FP711A MULTICENTRIC STUDY OF THE RELATIONSHIP BETWEEN DEPRESSION AND QUALITY OF SLEEP IN HEMODIALYSIS PATIENTS

Abstract

INTRODUCTION: End-stage renal disease patients are viewed as highly susceptible to psychological disturbances because of the chronic stress related to disease burden, dietary restrictions, functional limitations, adverse effects of medications, comorbidities and fear of death. Still, such conditions often remain under-recognized because of a strong overlap with uremic symptoms and the fact that not all patients clearly manifest full clinical picture. The purpose of this study was to assess the prevalence of depression and poor quality of sleep in hemodialysis (HD) patients and to investigate associations between these disorders and demographic, dialysis-related and clinical characteristics of these patients. METHOD(S): This cross-sectional multicentric study included 372 (215 males and 157 females, age range 20 - 85 years, time on dialysis 6 - 324 months) randomly selected individuals who fulfilled inclusion criteria out of 400 HD patients from five HD centers. Standard blood analyses and Kt/V were determined in all patients. Depression and sleep quality were assessed by the self-administered Beck Depression Inventory and Pittsburgh Sleep Quality Index questionnaires respectively. Other relevant demographic and clinical data were obtained from patients' medical records. The results were analyzed with independent sample T test, the chi 2 statistic and Pearson correlation test. RESULT(S): The average BDI was 14.58+/-10.86 (range 0 - 52), and average PSQI 7.44+/-4.43 (range 0 -19). Nearly half of the patients (42.7%) had depressive symptoms (BDI >=14) and almost two thirds (63.7%) had poor sleep quality (PSQI >=5). Poor sleep quality was significantly more prevalent in females (p=0.009) and unemployed patients (p=0.002). Patients with poor sleep quality had significantly higher serum calcium (2.27+/-0.20 vs 2.20+/-0.18 mmol/L, p=0.014) and lower urea and creatinine (22.95+/-5.26 vs 25.16+/-5.85 mmol/L, p=0.008 and 825.40+/-208.84 vs 888.10+/-195.33 umol/L, p=0.034 respectively) levels. Patient with inadequate HD (Kt/V<1.20) more often had depressive symptoms (p=0.024). Patients with depressive symptoms had significantly lower potassium (5.23+/-0.95 vs 5.49+/-0.88 mmol/L, p=0.041), urea (22.86+/-5.40 vs 24.60+/-5.61 mmol/L, p=0.030) and creatinine (800.98+/-204.89, vs 891.31+/-197.86 p=0.002) levels. No statistically significant differences were found in the prevalence of neither poor sleep quality nor depression in relation to age, marital status, smoking habit, underlying renal disease, diabetes, hepatitis B or C, dialysis modality, dialysis shift or type of vascular access. A significant positive correlation was found between PSQI and BDI (r=0.554, p<0.001). CONCLUSION(S): Both depressive symptoms and poor sleep quality are highly prevalent and interrelated in maintenance HD patients.