Depression in dialysis patients

Abstract

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.

Depressive Symptoms in Dialysis: Prevalence and Relationship with Uremia-Related Biochemical Parameters

“…Moreover, depression is a known independent risk factor for mortality, morbidity and hospitalization in CKD and dialysis [17][18]. Therefore, we face the paradox of a very common and clinically relevant disorder among dialysis patients but that which is still underdiagnosed and undertreated [19][20]. The meta-analysis of Palmer et al [4] confirms the estimated high prevalence of depression in patients with CKD and highlights that it varies according to the stage of CKD and the tools used for diagnosis.…”

Self‐cannulation of the vascular access in home hemodialysis: Overcoming patient‐level barriers

“…In addition, patients diagnosed with chronic illness commonly experience adjustment reactions or depression as the patient is under considerable stress and must F I G U R E 1 Arteriovenous access mapping can help demonstrate the course of the venous system to the patient and be used as a cannulation guide [Color figure can be viewed at wileyonlinelibrary.com] contemplate new limitations and life-style changes. 20 Patients are required to make treatment care decisions but may feel they are not prepared to do so or initially are unable participate in care.…”

Long-term bicycle riding ameliorates the depression of the patients undergoing hemodialysis by affecting the levels of interleukin-6 and interleukin-18

“…Depression is one of the main symptoms in patients receiving hemodialysis 1,2. This disease is characterized by pervasive feelings of sadness,3,4 irritation,5,6 low self-esteem7 and poor sleep,8,9 which directly affect the quality of life of the patients; especially, anxiety and depression feelings are mental problems.…”