Depression in Patients Receiving Peritoneal Dialysis

Article excerpt

Abstract

Objectives: To identify the prevalence and correlates of depression among Chinese peritoneal dialysis patients.

Methods: In this cross-sectional study, from October 2007 to June 2008, 141 peritoneal dialysis patients were recruited from a local renal clinic. All participants were interviewed by the first author using the Chinese bilingual version of the Structured Clinical Interview for DSM-IV (Axis I) to identify patients suffering from major depressive disorders and psychiatric illnesses associated with elevated depressive symptoms. Socio-demographic and clinical data were collected. Co-morbid medical illnesses and perceived social support were assessed by standardised questionnaires, namely: the Cumulative Illness Rating Scale, and the Chinese version of Multidimensional Scale of Perceived Social Support (MSPSSC).

Results: The point prevalence of a current major depressive episode was 16%; another 21% had had at least 1 past episode of major depression. Low MSPSS-C score, muscle cramps, chronic back pain, joint stiffness, and receipt of Social Security Allowance were independent correlates of elevated depressive symptoms.

Conclusions: The prevalence of depression was higher in Chinese patients receiving peritoneal dialysis. Independent correlates are useful to help physicians identify patients suffering from depressive disorders in busy renal clinics.

Key words: Depression; Peritoneal dialysis; Prevalence

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Introduction

End-stage renal disease (ESRD) is a chronic condition in which the kidneys can no longer regulate electrolytes and acid-base balance, and excrete waste products at a level necessary for day-to-day life.1 In 2005 the incidence of dialysis-dependent ESRD in Hong Kong was 173 per million inhabitants, while the prevalence of ESRD was 965 per million.2 The Hospital Authority of Hong Kong provides treatment for 95% of these dialysis patients. About 81% of them receive peritoneal dialysis (PD) and the rest receive haemodialysis (HD). Although PD is a life-saving treatment, it is only a partial replacement for the excretory function of the kidneys. Patients are faced with complicated and demanding treatment regimens, which include dietary and fluid restrictions, together with complex medication schedules. Prolonged survival in patients with ESRD is associated with various functional impairments in almost all body systems. These lead to negative effects on quality of life.3 Epidemiological and clinical studies worldwide have revealed a higher prevalence of depression in PD patients than in the general population.4-6 It is important to identify depression in these patients because it is associated with impaired quality of life as well as reduced survival.7 Yet in this group, depression is commonly unrecognised and underdiagnosed.8 Moreover, there has been no local study examining the prevalence of depression in PD patients by standardised psychiatric interview. This study therefore aimed to explore the prevalence of depression among local Chinese patients receiving PD and investigate the corresponding correlates of depression.

Literature Review

Little data are available for the prevalence of depression, specifically in patients receiving PD. Most studies focused on the point prevalence of depression in ESRD patients receiving various types of renal replacement therapy. A recent systematic review of 60 such studies indicated that the prevalence of depression varied widely from 5% to 58%, with an average of 27%.9 The disparity in reported prevalence rates may be partially explained by the difference in instruments used to detect depression. It is also important to distinguish between the diagnosis of major depressive disorder and the symptoms of depression or a high level of depressive affect. In a study in the United States, about half of the dialysis patients were categorised as depressed using the Beck Depression Inventory (BDI), compared with 17% using the Multiple Affect Adjective Check List, but only in 5% of those sampled by clinical interview using the DSM-III criteria. …