Relation between depression, some laboratory parameters, and quality of life in hemodialysis patients

Depression is common in patients with end-stage renal disease (ESRD) and is associated with increased mortality and morbidity. Several investigators have estimated that depression occurs in about 20% to 30% of dialysis patients. The aim of this study was to investigate the relationship between depression, some laboratory parameters, and quality of life (QOL) in hemodialysis patients. Forty-three hemodialysis patients (mean age 40.5+/-15.2; M=28, F=15) were included in the study. Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), and short form with 36 (SF-36) were used for evaluation. Subsequently, patients were divided into two groups according to HAMD scores: group 1, those who had a low HAMD score (between 0 and 7), and group 2, those who had a high HAMD score (over 7). The two groups were compared in terms of anxiety scores, QOL scores, and some laboratory parameters. The group 2 patients (n=21; M= 13, F=8) had lower levels of hemoglobin than the group 1 patients (9.5+/-1.7 vs. 10.7+/- 1.4 g/dL, respectively; p<0.01). Group 2 patients also had lower SF-36 scores than group 1 patients (91.5+/-21.3 vs. 74.9+/- 13.6, respectively; p=0.03). On the contrary, the patients of group 2 had higher HAMA scores than group 1 patients (16.6+/-6.9 vs. 6.3+/-3.5, respectively; p<0.01) and CRP level (10.7+/-4.6 vs. 4.5+/-3.8, respectively; p<0.001). A significant correlation was found between depression scores and C-reactive protein (CRP) (r= 0.57, p < 0.001) and HAMA scores (r=-0.43, p<0.05). In contrast, a negative correlation was found between HAMD scores and albumin (r=-0.43, p<0.05), hemoglobin (r=-0.38, p=0.015) and SF-36 scores (r=0.39, p=0.032). These findings demonstrate that there is a relationship among high depression score, low levels of hemoglobin and albumin, high CRP level, low SF-36 score, and high anxiety score. Evaluation of psychiatric status should be part of the care provided to hemodialysis patients.     

Nutritional status in hemodialysis patients and bioimpedance vector analysis.

The goal of our study was to evaluate the nutritional status of a hemodialysis population through bioimpedance vector analysis (BIVA) and compare the obtained results with conventional clinical laboratory indexes, the validity of which are still a subject of controversy. Eighty adult white hemodialysis patients were enrolled in the study. Their nutritional status was estimated through their body mass index, the percentage deviation of the real body weight to ideal body weight (DeltaP%), Kt/V, normalized protein catabolic rate (nPCR), serum albumin, and BIVA. The incidence of malnutrition was different according to the parameter considered. The logistic regression analysis between the BIVA score and the other nutritional parameters showed that albumin and nPCR can be considered as independent factors able to influence BIVA, with statistical significance. This affects patients with normal values of other nutritional indexes, but fades out when considering patients with low nutritional values. Therefore, nPCR and albumin influence the BIVA determination of the examined population, but this influence affects patients with normal nutritional indexes and disappears when we consider undernourished patients. In conclusion, our results show that hypoalbuminemia, inadequate protein intake, a low Kt/V, a high DeltaP%, or a low body mass index cannot be considered as reliable markers for malnutrition.     

Association between serum bicarbonate and pH with depression,cognition and sleep quality in hemodialysis patients

Abstract

Metabolic acidosis is a common feature in chronic renal failure patients, worsening progressively as renal function declines. There are conflicting data in hemodialysis (HD) patients with regard to acidosis, alkalosis and mortality. In HD patients, cognitive impairment, depression, sleep disorders and impaired quality of life are very common. Besides, these conditions are related with increased morbidity and mortality. However, no previous study investigated the relationship between pH, venous bicarbonate and anion gap with depression, sleep problems and cognitive function in HD patients. In this study we investigated these relationships. In total, 65 HD patients were included. The demographic parameters and laboratory parameters including bicarbonate, pH and anion gap was measured for all patients. Depressive symptoms, sleep quality and cognitive function, were measured by Beck depression inventory, The Pittsburgh Sleep Quality Index and by Mini Mental State Examination, respectively. We found that, sleep quality but not cognitive function or depression was independently related with venous pH and bicarbonate. Anion gap has no independent relationship with sleep quality, cognitive function and depression. In conclusion, metabolic acidosis and bicarbonate levels were independently related with sleep quality in HD patients. However, there was no association between metabolic acidosis and bicarbonate levels with cognitive function and depression.     

