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. 15 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. 16