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

Abstract

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.