Association of depression with malnutrition in hemodialysis patients
Subject Areas :Mohsen Taghavi 1 , Seyyed Ali Keshavarz 2 , Alireza Hoveyda 3 , Asal Ataie-Jafari 4
1 - Department of Nutrition, Science and Research Branch, Islamic Azad University, Tehran, Iran
2 - Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
3 - Department of Nutrition, Science and Research Branch, Islamic Azad University, Tehran, Iran
4 - Department of Nutrition, Science and Research Branch, Islamic Azad University, Tehran, Iran
Keywords: depression, Malnutrition, Hemodialysis, Malnutrition-Inflammation Scor, Subjective Global Assessment, Dialysis-Malnutrition Score,
Abstract :
Chronic renal failure (CKD) is a progressive and irreversible disease that in the final stages (ESRD), the person forever needs kidney replacement therapy such as hemodialysis. Protein-energy malnutrition is very common among hemodialysis patients and depression is also very common in these patients. This study was designed to determine the relationship between depression and malnutrition in patients undergoing hemodialysis. In this study, the Depression, Anxiety and Stress Scale- 21 Items (DASS-21) questionnaire was used to determine depression and Subjective Global Assessment (SGA), Malnutrition Inflammation Score (MIS), and Dialysis Malnutrition Score (DMS) questionnaires were used to determine malnutrition. Demographic, anthropometric, biochemical, and clinical indicators were also examined. The study involved 100 patients (59 men and 41 women). The mean age of participants was 62.12 ± 13.22. According to the DASS-21 questionnaire, 59% of patients had depression. Also, 23%, 25%, and 23% of patients were malnourished based on the results of SGA, MIS, and DMS questionnaires. There was no statistically significant relationship between depression and malnutrition. Also, the relation between depression and most demographic, anthropometric, biochemical, and clinical variables was not significant. But there was a significant relationship between depression and the duration of hemodialysis in men (r =-0.29, p=0.02) and serum level of TIBC in all participants (r =-0.21, p=0.03). In this study, depression was not associated with malnutrition. Further studies are needed to determine this relationship.
1. Mehrotra R, Kopple JD. Nutritional management of maintenance dialysis patients: Why aren’t we doing better? Annual Review of Nutrition. 2001;21(1):343–79.
2. Sohrabi Z, Eftekhari MH, Eskandari MH, Rezaeianzadeh A, Sagheb MM. Malnutrition-inflammation score and quality of life in hemodialysis patients: Is there any correlation? Nephro-Urology Monthly. 2015;15;7(3). e27445.
3. Mushi L, Marschall P, Fleßa S. The cost of dialysis in low and middle-income countries: A systematic review. Vol. 15, BMC Health Services Research. BioMed Central Ltd.; 2015.
4. Kopple JD. McCollum Award Lecture, Protein-energy malnutrition in maintenance dialysis patients. American Journal of Clinical Nutrition. American Society for Nutrition; 1997; 65:1544–57.
5. Harvinder GS, Swee WCS, Karupaiah T, Sahathevan S, Chinna K, Ahmad G, et al. Dialysis malnutrition and malnutrition inflammation scores: Screening tools for prediction of dialysis - related protein-energy wasting in Malaysia. Asia Pacific Journal of Clinical Nutrition. 2016; 1;25(1):26–33.
6. Fouque D, Kalantar-Zadeh K, Kopple J, Cano N, Chauveau P, Cuppari L, et al. A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease. In: Kidney International. Nature Publishing Group; 2008; 391–8.
7. Marcen R, Teruel JL, de la Cal MA, Gamez C. The impact of malnutrition in morbidity and mortality in stable haemodialysis patients. Spanish cooperative study of nutrition in Hemodialysis. Nephrology Dialysis Transplantation. 1997;12(11):2324-31.
8. Lopes AA, Lantz B, Morgenstern H, Wang M, Bieber BA, Gillespie BW, et al. Associations of self-reported physical activity types and levels with quality of life, depression symptoms, and mortality in hemodialysis patients: The DOPPS. Clinical Journal of the American Society of Nephrology. 2014;9(10):1702–12.
9. Palmer SC, Vecchio M, Craig JC, Tonelli M, Johnson DW, Nicolucci A, et al. Association between depression and death in people with CKD: A meta-analysis of cohort studies. The American Journal of Kidney Diseases. 2013;62(3):493–505.
10. Aziz F, Chaudhary K. Life threatening nutritional deficiencies in a dialysis patient. Hemodialysis International. 2017;21(3):E50-E53.
11. Walters BAJ, Hays RD, Spritzer KL, Fridman M, Carter WB. Health-related quality of life, depressive symptoms, anemia, and malnutrition at hemodialysis initiation. The American Journal of Kidney Diseases. 2002;1;40(6):1185–94.
12. Cohen SD, Kimmel PL. Nutritional status, psychological issues and survival in hemodialysis patients. Contributions to Nephrology. 2007;155:1–17.
13. Trayes K, Studdiford J. Edema: Diagnosis and Management. American Family Physician. 2013;15;88(2):102-110.
14. Ibrahim S, El Salamony O. Depression, quality of life and malnutrition-inflammation scores in hemodialysis patients. American Journal of Nephrology. 2008;28(5):784-91.
15. Barros A, da Costa BE, Mottin CC, D’Avila DO. Depression, quality of life, and body composition in patients with end-stage renal disease: A cohort study. Revista Brasileira de Psiquiatria. 2016;38(4):301–6.
16. Liu X, Yang X, Yao L, Zhang Q, Sun D, Zhu X, et al. Prevalence and related factors of depressive symptoms in hemodialysis patients in northern China. BMC Psychiatry. 2017;5:17(1).
17. Li ZJ, An X, Mao HP, Wei X, Chen JH, Yang X, et al. Association between depression and malnutrition-Inflammation complex syndrome in patients on continuous ambulatory peritoneal dialysis. International Urology and Nephrology. 2011;43(3):875–82.
18. Teles F, de Azevedo VFD, de Miranda CT, de Melo Miranda MP, Teixeira MDC, Elias RM. Depression in hemodialysis patients: The role of dialysis shift. Clinics. 2014;69(3):198–202.
19. Ekramzadeh M, Mazloom Z, Sagheb M. Association of depression with selenium deficiency and nutritional markers in the patients with end-stage renal disease on hemodialysis. Journal of Renal Nutrition. 2015 ;1,25(4):381–7.
20. Fructuoso MR, Castro R, Oliveira I, Prata C, Morgado T. Quality of life in chronic kidney disease. Nefrologia. 2011;31(1):91–6.
21. Bossola M, Ciciarelli C, Di Stasio E, Panocchia N, Conte GL, Rosa F, et al. Relationship between appetite and symptoms of depression and anxiety in patients on chronic hemodialysis. Journal of Renal Nutrition. 2012;22(1):27–33.
22. Chilcot J, Norton S, Wellsted D, Davenport A, Firth J, Farrington K. Distinct depression symptom trajectories over the first year of dialysis: Associations with illness perceptions. Annals of Behavioral Medicine. 2013;45(1):78–88.
23. Hosseini SR, Zabihi A, Ebrahimi SH, Amiri SRJ, Kheirkhah F, Bijani A. The prevalence of anemia and its association with depressive symptoms among older adults in north of Iran. Journal of Research in Health Sciences. 2018;18(4):431.