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Saudi Journal of Kidney Diseases and Transplantation
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Table of Contents   
LETTER TO THE EDITOR  
Year : 2013  |  Volume : 24  |  Issue : 5  |  Page : 1005-1008
Depressive disorders in Moroccan chronic hemodialysis patients


1 Nephrology-Hemodialysis Division, UHC Mohammed VI, Cadi Ayyad University, Marrakech, Morocco
2 Psychiatry Department, UHC Mohammed VI, Cadi Ayyad University, Marrakech, Morocco

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Date of Web Publication12-Sep-2013
 

How to cite this article:
Fadili W, Ennasri S, Knidiri H, Touhami M, Asri F, Laouad I. Depressive disorders in Moroccan chronic hemodialysis patients. Saudi J Kidney Dis Transpl 2013;24:1005-8

How to cite this URL:
Fadili W, Ennasri S, Knidiri H, Touhami M, Asri F, Laouad I. Depressive disorders in Moroccan chronic hemodialysis patients. Saudi J Kidney Dis Transpl [serial online] 2013 [cited 2019 Nov 12];24:1005-8. Available from: http://www.sjkdt.org/text.asp?2013/24/5/1005/118075
To the Editor,

Psychiatric illness is common among patients with chronic disorders, particularly in those with end-stage renal disease (ESRD) on renal replacement therapy. [1],[2],[3] Depression is the most prevalent psychiatric problem and accounts for a 1.5-3.0-times higher rate of hospitalization among dialyzed patients compared with those with other chronic illnesses. [4] The exact incidence of depression in dialysis patients is unclear, reportedly ranging from 10% to 50%. [5],[6]

Recently, we evaluated the prevalence of depressive disorders among a population of Moroccan adult hemodialysis patients in three different dialysis units across the region of Marrakech. This was performed as a transversal multicentric study during the month of February 2011. The patients' socio-demographic, clinical and biological characteristics were also identified and evaluated.

Data of 70 ESRD patients who were on chronic hemodialysis for more than three months in the dialysis units in Marrakech University Hospital Mohammed VI and two private clinics were collected during this period. All patients were informed about the aim of the study and necessary consents were obtained. Structured questionnaires were filled by one medical investigator according to patients' response. The response rate was 100%. Various demographic parameters, comorbidities, dialysis parameters and biochemical values were collected for each patient.

We used the Mini International Neuropsychiatric Interview (MINI), translated and validated in the Moroccan Arabic dialect. [7] The MINI is a short, structured clinical interview that enables researchers to diagnose psychiatric disorders according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) or the International Statistical Classification of Diseases and Related Health Problems (ICD-10). The administration time of the interview was approximately 15-20 min. Statistical analysis of the data obtained was fed to the SPSS for analysis. Significance was assumed at P <0.05.

Patients younger than 18 years were excluded as were patients who did not speak the Moroccan Arabic dialect and who had a known psychiatric disorder before the start of hemodialysis.

Of our 70 patients, males represented 51.4% of all cases. The mean age of the patients was 49.6 ± 12 years (range: 25-80 years). The assessment of educational level showed that 17 cases (24.3%) were illiterate, 44 cases (62.85%) were of secondary education and nine cases (12.9%) had higher education. 68.8% of our study population were married, 24.3% were singles, 5.7% were widows and 1.4% were divorced. Forty patients had free health care (57.14%). The comorbidities identified were arterial hypertension (33 cases; 47.1%), diabetes mellitus (five cases; 7.1%), smoking (11 cases; 15.7%), drug addiction (five cases; 7.1%) and alcoholism (four cases; 5.7%). Anxiolytics were prescribed by treating physicians in 13 cases (18.6%). The mean age of the start of hemodialysis was 40.6 ± 13.81 years, with a mean dialysis duration of 8.8 ± 5.99 years.

