusted hazard ratio 1.41 (95% confidence interval 1.03–1.93)]. Depressive symptoms were not significantly associated with a higher hazard of dialysis initiation, or with the combined outcome (i.e. dialysis initiation and all-cause mortality).

Conclusions

There was no significant association between depressive symptoms at baseline and decline in kidney function over time in older patients with advanced CKD. Depressive symptoms at baseline were associated with a higher mortality rate in men.

Health-Related Quality of Life according to Renal Function: Results from a Nationwide Health Interview and Examination Survey

BACKGROUND

Most studies on health-related quality of life (HRQoL) in chronic kidney disease (CKD) focus on patients with end-stage kidney disease although they represent a small proportion of patients with CKD. We aimed to analyze HRQoL according to glomerular filtration rate (GFR) categories in a population-based sample of adults living in Germany.

METHODS

Data from the German health interview and examination survey conducted from 2008 to 2011 were used. Participants with valid interview and examination data aged 40-79 years were included (n = 5,159). Serum creatinine levels were used to calculate estimated GFR via the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. We classified kidney function in GFR categories according to the Kidney Disease Improving Global Outcomes Initiative (KDIGO) guidelines on CKD: G1 (high): ≥90 mL/min/1.73 m2, G2 (normal): 60-89 mL/min/1.73 m2, G3a (mildly decreased): 45-59 mL/min/1.73 m2, G3b (moderately decreased): 30-44 mL/min/1.73 m2, G4/5 (severely decreased/end-stage kidney disease): <30 mL/min/1.73 m2. HRQoL was evaluated with the Short Form Health Survey (SF-36). Different multivariate linear and logistic regression models were used to analyze the association of HRQoL with GFR categories.

RESULTS

Overall, 5.9% had a GFR <60 mL/min/1.73 m2 (corresponding to categories G3a, G3b, and G4/5). Compared to category G2 linear regression showed a decline in physical HRQoL in categories G3a (-2.34, p = 0.004), G3b (-5.37, p = 0.009), and G4/5 (-4.82, p = 0.117). No decline in mental HRQoL was detected with increasing GFR categories. Categories G3a to G4/5 were significantly associated with a low perceived general state of health (G3a: odds ratio [OR] = 2.03, p = 0.001; G3b: OR = 3.01, p = 0.009; G4/5: OR = 8.70, p = 0.016) when compared to category G2.

CONCLUSION

In a representative sample of adults living in Germany, both physical HRQoL and the perceived general state of health are already significantly reduced in category G3a.

Cognitive disorders in patients with chronic kidney disease: specificities of clinical assessment

Neurocognitive disorders are frequent among chronic kidney disease (CKD) patients. Identifying and characterizing cognitive impairment (CI) can help to assess the ability of adherence to CKD risk reduction strategy, identify potentially reversible causes of cognitive decline, modify pharmacotherapy, educate the patient and caregiver and provide appropriate patient and caregiver support. Numerous factors are associated with the development and progression of CI in CKD patients and various conditions can influence the results of cognitive assessment in these patients. Here we review clinical warning signs that should lead to cognitive screening; conditions frequent in CKD at risk to interfere with cognitive testing or performance, including specificities of cognitive assessment in dialysis patients or after kidney transplantation; and available tests for screening and observed cognitive patterns in CKD patients.

Fatigue in CKD: Epidemiology, Pathophysiology, and Treatment

Fatigue is a commonly reported and debilitating symptom among patients with CKD, yet little is known about its epidemiology, pathogenesis, and treatment. Various measurement tools have been used in published studies to identify and quantify fatigue. These include several single-item measures embedded in longer questionnaires for assessing depression, quality of life, or symptom burden in patients with kidney disease. Approximately 70% of patients with CKD report fatigue, with up to 25% reporting severe symptoms. Patient-reported fatigue is associated with death, dialysis initiation, and hospitalization among individuals with CKD. The pathophysiology is multifactorial and likely includes decreased oxygen delivery and increased reliance on anaerobic metabolism, thus generating lactic acidosis in response to exertion; the effects of chronic metabolic acidosis and hyperphosphatemia on skeletal muscle myocytes; protein-energy wasting and sarcopenia; and depression. Physical activity has been shown to improve fatigue in some small but promising trials, and so should be recommended, given the additional benefits of exercise. Targeting higher hemoglobin levels with erythropoiesis-stimulating agents may improve fatigue, but potential adverse cardiovascular effects preclude their use to solely treat fatigue without the presence of another indication. Current guidelines recommend cautious individualization of hemoglobin targets for those at low cardiovascular risk who still experience fatigue or functional limitation despite a hemoglobin level of 10 g/dl. Sodium bicarbonate supplementation for the treatment of metabolic acidosis may also improve functional status. Selective serotonin reuptake inhibitors have not been consistently shown to improve fatigue in patients with kidney disease, but an ongoing trial will evaluate the effect of alternative antidepressant drug and behavioral activation therapy on fatigue in patients with CKD. Overall, more research is needed to further clarify underlying mechanisms of fatigue and identify effective, targeted treatments for patients with CKD.

