Original investigation: dialysis therapies
Association of depression with malnutrition in chronic hemodialysis patients

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Abstract

Background:

Depression is the most common psychological complication and may increase mortality in chronic hemodialysis patients. Because depression could be associated with poor oral intake and activation of proinflammatory cytokines that could further increase mortality by malnutrition, we investigated the relation between depression and nutritional status in chronic hemodialysis patients.

Methods:

Sixty-two Korean patients completed the Beck Depression Inventory (BDI) questionnaire, and the diagnosis of depression was confirmed by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for major depressive disorder. Nutritional status was evaluated using serum albumin level, normalized protein catabolic rate, subjective global assessment (SGA), and anthropometric measurement.

Results:

Mean BDI score was 22.7 ± 11.4, and 35 patients (56.5%) had a BDI score greater than 21, which is the suggested cutoff score for the diagnosis of depression for the Korean population. Of 40 patients who had a score higher than 18 on the BDI, 34 patients met DSM-IV criteria for major depressive disorder. BDI score correlated negatively with a variety of nutritional parameters: serum albumin level (r = −0.47; P < 0.001), normalized protein catabolic rate (r = −0.32; P < 0.05), SGA (r = −0.47; P < 0.01), triceps skinfold thickness (r = −0.40; P < 0.05), midarm muscle circumference (r = −0.57; P < 0.01), and body mass index (r = −0.28; P < 0.05). Multiple regression analysis also identified BDI score as an independent determinant for all kinds of nutritional parameters.

Conclusion:

In patients on chronic hemodialysis therapy, depression is related closely to nutritional status and could be an independent risk factor for malnutrition.

Section snippets

Patient characteristics

This study enrolled all patients with chronic renal failure who were free of acute illness within the past 3 months, not administered corticosteroids, and on dialysis therapy for more than 6 months at the outpatient hemodialysis unit of Hallym University Hospital (Chunchon, Korea). Of 76 eligible patients, 14 patients who were uncooperative with this study or refused to answer the depression scale inventory were excluded. Sixty-two patients completed the cross-sectional study. Causes of chronic

Results

Principal clinical data and nutritional status of patients are listed in Table 1. Mean total BDI score was 22.7 ± 11.4, which falls in the range of moderate to severe depression using criteria for the Western population. Thirty-five patients (56.5%) had a BDI score higher than 21, which is the cutoff score for the diagnosis of depression for the Korean population.

There was a significant correlation between age and severity of depression (BDI score, r = 0.45; P < 0.001; CDI score, r = 0.39; P <

Discussion

This study showed a high incidence of depression and positive correlations between severity of depressive symptoms and degree of malnutrition in chronic hemodialysis patients. Multiple regression analysis also identified severity of depression as an independent determinant for a variety of nutritional parameters. This relation might simply reflect a psychological response to a worse overall medical condition.

However, depression commonly is associated with poor oral intake, which can aggravate

Acknowledgements

The authors thank Eun-Young Noh, RN, and Seung-Nam Cho, RN, of Hallym University Hospital for their assistance with the study.

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  • Cited by (0)

    Supported by a Research Grant from Hallym University, Korea.

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