Depression screening in chronic hemodialysis patients, a cross-sectional study.

PurposeDepressive disorder is common among hemodialysis (HD) patients and is associated with higher mortality rate. However, depression screening and treatment in dialysis population remains insufficient. The aim of the study was to show the prevalence of depression in patients on maintenance HD and to discuss the proper diagnostic approach, including dementia screening. Patients and methodsWe conducted a cross-sectional study that included 103 HD patients from one Dialysis Centre in Gda[n]sk (Poland). Cognitive functions were evaluated using Mini-Mental State Examination (MMSE). The screening for depression was assessed using Beck Depression Inventory (BDI-II). The diagnosis of depressive disorder was confirmed and its severity evaluated by psychiatrists based upon clinical assessment and scales. Sociodemographic, laboratory and dialysis data were also collected. ResultsAccording to BDI-II depressive symptoms were present in 43% of patients while the diagnosis of clinical Major Depressive Disorder (MDD) was confirmed by the psychiatrists in 13% of all subjects. In the depressive disorder group there was a prevalence of female and patients suffering from diabetes mellitus, levels of calcium phosphate index (CaxPi) were higher and Kt/V was lower. The optimal cut- off score for diagnosing major depressive disorder using BDI-II was [≥] 20 points. Cognitive impairment on the level of major neurocognitive disorder (dementia) was found in 18 % of the study group. ConclusionsThe prevalence of depression assessed using self- or clinician-administered questionnaires was higher than reported by clinical interview performed by the psychiatrist. Higher scores of CaxPi and lower Kt/V in depressive patients may suggest worse compliance in this group. The psychiatrists examination as a part of care at the Dialysis Centre could improve diagnosis of depression and its treatment with the goal to improve quality of life and lower the mortality rate in this population.