Treatment with antidepressive drugs improved quality of life in chronic hemodialysis patients

The Relationship Between Serum Selenium Level, Cognitive Functions, and Depression in Patients With Chronic Kidney Disease

Introduction Impairment of cognitive functions can commonly develop in patients with chronic kidney disease (CKD) and increase morbidity and mortality. The antioxidant activity of selenium reduces cognitive decline by protecting neurons from free radical damage. We aimed to explore the associations between serum selenium levels, cognitive impairment, and depression in CKD patients in this research. Methods In this prospective cross-sectional research, 100 participants between the ages of 20 and 65 were included, and four groups of 25 patients each were formed (control group, stage 3-4 CKD, peritoneal dialysis [PD], hemodialysis [HD]). The Standardized Mini Mental Test (sMMT) was used to measure cognitive skills, and the Beck Depression Inventory (BDI) was utilized to diagnose depression. Simultaneously, measurements of serum selenium levels were done from collected blood samples. Results Cognitive impairment was detected in 4% of the control group, 16% of CKD patients (n=75), and 30% of the dialysis patients (n=50). Depression was found in 16% of the control group, 40% of the stage 3-4 CKD group, 50% of the PD group, and 44% of the HD group. In the control group, sMMT scores were higher than the other groups (p<0.001 for all), while the BDI score was statistically significantly lower (p=0.003). Serum selenium levels were found to be higher than HD and PD groups in patients with non-dialysis CKD and control groups in the post hoc analyses (p=0.001, p<0.001, p<0.001, p<0.001, respectively). Conclusion Depression and cognitive impairment are particularly prevalent in CKD and dialysis patients. Our results indicate serum selenium insufficiency may be related to depression and cognitive impairment in this patient group. Nonetheless, these findings need to be confirmed by larger-scale studies.

Using the Intelligent System to Improve the Delivered Adequacy of Dialysis by Preventing Intradialytic Complications

Acute kidney failure patients while detoxificated by hemodialysis (HD) mostly or continuously faced regular problems such as low blood pressure (hypotension), muscle cramps, nausea, or vomiting. Higher intradialytic symptom leads to low-quality HD treatment. Although more known therapeutic interventions are used to relieve the HD side effects, this study was designed to investigate how intelligent systems can make highly beneficial alterations in dialysis facilities and equipment to ease intradialytic complications and help the staff deliver high-quality treatment. A search was performed among relevant research articles based on nonpharmacological intervention methods considered to prevent adverse effects of renal replacement therapy until 2020 in the PubMed databases using the terms “intradialytic complications,” “intradialytic complication interventions,” “nonpharmacological interventions,” “intradialytic exercises,” and “adequacy calculation methods.” Studies included the prevalence of intradialytic complications, different strategies with the aim of preventing complications, the outcome of intradialytic exercises on dialysis symptoms, and dialysis dose calculation methods. The results showed the incidence of hypotension varying between 5% and 30%, fatigue, muscular cramps, and vomiting as the most common complications during dialysis, which greatly affect the outcome of HD sessions. To prevent hypotension, ultrafiltration profiling, sodium modeling, low dialysate temperature, and changing the position to Trendelenburg are some strategies. Urea reduction ratio (URR), formal urea kinetic modeling (FUKM), formal single-pool urea kinetics, and online clearance monitoring (OCM) are methods for calculating the delivered dose of dialysis in which OCM is a low-cost and accessible way to monitor regularly the quality of dialysis delivered. Integration of the chair and HD machine which is in direct contact with the patient provides an intelligent system that improves the management of the dialysis session to enhance the quality of healthcare service.

The Quality of Life, Depression Levels and Coping Styles of Patients on Kidney Transplant Waiting List

This study aims to understand the coping strategies, depression levels, sociodemographic characteristics of Turkish patients with hemodialysis, and the other factors explain quality of life levels. This research is a cross-sectional study. The convenience sampling consisted of 292 patients with hemodialysis. The data were collected using the brief COPE, QOL, Beck Depression Inventory and sociodemographic form. According to the research results, patients show mild (score range 10-16) depression symptoms. One of the most important findings of this study is that the coping strategies and level of depression with chronic kidney patients accounted for a significant amount of variance in their quality of life. The relationship between emotion-focused coping strategy and quality of life was not statistically significant. In addition, high level of depression in chronic renal failure patients significantly reduce the quality of life. As a result of the study, the relationship between the high quality of life of patients who use problem-focused coping strategy more intensively and patients with low depression levels was determined. The findings point to the importance of taking individual coping strategies into account when evaluating the impact of a disease on psychosocial wellbeing. Delineation of coping strategies might be useful for identifying patients in need of particular counseling and support. These patients should have frequent contact with a multidisciplinary team of health care givers, possibly allowing for early diagnosis and prompt treatment. Results suggest targeted interventions to stimulate future research regarding the psychological care of patients with chronic kidney disease.

Pharmacologic and psychological interventions for depression treatment in patients with kidney disease

PURPOSE OF REVIEW

It remains controversial whether existing therapies, including pharmacologic and psychological interventions, are effective for treatment of depression in patients with chronic kidney disease (CKD) and end-stage kidney disease.

