Biochemical and Sociodemographic Correlates of Major Depressive Disorder in Patients With Chronic Kidney Disease Receiving Hemodialysis

Abstract

Introduction Chronic kidney disease (CKD) is a chronic disabling illness with multiple physical and psychosocial consequences. A major treatment modality for CKD is renal replacement therapy in the form of hemodialysis. A bidirectional relationship between depression and CKD is proposed, as depressive symptoms lead to poorer outcomes in CKD and vice versa. This study aimed to determine the prevalence of major depressive disorder (MDD) in CKD patients on maintenance hemodialysis and find any sociodemographic, clinical, or biochemical correlates. Material and methods This was a cross-sectional study conducted at a tertiary care teaching hospital in north India. We used clinical interviews for diagnosing MDD according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The severity was quantified using Hamilton Depression Rating Scale (HAM-D) in those diagnosed with MDD.  Results A total of 77 patients were included in the study. The prevalence of MDD in patients with CKD undergoing hemodialysis was 31.17%, much higher than in the general population. Most of those who were depressed had moderate to severe depression. Male gender and lower socioeconomic status were significantly associated with the diagnosis of MDD. Those undergoing dialysis less frequently or having more work days lost due to CKD were more likely to be depressed. Additionally, patients with MDD were found to have significantly lower blood hemoglobin levels, lower serum ionized calcium levels, and a lower urea reduction ratio compared to those who did not have MDD. Conclusion The high prevalence of MDD in patients with CKD undergoing hemodialysis suggests that clinicians should actively evaluate for depressive symptoms in this patient population and refer them to mental health services when required, especially those with the above-identified sociodemographic and biochemical risk factors.