Lack of association between erythropoietin treatment and risk of depression in patients with end-stage kidney disease on maintenance dialysis: a nationwide database study in Taiwan

Background

Patients with end-stage kidney disease (ESKD), have been associated with higher risk of developing depression. Erythropoietin (EPO), frequently used for the treatment of anemia in ESKD patients, has been shown to have neuroprotective and antidepressant effects. In this study, we examined whether EPO treatment changed the risk of depression in ESKD patients.

Methods

In a nationwide population-based cohort in Taiwan from 1998 to 2013, patients with a diagnosis of ESKD on maintenance dialysis and aged greater than 18 years were classified into EPO treatment group or non-EPO treatment group. All patients were followed up until the diagnosis of depressive disorder or the end of the study period.

Results

In this cohort (13,067 patients in the EPO and 67,258 patients in the non-EPO group), 5569 patients were diagnosed as depressive disorder in the follow-up period. We found the risk of depression in EPO group was not significantly different from that in non-EPO group (adjusted hazard ratio = 0.98, 95% confidence interval 0.92-1.04, p = 0.499) after adjusting for sex, age, certification year of catastrophic illness for ESKD, physical co-morbidities, and use of benzodiazepines.

Conclusion

In summary, using the nationwide reimbursement data in Taiwan, we found that EPO treatment in ESKD patients was not associated with their general risk of developing depression.

Early estimated glomerular filtration rate and depression in kidney transplantation recipients: a longitudinal study

Depression is a common psychological problem in kidney transplantation (KT) recipients and affects long-term graft outcomes. Estimated glomerular filtration rate (eGFR) as a commonly used indicator of renal function plays a vital role in follow-up detection after KT. The aim of this study is to observe the change of early eGFR within 3 months after KT and to explore the correlation between eGFR and depression before and after transplantation. The Self-rating Depression Scale was used to evaluate depression. Among 135 patients with KT, 128 patients completed the longitudinal study. We used a one-way repeated-measures analysis of variance to analyze eGFR and a generalized estimating equation model to examine the relationship between depression and eGFR in KT recipients with pre-transplant and 30, 60, 90 days post-transplant. The mean eGFR of KT recipients at four time-points was 5.97 ± 4.83, 72.84 ± 26.06, 79.06 ± 26.45 and 81.79 ± 25.62, respectively. The results demonstrated that eGFR kept steady at 60 days and 90 days post-transplant; depression was significantly associated with eGFR. Earlier identification and treatment of depression in KT recipients may be essential to promote their recovery of early renal function.

Health-related quality of life in patients with chronic kidney disease

Introduction: In the last three decades, health systems have continued to pay increasing attention to the quality of life (QOL) due to definitional changes in the concept of health and disease. The health-related quality of life (HRQOL) in patients with chronic kidney disease (CKD) is significantly affected, regardless of the stage of CKD. Areas covered: We attempt to thoroughly explore how CKD affects HRQOL domains with a quick primer on HRQOL assessment instruments in patients with CKD. Also, we pointed out the factors affecting HRQOL in patients with CKD as well as the clinical application of HRQOL in CKD management. Expert opinion: The general population enjoys higher HRQOL than patients with CKD in all domains. Similarly, pre-dialysis and kidney-transplant patients have better HRQOL than dialysis population. There are many factors which negatively impact HRQOL in CKD which include for example depression, anxiety, and cognitive impairment for the social domain, inactivity, and frailty for the physical domain as well as lack of social support and extroversion in the social domain. Additionally, social disparities and CKD-related factors would influence HRQOL. Of note, there is no global standard HRQOL assessment tool. Finally, HRQOL should be included in future CKD management guidelines.