RECENT FINDINGS

Most studies of depression treatment were underpowered or uncontrolled. The CKD Antidepressant Sertraline Trial showed no benefit of a serotonin-selective reuptake inhibitor (SSRI), sertraline, over double-blind matched placebo for the treatment of depressive symptoms in patients with nondialysis CKD. A Trial of Sertraline vs. Cognitive Behavioral Therapy (CBT) for End-stage Renal Disease Patients with Depression showed improvement in depressive symptoms from baseline in both groups and a marginal benefit of sertraline over CBT that was of unclear clinical significance, given the lack of an active control group. SSRIs are associated with poor tolerability in clinical trials and serious adverse outcomes in large retrospective studies.

SUMMARY

Although the data do not support unlimited use of SSRIs in patients with CKD or end-stage kidney disease, it is reasonable to initiate a cautious trial of sertraline while closely monitoring for depressive symptom improvement and adverse effects. CBT is a low-risk, possibly effective intervention to treat major depressive disorder in patients with kidney disease who have access to such treatments.

Patterns and predictors of depression treatment among adults with chronic kidney disease and depression in ambulatory care settings in the United States

PURPOSE

One in five adults with chronic kidney disease (CKD) in the United States (US) suffers from depression. Comorbid depression in adults with CKD is associated with higher morbidity and mortality. This study used US national survey data to examine patterns and predictors of depression treatment among adults with non-dialysis-dependent CKD in the US.

METHODS

A retrospective, cross-sectional study was conducted using 2014-2015 National Ambulatory Medical Care Survey (NAMCS) data. The final study sample consisted of visits by 9.02 million adults (unweighted n = 262; age ≥ 18 years) with CKD and depression in the US. Depression treatment was defined as antidepressant use with or without psychotherapy. To identify predictors of depression treatment, multivariable logistic regression analysis was conducted adjusting for predisposing, enabling, and need factors.

RESULTS

Approximately half of adults with CKD and depression received depression treatment. Primary care was the main setting of treatment, and the most commonly prescribed antidepressant class was selective serotonin reuptake inhibitors. Adults being seen for treatment of a chronic problem were 3.2 times more likely to receive depression treatment (OR 3.20; 95% CI 1.38-7.21). In addition, there was a 9% higher likelihood of receiving depression treatment for each unit increase in total number of medications (OR 1.09; 95% CI 1.01-1.19). Finally, adults receiving care in the South were 63% less likely to receive depression treatment (OR 0.37; 95% CI 0.15-0.89).

CONCLUSIONS

Depression treatment was recorded in approximately half of US ambulatory care visits involving adults with CKD and depression from 2014 to 2015. Further research is warranted to determine how to appropriately manage treatment of depression in adults with CKD.

Is successful treatment of depression in dialysis patients an achievable goal?

Depression is undisputedly common among individuals with End-Stage Kidney Failure and associated with adverse outcomes. It is well recognized that effective treatments for depression are needed within routine dialysis care. But, are we any closer to successfully treating depression in dialysis patients? We consider this question here with respect to two common treatments, antidepressant medication and cognitive behavioural therapy (CBT). Currently, there are limited data from randomized placebo-controlled trials regarding the acceptability and efficacy of antidepressants. CBT trials appear to show more consistent treatment effects, albeit the feasibility of routine delivery remains unknown. No studies in dialysis patients has evaluated the combined effects of CBT with antidepressants. There is a need to consider pragmatic depression treatment trials in dialysis patients in order to increase study recruitment in order to have more reliable data from which to evaluate the evidence base. Furthermore, we need to understand why treatments work, and for whom do they work? Lastly, addressing issues surrounding treatment acceptability and implementation as part of regular care remain as key challenges that require attention if we are to improve the mental health of individuals on dialysis.

Health-Related Quality of Life in Dialysis Patients with HCV Infection

Measuring the impact of chronic kidney disease (CKD) treatment on patient quality of life has become increasingly recognized as an important outcome measure. Despite improvements in the treatment of chronic kidney disease, health-related quality of life (HRQOL) is lower than in the general population. HRQOL measures, particularly the Physical Component Summary (PCS), have predictive validity for risk of both mortality and hospitalization in dialysis populations. For every 10-point lower PCS score, the relative risk (RR) of death increases by 29% (RR=1.29; 95% Cl=1.23 to 1.35; p<0.001) and the risk of hospitalization increases by 15% (RR=1.15; 95% Cl=1.11 to 1.19, p<0.001), according to the Dialysis Outcomes and Practice Patterns Study (DOPPS). Hepatitis C virus (HCV) infection remains prevalent among dialysis patients with a recent meta-analysis showing that anti-HCV seropositive status was an independent and significant risk factor for death in patients on maintenance dialysis. Seven studies with 11,589 unique patients on maintenance dialysis were identified; the summary estimate for adjusted relative risk (aRR) (all-cause mortality) was 1.34 with a 95% confidence interval (CI) of 1.13–1. 59. In non-uremic populations HCV diminishes HRQOL, and individuals with HCV scored lower than controls across all scales of the short form 36 (SF-36). Patients achieving sustained virological responses (SVR) scored higher across all scales versus patients without SVR, especially in the physical health domains. Whether the adverse influence of HCV on survival in dialysis population is related to the negative impact of HCV on HRQOL requires further research. Information on HRQOL indices in patients with HCV on maintenance dialysis is extremely limited but the available evidence shows that HCV infection impairs HRQOL, especially in mental aspects, among patients on maintenance hemodialysis.