血液透析患者睡眠状况调查

匹兹堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)作为各类人群近1个月睡眠质量的综合评估,已被广泛应用.我们分析了血液透析患者匹兹堡睡眠质量指数的特征,并与同期常规体检者进行比较.一、对象与方法1.对象:选择2004年5月至2010年5月在本院行血液透析3次以上患者136例为观察组,男85例,女51例,年龄(55.12±11.34)岁;初中以下文化程度52例,高中以上文化程度84例;居住在农村59例,居住在城镇77例.     

Effects of regular exercise on anxiety,depression, and quality of life in maintenance hemodialysis patients

BACKGROUND: Psychological problems such as depression and anxiety are common in hemodialysis patients. In several studies, exercise programs were effective in relieving depression or anxiety in these patients, although not all agree. PURPOSE: In this study, we evaluated the effects of an exercise program on exercise capacity, anxiety, depression and quality of life in maintenance hemodialysis patients. METHODS: Twenty hemodialysis patients were enrolled in the study. Six patients were later excluded; two due to anemia, one due to nausea with vomiting during exercise, one due to a neurologic problem, and the other two due to noncompliance. Thus, fourteen patients, 3 men and 11 women, aged 42 +/- 10 years, completed the study. The exercise program composed of bicycle ergometer, treadmill or upper limb ergometer, 60 min per session, 3 times per week, for 12 weeks. At the beginning and the end of the exercise program, the exercise capacity was determined by measuring the maximal oxygen consumption and exercise duration. In addition, psychological tests for the assessment of depression, anxiety and quality of life were performed. RESULTS: Maximal oxygen consumption was increased from 26.3 +/- 4.6 mL/kg/min to 29.8 +/- 4.9 mL/kg/min (p = 0.013). Exercise duration was 483 +/- 138 s at the start. At the end of the exercise program it was increased to 607 +/-119s (p = 0.002). The score of anxiety was significantly improved from 47.9 +/- 5.9 to 42.8 +/- 6.3 after exercise (p = 0.004). Though it did not reach statistical significance there was a trend of improvement in depression (from 44.8 +/- 8.4 to 39.7 +/- 6.4, p = 0.073). The score of quality of life also showed a significant improvement (from 124.5 +/- 16.5 to 133.6 +/- 19.3, p = 0.031). CONCLUSION: The results of this study indicate that an appropriate application of exercise program would improve the psychological status in long-term maintenance hemodialysis patients.     

Nutritional status and quality of life following gastrectomy

The nutritional status of 18 patients after total gastrectomy was recorded by anthropometric measures, serum protein and immunological investigations. 15 patients underwent gastrectomy due to carcinoma, the others due to benign diseases. Those patients with carcinoma had been free of signs of malignancy for at least 6 months. According to the elected criteria no patient had a normal nutritional status, there were slight to moderate disturbances of the protein metabolism. By mass reduction the body of the gastrectomised patients had adapted to the decreased intake of protein and calories. In this way the body reaches a new balance and remains efficient. The quality of life of most gastroectomised patients is satisfactory. It depends on the incidence of alimentary complaints and the ability of intake of sufficient food. On the basis of these results there are no serious arguments against Graham's oesophagojejunostomy.     