Patterns of Association between Depressive Symptoms and Chronic Medical Morbidities in Older Adults

OBJECTIVES

To investigate the association between depressive symptoms and several medical morbidities, and their combination, in a large older population.

DESIGN

Cross-sectional study of baseline data from the ASPirin in Reducing Events in the Elderly (ASPREE) trial.

SETTING

Multicentric study conducted in Australia and the United States.

PARTICIPANTS

A total of 19,110 older adults (mean age = 75 years [standard deviation = ±4.5]).

MEASUREMENTS

Depressive symptoms were measured using the Center for Epidemiological Studies Depression (CES-D 10) scale. Medical morbidities were defined according to condition-specific methods. Logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) to test associations before and after accounting for possible confounders.

RESULTS

Depressive symptoms were significantly associated with obesity (OR = 1.19; 95% CI = 1.07-1.32), diabetes (OR = 1.22; 95% CI = 1.05-1.42), gastroesophageal reflux disease (GERD) (OR = 1.41; 95% CI = 1.28-1.57), metabolic syndrome (OR = 1.16; 95% CI = 1.03-1.29), osteoarthritis (OR = 1.41; 95% CI = 1.27-1.57), respiratory conditions (OR = 1.25; 95% CI = 1.10-1.42), history of cancer (OR = 1.19; 95% CI = 1.05-1.34), Parkinson's disease (OR = 2.56; 95% CI = 1.83-3.56), polypharmacy (OR = 1.60; 95% CI = 1.44-1.79), and multimorbidity (OR = 1.29; 95% CI = 1.12-1.49). No significant association was observed between depressive symptoms and hypertension, chronic kidney disease, dyslipidemia, and gout (P > .05). A significant dose-response relationship was evident between the number of medical comorbidities and the prevalence of depression (OR = 1.18; 95% CI = 1.13-1.22).

CONCLUSION

Late-life depressive symptoms are significantly associated with several medical morbidities, and there appears to be a cumulative effect of the number of somatic diseases on the prevalence of depression. These findings augment the evidence for a complex relationship between mental and physical health in an otherwise healthy older population and might guide clinicians toward early recognition of high-risk individuals. J Am Geriatr Soc 68:1834-1841, 2020.

Déficit de actividades recreativas en hemodiálisis. Satisfacción y coste económico ante un proyecto lúdico terapéutico

Introducción: Se ha documentado que implementar programas de actividades recreativas durante las sesio-nes de diálisis es una buena alternativa para mejorar no solo la percepción hacia el tratamiento, sino también otras alteraciones presentes en las personas con enfer-medad renal crónica en tratamiento con hemodiálisis. Objetivos: Analizar la satisfacción de los pacientes con el Proyecto Déficit de Actividades Recreativas, así como cuantificar el coste económico del mismo. Material y método: Estudio descriptivo transversal realizado en 2019. Se recogieron datos clínicos. Se va-loró la satisfacción con el proyecto de actividades pro-puesto. Se recogieron datos de autopercepción sobre el estado de salud y el tratamiento. Se cuantificó el coste económico del proyecto. Resultados: Evaluados 37 pacientes. La puntuación mediana de satisfacción para las actividades fue: Pro-grama Pallapupas 8/10 [P25:6; P75:10], Celebraciones mensuales 10/10 [P25:8; P75:10], Ejercicio físico intra-diálisis 7/10 [P25:5; P75:10], Conciertos en directo 7/10 [P25:5,5; P75:9,5]. En la autopercepción, un 37,84% (n=14) percibía negativamente el tratamiento y un 29,73% (n=11) no estar satisfecho con la inversión de tiempo. El 91,89% (n=34) desea continuar participan-do en las actividades organizadas. El coste total teórico de las 4 actividades evaluadas es de 33.715,22 euros al año.Conclusiones: Se ha hallado una alta satisfacción de los pacientes con el Proyecto déficit de actividades re-creativas en hemodiálisis, pudiendo ser el coste anual de dicho proyecto asumible.