Depressive symptoms, frailty, and mortality among dialysis patients

Abstract

Introduction: Frailty and depression are highly prevalent in the dialysis population, but the association between them, the risk factors for their development, and their independent associations with mortality have not been studied. Methods: We examined 771 patients enrolled in the ACTIVE/ADIPOSE prevalent dialysis cohort study. Fried’s frailty phenotype and the Center for Epidemiologic Studies Depression score were used to determine frailty and presence of depressive symptoms, respectively. We assessed the baseline association between frailty and depressive symptoms, whether one entity is a risk factor for development of the other, and associations between frailty and depressive symptoms with mortality. Findings: At baseline, 13.1% of our population screened positive for depressive symptoms, 21.8% met criteria for frailty, and 10.0% met criteria for both. During follow-up, 26.6% of our population developed frailty and 12.7% developed depressive symptoms. Using multivariable logistic regression, baseline depressive symptoms were associated with 2.14-fold higher odds of being frail at baseline (95% confidence interval [CI] 1.45–3.17) and with a 2.16-fold higher odds of incident frailty during follow-up (95% CI 1.22–3.82). However, baseline frailty was not associated with incident depressive symptoms. Frailty and depressive symptoms were independent predictors of mortality in time-varying survival analysis (meeting frailty criteria: hazard ratio [HR] 1.53, 95% CI 1.05–2.23; depressive symptoms: HR 2.21,95% CI 1.50–3.25). Discussion: Frailty and depressive symptoms remained highly prevalent over time and were strongly associated with one another and independently associated with mortality among dialysis patients. Future studies should investigate whether interventions for depression could potentially mitigate the appearance of frailty and its associated poor outcomes.

The Burden of Frailty on Mood, Cognition, Quality of Life, and Level of Independence in Patients on Hemodialysis: Regina Hemodialysis Frailty Study

“…28-30 The prevalence of depression in our study was 53% which is similar to Jaber et al 31 but higher than other studies. 22 There is a growing body of evidence that depression is associated with poor outcomes such as post dialysis fatigue, higher mortality, and hospitalizations. There was a substantial overlap among frailty, cognition, and depression.…”

Frailty, Quality of Life, Anxiety, and Other Factors Affecting Adherence to Physical Activity Recommendations by Hemodialysis Patients

“…Our study appears to be the first to demonstrate the effect of frailty on adherence to recommendations in hemodialysis patients, also of younger age. Depending on assessment method, several authors reported frailty was three- to tenfold more common in hemodialysis patients compared to older subjects with normal renal function [5,17,22,51,52]. Since low physical activity is a criterion in frailty definition [53], interventions leading to increased physical activity might reduce or reverse frailty status, both directly and indirectly, provided they improve physical fitness or reduce the symptoms of fatigue and exhaustion [54].…”

Neuropsychiatric Disorders in Chronic Kidney Disease

“…At baseline, 13.1% of individuals presented depressive symptoms based on the Center for Epidemiologic Studies Depression scale, 21.8% had frailty, and 10.0% met criteria for both. After 2 years of follow-up, 26.6% of CKD patients had frailty, and 12.7% exhibited depressive symptoms, and depressive symptoms and frailty were independent predictors of mortality (Sy et al, 2019).…”