Nutritional profile and inflammatory status of hemodialysis patients

BACKGROUND: Malnutrition and abnormal inflammatory markers are prominent features of the uremic syndrome, but associations and repercussions are somewhat controversial. OBJECTIVE: To determine nutritional and clinical profile of hemodialysis patients, aiming at potential diagnostic recommendations for stable subjects with elevated C-reactive protein. MATERIAL AND METHOD: Design: Prospective observational cross-sectional clinical study in a stable chronic hemodialysis population; Setting: Renal and Nutritional Service of a mid-size charity academic hospital; Patients: Subjects (n=44) were analyzed concerning nutritional status and C-reactive protein. Some displayed acute infections (Group I, n=9) and others did not (Group II, n=35). Age was 47.0 +/- 16.9 years with 63.6% males. Body mass index (BMI) was 22.2 +/- 3.9 kg/m2, calorie intake was 1262 +/- 601 kcal/day (20.7 +/- 6.7 kcal/kg/day), and protein ingestion was 74.3 +/- 16.6 g protein/day (1.2 g/kg/day); Intervention: No nutritional supplement or artificial modality of alimentation was employed in this series; Main outcome measures: Subjective global assessment and C-reactive protein. RESULTS: Malnutrition estimated by subjective global assessment (SGA) was very common (>90%), despite acceptable BMI and serum albumin. C-reactive protein was moderately elevated in 40.9% and was positively associated with SGA and negatively with plasma proteins. Comorbidities were associated positively with extracellular water and negatively with reactance (bioimpedance). When infected versus non-infected cases were analyzed, 100% of the former displayed high CRP concentrations in contrast with 22.9% of remaining patients. CONCLUSIONS: (1) Malnutrition profile was rather unique, with relatively favorable objective findings (body mass index, serum albumin) and more deranged SGA; (2) Bioimpedance analysis suggested that phase angle could be used as an indicator of nutritional status; (3) Creactive protein was negatively associated with plasma proteins; (4) Infected subjects, although few and displaying moderate clinical troubles, were responsible for most C-reactive protein determinations above 8 mg/L; (5) Investigation of occult infectious foci is advised in these circumstances.     

The relationship between breakfast, lunch and dinner eating pattern and hemodialysis sessions, quality of life, depression and appetite in hemodialysis patients

Objective

To evaluate the relationship between eating pattern (regular breakfast, lunch and dinner) and dialysis sessions, laboratory and sociodemographic characteristics in hemodialysis (HD) patients.

Materials and Methods

In this cross-sectional study eating patterns, sociodemographic, laboratory and clinical parameters, depressive symptoms, quality of life, cognitive function and appetite status were assessed.

Results

Eighty-two HD patients on morning session and 60 patients on midday HD session schedules were included. Ten patients had only breakfast, 17 patients had only lunch, 26 patients had only dinner, 5 patients had breakfast and lunch but not dinner, 28 patients had breakfast and dinner but not lunch, 29 patients had lunch and dinner but not breakfast, and 19 patients had neither breakfast, nor lunch, nor dinner. In the whole group, only 8 patients reported that they had regularly eaten breakfast, lunch or dinner in all days of the week. Midday HD session, better appetite, and higher income were independently associated with having breakfast. Morning HD session, better appetite score, and higher income were independently associated with having lunch. Morning session versus midday session, nPNA, presence of hypertension, and the Mental Component Summary Score of SF-36 were independently associated with having dinner.

Conclusion

The majority of HD patients eat one or two meals per day. Having breakfast (or lunch) is associated with midday dialysis session (or morning dialysis session, respectively), better appetite, and satisfactory income. Eating dinner was associated with morning dialysis session, hypertension, higher protein intake and higher SF-36 mental component summary score.     

Nutritional status of patients on hemodialysis and peritoneal dialysis

In a cross-sectional study, the nutritional status of 32 patients on hemodialysis (HD) and 16 patients on peritoneal dialysis (CAPD) was determined. Protein-caloric malnourishment assessed from a score system based on triceps skin-fold, midarm muscle circumference, S-transferrin and relative body weight was recorded in 54% of the patients. No significant differences between the nutritional status of HD and CAPD patients were found. Malnutrition was more frequent among patients in early stage dialysis (i.e., dialysis for less than 12 months) than among other patients (p less than 0.02). Frequent assessment of the nutritional status is mandatory for optimal nourishment.     

维持性血液透析患者营养状况及其影响因素分析

目的 观察分析维持性血液透析(maintenance hemodialysis,MHD)患者营养状况及其影响因素,提出相应的防治对策.方法 选取本中心MHD患者103例,采用改良定量主观整体评估表进行营养状况评估,将患者分为营养正常组(评分≤10分)和营养不良组(评分＞10分),分析影响MHD患者营养不良的相关因素.结果 103例MHD患者中,营养正常组59例,营养不良组44例,营养不良发生率为42.72％.多因素Logistic回归分析结果显示:增龄[95％CI(1.004,1.072),P=0.027]、糖尿病[95％ CI(1.113,16.143),P=0.034]、肾病营养知识知晓率低[95％ CI(1.253,12.531),P=0.019]为MHD患者发生营养不良的危险因素.结论 MHD患者营养不良发生率高,年龄、糖尿病、肾病营养知识知晓率与患者发生营养不良有关.临床工作中应采取有效合理的干预方法加强营养,改善患者营养状况.     

