The Burden of Depression Among Patients With End Stage Renal Disease Undergoing Hemodialysis at Kenyatta National Hospital, Nairobi Hospital, and Parklands Kidney Center
Abstract
BACKGROUND
Depression is the commonest psychological disorder in end stage renal disease (ESRD). The
presence of depression has been linked with high rates of morbidity and mortality, as well as
having an impact on the quality of life. Early diagnosis and treatment of depression in chronic
kidney disease (CKD) improves disease outcome. This study sought to assess the prevalence
and determinants of depression in patients with ESRD undergoing haemodialysis (HD).
OBJECTIVES
The main objective of this study was to determine the prevalence of depression in ESRD
patients undergoing maintenance HD at the Kenyatta national hospital (KNH), Nairobi
hospital (NH), and Parklands kidney centre (PKC). The secondary objective was to assess
selected determinants of depression amongst this population of patients undergoing
maintenance HD.
METHODOLOGY
This was a cross sectional descriptive study carried out at the renal units in KNH, NH and
Parklands kidney centre over a period of 2 months. The study population comprised adults
aged 18 years and above undergoing maintenance HD at the renal units in KNH, NH and
PKC. Patients who met the inclusion criteria and gave written informed consent were
enrolled in the study. A study pro forma was used to collect socio demographic data and
cardiovascular diseases history coronary artery disease (CAD), cerebrovascular accident
(CVA), peripheral arterial disease (PAD). The patient health questionnaire 9 (PHQ - 9) was
used to establish presence and severity of depression among participants. The
multidimensional scale of perceived social support (MSPSS) was used to assess the level of
social support among the study participants.
DATA MANAGEMENT AND ANALYSIS
The prevalence of depression was calculated as a proportion of patients with any degree of
depression and expressed as a percentage. The chi- square test was used to determine the
association between presence of depression, and selected determinants. All analyses were
conducted using SPSS version 21.0 Chicago Illinois.
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RESULTS
This study involved 170 patients undergoing maintenance HD with a mean age of 56.44
±13.5 years and a sex ratio (M: F) of 1.2:1. The prevalence of depression was 32.4%, mild
depression 24.14%, moderate 7.06% and severe 1.17%. High social support was present for
74.12% of subject who participated, while 23.53% and 2.35% had moderate and low social
support respectively. Age (18 - 29 years, p = 0.005), lack of any formal education (p =
0.048), retirement from formal employment (p = 0.036) and lack of social support (p = 0.001)
were significantly associated with depression.
CONCLUSION
A substantial proportion of subjects undergoing HD have concomitant depression. The vast
majority of these subjects have mild depression. Factors that increased the risk of depression
were aged (18 - 29 years), lack of formal education, retirement from formal employment and
lack of social support.
The findings of this study highlight the extent to which depression is under recognised and
suggest the need for active screening. Carrying out of validated questionnaires to assess for
the presence of depression in patients initiating HD may be helpful in early recognition. The
quality of life and clinical outcomes in patients diagnosed with ESRD undergoing HD can be
greatly improved by early diagnosis and treatment.
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Publisher
University of Nairobi
Rights
Attribution-NonCommercial-NoDerivs 3.0 United StatesUsage Rights
http://creativecommons.org/licenses/by-nc-nd/3.0/us/Collections
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