Patient-perceived barriers to a screening program for depression: a patient opinion survey of hemodialysis patients

Background

Depression is a prevalent, yet underdiagnosed, psychiatric disorder among patients with end-stage renal disease. Active case identification through routine screening is suggested; however, patient-related barriers may reduce the effectiveness of screening for, and treating, depression. This study aimed to explore the perceived barriers that limit patients from participating in screening and treatment programs for depression.

Methods

In a cross-sectional study of chronic maintenance hemodialysis patients, the Perceived Barriers to Psychological Treatment questionnaire, adapted to include screening, was used to measure perceived barriers. The two-item Patient Health Questionnaire was used to identify patients with depressive symptoms.

Results

Of 160 participants, 73.1% reported at least one barrier preventing them from participation [95% confidence interval (95% CI) 66.2–80.0%]. Patients with depressive symptoms were more likely to perceive at least one barrier to a screening program for depression compared with those without depressive symptoms (96% versus 68.9%, respectively; odds ratio = 10.8; 95% CI 1.4–82.8; P = 0.005). The association of the barrier scores with depressive symptoms remained significant after adjustment for patient’s characteristics. The most common barriers that patients expressed were concerns about the side effects of any antidepressant medications that may be prescribed (40%), concerns about having more medications (32%), feeling that the problem is not severe enough (23%) and perceiving no risk of depression (23%).

Conclusions

Negative perceptions about depression and its treatment among hemodialysis patients constitute an important barrier to identifying this condition and first need to be addressed before implementing a screening program in this population.

Effect of Sertraline on Depressive Symptoms in Patients With Chronic Kidney Disease Without Dialysis Dependence: The CAST Randomized Clinical Trial

IMPORTANCE

Major depressive disorder (MDD) is prevalent among patients with chronic kidney disease (CKD) and is associated with morbidity and mortality. The efficacy and adverse events of selective serotonin reuptake inhibitors in these patients are unknown.

OBJECTIVE

To determine whether treatment with sertraline improves depressive symptoms in patients with CKD and MDD.

DESIGN, SETTING, AND PARTICIPANTS

The Chronic Kidney Disease Antidepressant Sertraline Trial (CAST) was a randomized, double-blind, placebo-controlled trial involving 201 patients with stage 3, 4, or 5 non-dialysis-dependent CKD, who were enrolled at 3 US medical centers. The Mini Neuropsychiatric Interview was used to establish MDD. The first participant was randomized in March 2010 and the last clinic visit occurred in November 2016.

INTERVENTIONS

After a 1-week placebo run-in, participants were randomized to sertraline (n = 102) for 12 weeks at an initial dose of 50 mg/d (escalated to a maximum dose of 200 mg/d based on tolerability and response) or matching placebo (n = 99).

MAIN OUTCOMES AND MEASURES

The primary outcome was improvement in depressive symptom severity from baseline to 12 weeks determined by the 16-item Quick Inventory of Depression Symptomatology-Clinician Rated (QIDS-C16) (score range, 0-27; minimal clinically important difference, 2 points). Secondary outcomes included improvement in quality of life (Kidney Disease Quality of Life Survey-Short Form; score range, 0-100; higher scores indicate more favorable quality of life) and adverse events.

RESULTS

There were 201 patients (mean [SD] age, 58.2 [13.2] years; 27% female) randomized. The primary analysis included 193 patients who had at least 1 outcome assessment after randomization. The mean (SD) baseline QIDS-C16 score was 14.0 (2.4) in the sertraline group (n = 97) and 14.1 (2.4) in the placebo group (n = 96). The median participation time was 12.0 weeks and the median achieved dose was 150 mg/d, which was not significantly different between the groups. The QIDS-C16 score changed by -4.1 in the sertraline group and by -4.2 in the placebo group (between-group difference, 0.1 [95% CI, -1.1 to 1.3]; P = .82). There was no significant between-group difference in change in patient-reported overall health on the Kidney Disease Quality of Life Survey (median score, 0 in the sertraline group vs 0 in the placebo group; between-group difference, 0 [95% CI, -10.0 to 0]; P = .61). Nausea or vomiting occurred more frequently in the sertraline vs placebo group (22.7% vs 10.4%, respectively; between-group difference, 12.3% [95% CI, 1.9% to 22.6%], P = .03), as well as diarrhea (13.4% vs 3.1%; between-group difference, 10.3% [95% CI, 2.7% to 17.9%], P = .02).