Nutritional status in short daily hemodialysis versus conventional hemodialysis patients in China

Purpose

Malnutrition is the main determinant of mortality and morbidity in maintenance hemodialysis patients. In many countries except for China, it has been reported that short daily hemodialysis (SDHD) could improve nutritional status. We will report here the nutritional results obtained in the SDHD therapy period compared with conventional hemodialysis (cHD) therapy period in Chinese patients.

Methods

This study compared 29 SDHD patients (SDHD group), each patient served as his own control, with 30 cHD patients (cHD group) serving as the parallel controls. The hematologic parameters, anthropometric measurements, modified quantitative subjective global assessment (MQSGA) score, weekly standard Kt/V (std Kt/V) and average daily intake of protein were measured at baseline (SDHD₀ or cHD₀ period), at 3 months (SDHD₁ or cHD₁ period) and at 6 months (SDHD₂ or cHD₂ period).

Results

The average daily intake of protein, dry weight, body mass index, mid-arm circumference, mid-arm muscle circumference, serum albumin, prealbumin, cholesterol, hemoglobin, weekly std Kt/V values at SDHD₂ were higher than the corresponding values at SDHD₀ (p < 0.05, p < 0.05, p < 0.001, p < 0.05, p < 0.05, p < 0.05, p < 0.001, p < 0.05, p < 0.05, p < 0.001 and p < 0.001, respectively). Meanwhile, the average daily intake of protein, serum albumin, prealbumin, cholesterol, hemoglobin, weekly std Kt/V values at SDHD₂ were higher than the corresponding values at cHD₂ (p < 0.05, p < 0.001, p < 0.05, p < 0.05, p < 0.001 and p < 0.001, respectively), whereas the MQSGA score at SDHD₂ was lower than the score at SDHD₀ and cHD₀ (p < 0.05, respectively).

Conclusions

SDHD may improve the nutritional status compared with cHD in Chinese patients undergoing maintenance hemodialysis.

     

Nutritional status in hemodialysis patients: options for on-line convective treatment.

Although hemodialysis (HD) has improved the life expectancy of patients with end-stage renal disease (ESRD), uremic patients continue to experience high morbidity and mortality. Two of the most important risk factors for morbidity and mortality are protein-energy malnutrition (PEM) and inflammation. The causes for PEM in ESRD are numerous. The use of materials for dialysis, especially of the dialyzer membrane, is reported as one of the recognized causes for chronic inflammation in hemodialysis. We performed a 6-month prospective study examining the influence of on-line predilution hemodiafiltration on the inflammatory and nutritional status in a population of male hemodialysis patients using ultrapure dialysis fluid and polyamide dialyzers. We evaluated serum C-reactive protein, albumin, and transferrin and some nutritional parameters such as body mass index (BMI), phase angle (phi), fatty mass (FM), and free fatty mass (FFM) using bioelectrical impedance (BIA). Results showed significant amelioration of BMI and the re-equilibrium of the acute phase protein after on-line predilution hemodiafiltration. These results support the hypothesis that on-line predilution hemodiafiltration, as convective extracorporeal treatment, may be used to treat malnourished hemodialysis patients and to prevent malnutrition in the ESRD patient at risk for malnutrition.     

Effects of sildenafil and vardenafil treatments on sleep quality and depression in hemodialysis patients with erectile dysfunction

ED is prevalent in hemodialysis (HD) patients, and closely related to poor sleep and depression. Efficacy of treating ED either with sildenafil or vardenafil has been shown to be beneficial in ameliorating concomitant depression in non-HD patients. It is yet to be shown whether treatment of ED with a PDE-5 inhibitor would improve poor sleep in HD patients. We aimed to compare the effects of sildenafil and vardenafil on sleep quality and depression in HD patients with ED. A total of 32 maintenance HD patients with ED randomized into two groups to receive either sildenafil or vardenafil for 4 weeks. After a 2-week washout and a crossover, each group received the other drug for another 4-week period. Sleep quality and depression were evaluated via post-sleep inventory (PSI) and Beck's depression inventory (BDI), respectively, at baseline and at the end of the treatment. Sildenafil and vardenafil both improved PSI and BDI scores significantly compared with pretreatment values. However, there was no difference between sildenafil and vardenafil with respect to these parameters. PDE-5 inhibitors, sildenafil and vardenafil, caused a significant improvement in sleep quality and depression in this cohort of HD patients with ED.     

