Evaluation of objective and subjective indicators of death in a period of one year in a sample of prevalent patients under regular hemodialysis

Association between depressive symptoms and all-cause mortality in Chilean adult population: prospective results from two national health surveys

PURPOSE

Depression is a prevalent disorder with effects beyond mental health. A positive association with mortality has been mostly reported, however, evidence comes from a few high-income countries. This study aims to assess the association between depressive symptoms and all-cause mortality in the Chilean population and assess a potential secular effect in this association.

METHODS

This prospective study used data from the Chilean National Health Survey (CNHS). Data from 3151 and 3749 participants from the 2003 and 2010 CNHS, respectively, were linked to mortality register data. Cox survival analysis was performed. The main exposure was depressive symptoms, measured with CIDI-SF (cut-off ≥ 5), and the outcome all-cause mortality. The study period was limited to 8.5 years to allow for the same length of follow-up.

RESULTS

10% and 8.5% of participants from the 2003 and 2010 cohort died during the follow-up. Adjusting for age and sex, those with depressive symptoms had 1.58 (95% CI 1.18-2.13) and 1.65 (95% CI 1.14-2.12) times the risk to die than those without symptoms in the 2003 and 2010 cohort, respectively. In models adjusted for demographic, socioeconomic, behavioural variables and comorbidities, participants with depressive symptoms had 1.42 (95% CI 1.05-1.92) and 1.46 (95% CI 1.07-- 1.99) times the risk to die compared to those without symptoms in the 2003 and 2010 cohort, respectively.

CONCLUSION

Chilean adults with depressive symptoms are at higher risk of all-cause mortality compared to those without symptoms. The effect size was similar regardless of the economic development of the country.

Relationship between psychiatric symptoms and activities of daily living in patients undergoing hemodialysis

Background

Accurately identifying the factors contributing to decline in activities of daily living (ADL) is important for preventing such decline in patients undergoing hemodialysis (HD). We studied the prevalence and number of overlapping psychiatric symptoms (depressive symptoms, apathy, and sleep disturbance) in patients undergoing HD and examined the relationship between psychiatric symptoms and ADL.

Methods

The study utilized a cross-sectional research design. The sample included 203 outpatients (median age: 69 years) undergoing stable HD treatment three times a week. Patient characteristics, including age, sex, body composition, dialysis vintage, primary kidney disease, comorbidity, and nutritional status, were collected from patients’ medical records. Functional status was assessed based on the self-reported questionnaire that combined five basic and eight instrumental ADL items. Usual walking speed was used as an index of physical function. Additionally, the short version of the Center for Epidemiologic Studies Depression Scale was used to assess depressive symptoms. Further, apathy and sleep disturbance were assessed using the Motivation Score and the Athens Insomnia Scale, respectively.

Results

Overall, 59 (29.1%) patients demonstrated depressive symptoms, 100 (49.3%) reported apathy, 83 (40.9%) had sleep disturbance, 31 (15.3%) had three overlapping psychiatric symptoms, 43 (21.2%) had two overlapping psychiatric symptoms, 63 (31.0%) had only one symptom, and 66 (32.5%) had no psychiatric symptoms. Multiple logistic regression analysis showed that having two or three overlapping psychiatric symptoms was independently and significantly associated with ADL (functional status of 13 points for the ADL maintenance group, and of < 13 points for the ADL decline group, respectively), even after adjusting for patient characteristics and walking speed (odds ratio: 2.74, 95% confidence interval: 1.12–6.69, reference; no psychiatric symptoms).

Conclusion

The present study clarified that the overlapping symptoms, including depressive symptoms, apathy, and sleep disturbance, were independently associated with ADL decline in patients undergoing HD. It is useful to examine not only depressive symptoms but also other symptoms such as apathy and sleep disturbance to elucidate factors associated with deteriorated ADL in chronic patients. Our findings provide a strong basis for targeted interventions to prevent functional dependence in the HD population.

Health-related quality of life as a predictor of mortality in patients on peritoneal dialysis

Objective:

to characterize deaths that occurred, and the association between socio-demographic, clinical, laboratory variables and health-related quality of life and the outcome of death in patients on peritoneal dialysis, over a two year period after an initial assessment.

Method:

observational, prospective population study with 82 patients on peritoneal dialysis. The instruments used for the first stage of data collection were the mini-mental state examination, a sociodemographic, economic, clinical and laboratory questionnaire and the Kidney Disease and Quality of Life-Short Form. After two years, data for characterization and occurrence of death in the period were collected. The relative risk of death outcome was calculated through statistical analysis; the risk of death was estimated by the survival Kaplan-Meier curve, and determined predictors of death by the Cox Proportional Hazards Model.

Results:

of the 82 original participants, 23 had as an outcome death within two years. The increased risk for the outcome of death was associated with a lower mean score of health-related quality of life in the physical functioning domain.

Conclusion:

the worst health-related quality of life in the physical functioning domain, could be considered a predictor of death.