CONCLUSIONS AND RELEVANCE

Among patients with non-dialysis-dependent CKD and MDD, treatment with sertraline compared with placebo for 12 weeks did not significantly improve depressive symptoms. These findings do not support the use of sertraline to treat MDD in patients with non-dialysis-dependent CKD.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT00946998.

Depression in dialysis patients

Depression is the most common psychiatric illness in patients with end-stage renal disease (ESRD). The reported prevalence of depression in dialysis population varied from 22.8% (interview-based diagnosis) to 39.3% (self- or clinician-administered rating scales). Such differences were attributed to the overlapping symptoms of uraemia and depression. Systemic review and meta-analysis of observational studies showed that depression was a significant predictor of mortality in dialysis population. The optimal screening tool for depression in dialysis patients remains uncertain. The Beck Depression Inventory (BDI), Patient Health Questionnaire (PHQ) and Center for Epidemiologic Studies Depression Scale (CESD) have been validated for screening purposes. Patients who scored ≥14 using BDI should be referred to a psychiatrist for early evaluation. Structured Clinical Interview for DSM disorders (SCID) remains the gold standard for diagnosis. Non-pharmacological treatment options include cognitive behavioural therapy and exercise training programs. Although frequent haemodialysis may have beneficial effects on patients' physical and mental well-being, it cannot and should not be viewed as a treatment of depression. Selective serotonin reuptake inhibitors (SSRIs) are generally effective and safe in ESRD patients, but most studies were small, non-randomized and uncontrolled. The European Renal Best Practice (ERBP) guideline suggests a trial of SSRI for 8 to 12 weeks in dialysis patients who have moderate-major depression. The treatment effect should be re-evaluated after 12 weeks to avoid prolonging ineffective medication. This review will discuss the current understanding in the diagnosis and management of depression in dialysis patients.

Factors affecting quality of life in patients on haemodialysis: a cross-sectional study from Palestine

BACKGROUND

Haemodialysis (HD) is a life-sustaining treatment for patients with end-stage renal disease (ESRD). HD can bring about significant impairment in health-related quality of life (HRQOL) and outcomes. Therefore, we sought to describe the patterns of HRQOL and determine the independent factors associated with poor HRQOL in Palestinian patients on HD.

METHODS

A multicenter cross-sectional study was performed from June 2014 to January 2015 using the EuroQOL-5 Dimensions instrument (EQ-5D-5L) for the assessment of HRQOL. ESRD patients undergoing HD in all dialysis centres in the West Bank of Palestine were approached and recruited for this study. Multiple linear regression was carried out to identify factors that were significantly associated with HRQOL.

RESULTS

Two hundred and sixty-seven patients were participated in the current study giving response rate of 96 %. Overall, 139 (52.1 %) were male, and the mean ± standard deviation age was 53.3 ± 16.2 years. The reported HRQOL as measured by mean EQ-5D-5L index value and Euro QOL visual analogue scale (EQ-VAS) score was 0.37 ± 0.44 and 59.38 ± 45.39, respectively. There was a moderate positive correlation between the EQ-VAS and the EQ-5D-5L index value (r = 0.42, p < 0.001). The results of multiple linear regression showed a significant negative association between HRQOL with age, total number of chronic co-morbid diseases and the total number of chronic medications. However, a significant positive association was found between HRQOL with male gender, university education level and patients who live in village.

CONCLUSION

Our results provided insight into a number of associations between patient variables and their HRQOL. Healthcare providers should be aware of low HRQOL among patients with no formal education, female gender, patient's residents of refugee camps, multiple co-morbid diseases, multiple chronic medications, and elderly patients to improve their quality of life.

The efficacy of udenafil in end-stage renal disease patients undergoing hemodialysis

INTRODUCTION

Erectile dysfunction (ED) is frequently observed in end-stage renal disease (ESRD) patients on hemodialysis (HD) compared to non-uremic patients. This situation causes severe psychogenic problems in patients and disrupts the quality of life. Different phosphodiesterase type 5 (PDE-5) inhibitors have been used, and efficacies revealed, for the treatment of ED in HD patients; however, there are no studies related to udenafil use or results for HD patients. This study retrospectively evaluated the efficacy and reliability of udenafil for HD patients.

MATERIALS AND METHODS

The laboratory findings, side effects after treatment, and International Index of Erectile Function (IIEF) scores before and after treatment were compared and evaluated for HD patients who applied to our urology clinic with ED complaints and were treated with udenafil.

RESULTS

The results showed that in the HD patient group with ED, apart from ED, there were severe rates of other sexual dysfunction. In our patient group, there was a statistically significant improvement in all scores for erectile function (p = 0.033), orgasmic function (p < 0.001), sexual desire (p < 0.001), relationship satisfaction (p < 0.001), and general satisfaction (p < 0.001) after treatment. The reported side effects were headache in one patient and dyspepsia in one patient.

CONCLUSION

We concluded that udenafil is an effective and reliable treatment approach for HD patients; however, our results require support from prospective randomized crossover studies with sildenafil.