宫颈癌患者焦虑抑郁状况与生活质量相关性的研究

目的:本研究旨在了解宫颈癌患者的心理状况及生活质量,探讨宫颈癌患者焦虑抑郁状况与生活质量关系。方法:本研究通过一般人口特征量表、Zung抑郁自评量表(SDS)、Zung焦虑自评量表(SAS)及宫颈癌患者生活质量测评量表FACT-C问卷调查以了解宫颈癌患者与正常健康人心理状况和生活质量及相关的影响因素。结果:观察组的SDS与SAS评分都高于对照组(P<0.05)。观察组生活质量各维度得分都明显高于对照组(P<0.05)。观察组的生活质量情况得分与焦虑抑郁评分呈负相关(P相似文献   

Effect of high-flux hemodialysis on quality of life and neuropsychological function in chronic hemodialysis patients.

The objective was to evaluate the effect of high-flux hemodialysis on quality of life, intra- and interdialytic symptoms and neuropsychological function. The study was double-blind single cross-over with random allocation to order of treatment. The patients were stable adult hospital hemodialysis patients. Both the conventional and high-flux membranes were cellulose acetate, the dialysate was bicarbonate, and dialysate sodium was held constant. The high-flux membrane had an ultrafiltration rate of 15 ml/h/mm Hg transmembrane pressure, a B12 clearance of 88 ml/min and a beta 2-microglobulin clearance of 11.4 ml/min. The values of the conventional membrane were 3.5-5.0, 34-45 and negligible. Each treatment period was 4 months. Twenty-two patients completed both phases of the cross-over. The KT/V value was higher during high-flux than conventional treatment; 1.42 versus 1.27(p < 0.05). There were no differences between high-flux and conventional treatment with respect to quality of life. Symptoms during dialysis were less severe during high-flux than conventional treatment for 12/14 items. Only 3 items reached statistical significance (0.05 > p > 0.01) and none were clinically significant. Symptoms between dialyses were less severe during high-flux than conventional treatment for 18/20 items. No single item had a statistically significant improvement but 3 had clinically important improvement. Among the 23 neuropsychological variables, none demonstrated statistically significant changes.     

Quality of sleep and health-related quality of life in haemodialysis patients.

BACKGROUND: Sleep complaints are common in haemodialysis patients. In the general population, insomnia impacts negatively on health-related quality of life (HRQoL). The objective of this study was to examine the association between quality of sleep and HRQoL in haemodialysis patients independent of known predictors of HRQoL. METHODS: Quality of sleep was measured using the Pittsburgh Sleep Quality Index (PSQI) and HRQoL was measured using the Medical Outcomes Study 36-item Short Form (SF-36) in 89 haemodialysis patients. RESULTS: Sixty-three (71%) subjects were 'poor sleepers' (global PSQI >5). The SF-36 mental component summary (MCS) and physical component summary (PCS) correlated inversely with the global PSQI score (MCS, r = -0.28, P < 0.01; PCS, r = -0.45, P < 0.01). The PCS score also correlated with age (r = -0.24, P = 0.02), haemoglobin (r = 0.21, P = 0.048) and comorbidity (r = -0.40, P < 0.01), and mean PCS was lower in depressed subjects (26.2 vs 35.9, P = 0.02). Subjects with global PSQI >5 had a higher prevalence of depression, lower haemoglobin and lower HRQoL in all SF-36 domains. The global PSQI score was a significant independent predictor of the MCS and PCS after controlling for age, sex, haemoglobin, serum albumin, comorbidity and depression in multivariate analysis. CONCLUSIONS: Poor sleep is common in dialysis patients and is associated with lower HRQoL. We hypothesize that end-stage renal disease directly influences quality of sleep, which in turn impacts on HRQoL.