Rationale and design of A Trial of Sertraline vs. Cognitive Behavioral Therapy for End-stage Renal Disease Patients with Depression (ASCEND)

Major Depressive Disorder (MDD) is highly prevalent in patients with End Stage Renal Disease (ESRD) treated with maintenance hemodialysis (HD). Despite the high prevalence and robust data demonstrating an independent association between depression and poor clinical and patient-reported outcomes, MDD is under-treated when identified in such patients. This may in part be due to the paucity of evidence confirming the safety and efficacy of treatments for depression in this population. It is also unclear whether HD patients are interested in receiving treatment for depression. ASCEND (Clinical Trials Identifier Number NCT02358343), A Trial of Sertraline vs. Cognitive Behavioral Therapy (CBT) for End-stage Renal Disease Patients with Depression, was designed as a multi-center, 12-week, open-label, randomized, controlled trial of prevalent HD patients with comorbid MDD or dysthymia. It will compare (1) a single Engagement Interview vs. a control visit for the probability of initiating treatment for comorbid depression in up to 400 patients; and (2) individual chair-side CBT vs. flexible-dose treatment with a selective serotonin reuptake inhibitor, sertraline, for improvement of depressive symptoms in 180 of the up to 400 patients. The evolution of depressive symptoms will also be examined in a prospective longitudinal cohort of 90 HD patients who choose not to be treated for depression. We discuss the rationale and design of ASCEND, the first large-scale randomized controlled trial evaluating efficacy of non-pharmacologic vs. pharmacologic treatment of depression in HD patients for patient-centered outcomes.

Pharmacological and Non-pharmacological Treatment Options for Depression and Depressive Symptoms in Hemodialysis Patients

Depression is a mental disorder with a high prevalence among patients with end stage renal disease (ESRD). It is reported that depression afflicts approximately 20-30% of this patient population, being associated, amongst other, with high mortality rate, low adherence to medication and low perceived quality of life. There is a variety of medications known to be effective for the treatment of depression but due to poor adherence to treatment as well as due to the high need for medications addressing other ESRD comorbidities, depression often remains untreated. According to the literature, depression is under-diagnosed and undertreated in the majority of the patients with chronic kidney disease. In the current review the main pharmacological and non-pharmacological approaches and research outcomes for the management of depressive symptoms in hemodialysis patients are discussed.

Factors associated with depression and anxiety in patients with end-stage renal disease receiving maintenance hemodialysis

OBJECTIVES

To investigate anxiety, depression, and related factors in patients with end-stage renal disease (ESRD) receiving maintenance hemodialysis and provide a reference for the establishment of a healthier life for such patients.

METHODS

A total of 81 patients were enrolled in the study. Qualified participants filled out self-rating anxiety scale (SAS) and depression self-assessment scale (SDS) questionnaires as well as assessments of health knowledge and health self-efficacy. Linear regression analysis was performed to relate demographic factors, lifestyle habits, and nutrition parameters to SDS and SAS score indices.

RESULTS

The mean SAS and SDS score indices for the 81 patients were 52.96 and 46.71, respectively; 56 patients (69.1 %) had a depressive disorder (SDS score ≥ 50), and 31 patients (36.9 %) had anxiety symptoms (SAS score ≥ 50). SAS score index correlated with gender (p < .05) and history of alcohol use (p < .01), whereas SDS score index correlated with administration of erythropoietin (EPO) (p < .05) as well as gender and history of alcohol use.

CONCLUSION

History of alcohol consumption may predict less depressive symptoms and more anxiety among Chinese patients living in a northeastern Chinese city with ESRD. EPO administration may reduce anxiety in patients with ESRD. Female patients were more prone to anxiety, whereas males were more likely to show symptoms of depression. These factors should be evaluated by nephrologists treating patients with ESRD.

Rationale and design of the Chronic Kidney Disease Antidepressant Sertraline Trial (CAST)

Major Depressive Disorder (MDD) affects one in five patients with Chronic Kidney Disease (CKD) and is an independent risk factor for hospitalization and death before and after dialysis initiation. However, it remains an under-recognized and under-treated problem, in part due to the lack of well-controlled studies that support or refute the efficacy and safety of antidepressant medications in CKD patients. Major trials of antidepressant treatment excluded patients with stages 3-5 CKD, precisely those at higher risk for both depression and increased mortality. The Chronic Kidney Disease Antidepressant Sertraline Trial (CAST) is a randomized, double-blinded, placebo-controlled trial of sertraline, a selective serotonin reuptake inhibitor (SSRI). It will enroll 200 adults with stages 3-5 CKD and MDD excluding kidney transplant and chronic dialysis patients. Sertraline will be administered at an initial dose of 50mg once daily or matching placebo followed by a dose escalation strategy consisting of 50mg increments at 2week intervals (as tolerated) to a maximum dose of 200mg. The primary outcome is improvement in depression symptom severity measured by the Quick Inventory of Depressive Symptomatology scale. Secondary outcomes include safety endpoints and improvement in quality of life. Changes in cognitive function, adherence to medications, nutritional status, inflammation, and platelet function will be explored as potential mechanisms by which depression may mediate poor outcomes. We discuss the rationale and design of the CAST study, the largest placebo-controlled trial aimed to establish safety and efficacy of a SSRI in the acute phase treatment of CKD patients with MDD.

Religiousness, mental health, and quality of life in Brazilian dialysis patients

Patients with chronic kidney disease often use religion as a coping strategy to relieve suffering and serve as a source of strength. The aim of this study was to identify religious aspects associated with mental health and quality of life in Brazilian dialysis patients. A cross-sectional study was performed involving two dialysis centers in Brazil. Patients were selected consecutively over three typical dialysis treatment days. The questionnaire was self-administered and covered the following aspects: socio-demographic aspects, religiousness (using the Portuguese version of the Private and Social Religious Practice Scale), quality of life (World Health Organization Quality of Life brief Scale Brief Version), depression and anxiety (Beck Inventory), and pain grade. For statistical analysis, the hypothesis that different religious variables are associated (positively or negatively) with depressive/anxiety symptoms and quality of life in these patients was tested using linear regression, controlling for confounding variables. A total of 205 patients were invited to participate and 133 (64.8%) agreed to fill out the questionnaire. On the adjusted model, reading religious literature was found to be inversely associated with depressive symptoms (P < 0.001). In addition, the psychological domain of quality of life was positively associated with an increase in patient religiosity (P = 0.030) and greater religious importance for recovery from their dialysis condition (P = 0.016), whereas the environmental domain was positively associated with greater religious importance for recovery (P = 0.032). No religious aspects were associated with anxiety symptoms. Religiousness is associated with less depressive symptoms and better quality of life in Brazilian dialysis patients. Nephrologists should evaluate the patient's spirituality and religion in order to provide more integrative care.

A practical approach to the treatment of depression in patients with chronic kidney disease and end-stage renal disease

Depression is a common, under-recognized, and under-treated problem that is independently associated with increased morbidity and mortality in CKD patients. However, only a minority of CKD patients with depression are treated with antidepressant medications or nonpharmacologic therapy. Reasons for low treatment rates include a lack of properly controlled trials that support or refute efficacy and safety of various treatment regimens in CKD patients. The aim of this manuscript is to provide a comprehensive review of studies exploring depression treatment options in CKD. Observational studies as well as small trials suggest that certain serotonin-selective reuptake inhibitors may be safe to use in patients with advanced CKD and ESRD. These studies were limited by small sample sizes, lack of placebo control, and lack of formal assessment for depression diagnosis. Nonpharmacologic treatments were explored in selected ESRD samples. The most promising data were reported for frequent hemodialysis and cognitive behavioral therapy. Alternative proposed therapies include exercise training regimens, treatment of anxiety, and music therapy. Given the association of depression with cardiovascular events and mortality, and the excessive rates of cardiovascular death in CKD, it becomes imperative to not only investigate whether treatment of depression is efficacious, but also whether it would result in a reduction in morbidity and mortality in this patient population.

Depressive symptomatology in children and adolescents with chronic renal insufficiency undergoing chronic dialysis

This paper presents a descriptive study, using the Birleson Scale to determine the frequency of depressive symptomatology in children and adolescents with chronic renal insufficiency (CRI) undergoing hemodialysis (HD) and chronic peritoneal dialysis (CPD). There were 67 patients (40 female and 27 male) with a mean age of 14.76 ± 2.71 years, duration of illness ≥3 months, 43 (64.18%) patients with CPD and 24 (35.82%) undergoing HD. The frequency of high occurrence, low occurrence, and absence of depressive symptomatology was 10.45% (n = 7), 43.28% (n = 29), and 46.27% (n = 31), respectively; all of the seven (100%) patients with high occurrence of depressive symptomatology were female (P = 0.04), and none of these (0%) had a friend to confide in (P = 0.03). Depressive symptomatology in patients with CPD was associated with a lower weekly K(t)/V compared to those without depressive symptomatology (2.15 ± 0.68 versus 2.52 ± 0.65; P = 0.01). There was no association with patient age, caregiver, time and dialysis type, anemia, bone disease, nutritional or financial status, origin, schooling, or employment.

Effects of sildenafil and vardenafil on erectile dysfunction and health-related quality of life in haemodialysis patients: a prospective randomized crossover study

BACKGROUND

Erectile dysfunction (ED) is prevalent in end-stage renal disease (ESRD) and has been associated with impaired health-related quality of life (HRQoL). HRQoL, in turn, is related to morbidity and mortality in ESRD patients. Previous studies have shown improved HRQoL with ED treatment using sildenafil and vardenafil. However, no study has examined the effects of sildenafil or vardenafil on HRQoL in impotent ESRD patients. Furthermore, vardenafil has never been tested and its safety profile has not been determined in ESRD patients. The aim of this randomized crossover study was to compare the effects of sildenafil and vardenafil on measures of HRQoL and on ED scores as well as to determine the safety profile of vardenafil in ESRD patients.

METHODS

In 32 haemodialysis patients with impotence, ED and HRQoL were evaluated by the International Index of Erectile Function (IIEF-5) and the 36-item Short-Form Health (SF-36) surveys, respectively. Patients were randomized into sildenafil and vardenafil groups. After a 4-week treatment and 2-week washout periods, crossover was performed and an additional 4-week treatment was administered. IIEF-5 and SF-36 surveys were given before and after each treatment period. Adverse effects were evaluated by interview. Friedman tests and Bonferroni-adjusted Wilcoxon signed-rank tests were used to compare groups and for post hoc analysis, respectively.

RESULTS

IIEF-5 and SF-36 scores were significantly improved by both sildenafil and vardenafil compared to pretreatment values. There were no differences between sildenafil and vardenafil with respect to the studied parameters. Adverse effect profiles were also similar. No patient dropped out because of side effects.

CONCLUSIONS

Sildenafil and vardenafil caused similar improvements in ED and HRQoL in haemodialysis patients. Vardenafil was well tolerated in our patient population.

Depression in hemodialysis patients

Depression is the most frequent psychological complication of haemodialysis (HD) patients (pts) and has been associated with impaired Quality of Life (QoL). The aim of our study was to investigate the prevalence of depression in HD pts in relation to sociodemographic factors and the relationship between depression and QoL. 200 pts from Clinic for haemodialysis in Sarajevo, B&H were participating in the study. Mean age was 57.26+/-13.78 years and mean HD duration was 64.26+/-58.18 months. From the test material we applied BDI and SF-36. 51% of our pts have shown depression (BDI>11) in various degrees (30%-mild depression, 8.5%-moderate depression and 12.5%-severe depression). As we could expect, the most emphasized symptoms of depression were somatic symptoms. 55.5% of pts have shown QoL lower then average. Sociodemographic data such as gender, marital status and HD duration did not influence significantly on pt's QoL and occurrence of depression (p>0.05). As the age of the pts increased, level of depression increased too and QoL significantly decreased (p<0.05). Employed pts have shown significantly better QoL and lower level of depression in relation to unemployed pts (p<0.05). As the educational level of pts increased, QoL increased too and level of depression significantly decreased (p<0.05). Pts in 1st HD shift were significantly more depressed and have significantly worse mental health in compare to pts in 3rd HD shift (p<0.05). Our results showed a high prevalence of depressive symptoms among the study group that was linked to trend of poor QoL.

Sertraline treatment is associated with an improvement in depression and health-related quality of life in chronic peritoneal dialysis patients

OBJECTIVES

There is scarce data about effects of treatment of clinical depression in peritoneal dialysis (PD) population. We aimed to determine prevalence of depression, its association with health-related quality of life (HRQoL) and effects of sertraline treatment in PD patients.

MATERIALS AND METHODS

We included 124 PD patients who had been on PD at least for 6 months. Short Form of Medical Outcomes Study was used to evaluate HRQoL. Depression was screened by Beck Depression Inventory (BDI). Patients with a BDI score > or = 17 were deemed to have depression and were referred to a psychiatrist for evaluation via Diagnostic and Statistical Manual for Mental Disorders (DSM-IV) of diagnosis of clinical depression. About 25 patients diagnosed with clinical depression agreed to receive antidepressant treatment (Sertraline hydrochloride, 50 mg/day) for a 12-week period. After the treatment, biochemical analyses and questionnaires were repeated.

RESULTS

Thirty-two patients (25.8%) had depression. BDI score of patients were lower compared to those without depressive symptoms (23 + or - 6.7 and 9.8 + or - 3.0, respectively P < 0.001). Physical component scale (PCS) and mental component scale (MCS) domains of HRQoL were significantly decreased in patients with depression than in patients without depression (P < 0.001 for PCS and MCS). In bivariate analysis the BDI score was correlated inversely with the PCS and MCS (P < 0.001). Sertraline treatment improved BDI score of patients with depression (P < 0.001). HRQoL parameters also improved. No adverse effects requiring drug cessation was seen in the study group.

CONCLUSIONS

Treatment of depression with sertraline is associated with improvement of the HRQoL and symptoms related to depression.

[Mood disorders in patients with chronic kidney disease. Diagnosis, screening and treatment of depression]

Depression is a common co-morbid condition in patients suffering from a variety of chronic medical conditions. In spite of this, mental health of patients with chronic kidney disease is understudied. Accurate estimation of the prevalence of depressive disorders in this population is difficult due to the different definitions and assessment techniques and the overlap of depressive symptomatology with symptoms of uremia. Several potential pathways link depression and chronic kidney disease. The association between the two conditions is probably bidirectional. Consequently, treatment of mood disorders could impact medical outcome. Very little has been published about the therapeutic options for depression in patients with chronic kidney disease. Available data, however, suggest that several antidepressant medications and psychotherapeutic methods are likely to be safe and effective also in this population. In this review, which is the second of a series of reviews on this topic, we provide an overview of the literature concerning the diagnosis, screening and therapy of depressive disorders in patients with chronic kidney disease.

Health-related quality of life in CKD Patients: correlates and evolution over time

BACKGROUND AND OBJECTIVES

Very few large-scale studies have investigated the determinants of health-related quality of life (HRQOL) in chronic kidney disease (CKD) patients not on dialysis or the evolution of HRQOL over time.

DESIGN AND SETTING

A prospective evaluation was undertaken of HRQOL in a cohort of 1186 CKD patients cared for in nephrology clinics in North America. Baseline and follow-up HRQOL were evaluated using the validated Kidney Disease Quality Of Life instrument.

RESULTS

Baseline measures of HRQOL were reduced in CKD patients in proportion to the severity grade of CKD. Physical functioning score declined progressively with more advanced stages of CKD and so did the score for role-physical. Female gender and the presence of diabetes and a history of cardiovascular co-morbidities were also associated with reduced HRQOL (physical composite score: male: 41.0 +/- 10.2; female: 37.7 +/- 10.8; P < 0.0001; diabetic: 37.3 +/- 10.6; nondiabetic: 41.6 +/- 10.2; P < 0.0001; history of congestive heart failure, yes: 35.4 +/- 9.7; no: 40.3 +/- 10.6; P < 0.0001; history of myocardial infarction, yes: 36.1 +/- 10.0; no: 40.2 +/- 10.6; P < 0.0001). Anemia and beta blocker usage were also associated with lower HRQOL scores. HRQOL measures declined over time in this population. The main correlates of change over time were age, albumin level and co-existent co-morbidities.

CONCLUSIONS

These observations highlight the profound impact CKD has on HRQOL and suggest potential areas that can be targeted for therapeutic intervention.

Quality of life in hemodialysis patients: hepatitis C virus infection makes sense

PURPOSE

Hepatitis C virus (HCV) infection impairs quality of life (QOL) in patients who are not on dialysis therapy. In dialysis patients, how HCV infection affects QOL is unknown. In our study, we investigated the independent relationship between HCV infection and QOL.

METHODS

Sociodemographic and laboratory variables were recorded. Severity of depressive symptoms and QOL were assessed by Beck Depression Inventory (BDI) and Short Form-36 (SF-36), respectively.

RESULTS

Among 165 patients, 83 were anti-HCV antibody positive and 82 were anti-HCV antibody negative. Anti-HCV antibody positive patients had higher BDI scores than anti-HCV antibody negative patients (P = 0.011). Other than the social functioning subscale, all SF-36 subscales were lower in anti-HCV antibody positive patients when compared with anti-HCV negative patients. Anti-HCV antibody positive patients had lower physical (P = 0.003) and mental component summary scores (P = 0.018) than negative patients. Physical component summary score was independently associated with hemodialysis duration (P = 0.003), sleep disturbance (P = 0.046), BDI score (P = 0.027), albumin (P = 0.002), and serum hemoglobin (P < 0.0001). Physical component summary score was not associated with anti-HCV antibody positivity. Mental component summary score was independently associated with BDI score (P = 0.001), anti-HCV antibody positivity (P = 0.016), and serum hemoglobin (P < 0.0001).

CONCLUSION

HCV infection impairs QOL, especially in mental aspects, in hemodialysis patients.

Quality of life is not related with liver disease severity but with anemia, malnutrition, and depression in HCV-infected hemodialysis patients

Hepatitis C virus (HCV) infection may deteriorate quality of life. The relationship between HCV infection and quality of life in hemodialysis (HD) patients is unknown. The demographic characteristics, comorbidities, biochemical parameters, and Malnutrition-Inflammation Score (MIS) were recorded. Child-Pugh classification, Beck Depression Inventory, and SF-36 were performed. Liver histopathology was examined. Thirty-two patients (21 Child-Pugh-A, 11 Child-Pugh-B) were included. There was high-grade portal necroinflammatory activity in 14, high-grade lobular necroinflammatory activity in 26, and hepatic fibrosis in 19 patients. Three patients had cirrhosis. Patients with a high stage of liver fibrosis had lower social functioning scores than patient with a low stage of fibrosis (P= 0.011). The only correlation was between aspartate aminotransferase and the physical function subscale (r=-0.395, P= 0.025). None of the SF-36 scores differed between Child-Pugh A and B patients. Instead, most of the SF-36 subscale and summary scores were related with hemoglobin, albumin, MIS and Beck Depression Score. Quality of life in HCV-infected HD patients was independent of liver disease severity anchors, but was correlated with anemia, malnutrition, and depression.

Antidepressant treatment increases quality of life in patients with chronic renal failure

To evaluate the effect of citalopram treatment on quality of life (QoL) and depression in 141 patients with chronic renal failure (CRF), QoL was measured by means of the Short Form 36 (SF-36). Patients diagnosed with depression were treated with citalopram for eight weeks and evaluated for the effect of treatment on depressive symptoms and QoL. Thirty-four of 141 patients (24.1%) had depression and treatment with citalopram decreased Beck Depression Inventory Scores and increased the emotional role limitation and the mental health subscale scores of SF-36. This study suggests that citalopram can treat depression and improve QoL in patients with CRF.