Depression was diagnosed in 12 patients (17.1%) and anxiety in 14 patients (20%). [Table 1] summarizes the different psychological symptoms diagnosed by the MINI questionnaire in our patients. Of the 70 subjects, ten (14.3%) patients fulfilled the DSM-IV criteria for a major depresssive disorder, two patients (2.9%) reported suicidal ideation and five patients (7.1%) had generalized anxiety.
Table 1: Different psychological symptoms diagnosed in our series.

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[Table 2] summarizes the general characteristics of the depressed and non-depressed patients.
Table 2: General characteristics of depressed and non-depressed patients.

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There was no significant difference in the gender ratio, age, education, comorbidities, free health care and hemodialysis parameters, such as Kt/V, dry weight, pre- and post-dialysis arterial pressure, nutritional markers, anemia and phosphocalcium metabolism.

Compared with non-depressed patients, patients' depression was significantly associated with dialysis duration, interdialytic weight gain and level of C-reactive protein.

The depressed patients had a significantly higher frequency of anxiety, life-time panic disorder, agoraphobia, obsessive-compulsive disorder and post-traumatic stress state than the non-depressed patients [Table 3].
Table 3: Psychological characteristics of depressed and non-depressed hemodialysis patients.

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Despite being a common, prevalent and serious comorbidity of ESRD, depression is relatively understudied in this population. [5] Patients with renal disease are challenged by many stressors, including chronic fatigue, ESRD symptoms, familial and social adaptation difficulties and decreased physical and cognitive competence. [8],[9]

The diagnosis of psychiatric disorders is based on several structured interviews that have been developed to increase the reliability of psychiatric diagnoses when compared with open interviews. [10] Among them, the most important are the Structured Clinical Interview for DSM-IV-TR Axis I (SCID-I) [11] and the Composite International Diagnostic Interview (CIDI). [12] Despite the established validity and reliability of these tests, practicing psychiatrists rarely use them. [5] The need for a very short psychiatric screening instrument has led to the development of the MINI, which has a good diagnostic concordance with the SCID. [13]

A variety of syndromes associated with depressive affect exist, [8] including major depression, dysthymia and subthreshold depression. In our sample of 70 hemodialysis patients, we found that 17.1% were experiencing depression of varying degrees of severity and half of them had experienced at least one previous episode. Anxiety was found in 20% of the patients. The reported symptoms of depression were dysthymia in 2.9% of the patients and a current major depression episode in 14.3% of the patients, with a melancholic depression in 11.4% of the patients and a suicide ideation in 2.9% of the patients. In a study of 200 hemodialysis patients interviewed with the MINI questionnaire, Chen et al however have reported higher prevalences, symptoms of depression in 35% of the cases and anxiety in 21% of the cases. 23.5% of these patients presented a major depressive disorder and 21.5% had suicide ideation. [14] In our study, depressed patients had longer dialysis duration and, more importantly, higher interdialytic weight gain and evidence of inflammation shown by C-reactive protein levels. The relationship between depression and dialysis duration is controversial; some studies suggested that a short duration was associated with depressive disorders, [15] but others found no association. [16]

In agreement with our results, Taskapan et al reported in a study of 40 patients with ESRD that depressive symptoms were important determinants of patients' large interdialytic weight gain [17] and Dogan et al found in another study of 43 hemodialysis patients a significant association between high levels of C-reactive protein and high depression scores. [18] Koo et al reported that depression in hemodialysis patients was closely related to nutritional status and could be an independent risk factor for malnutrition, [19] but there was no association with nutritional parameters in our population.

In our study, there was a significant association with other psychiatric disorders, specially anxiety. Kin et al also found that depressed patients had significantly more suicidal ideation and suicide plans and a higher incidence of anxiety disorders than non-depressed patients. [14]

Psychiatric problems among chronic dialysis patients is an important aspect that nephrologists need to consider improving the quality of life of this population. Depression is the most prevalent psychiatric disorder in patients with ESRD treated with dialysis. It is, therefore, important to develop strategies to screen for and to treat clinical depression in this group of patients.

 
   References Top

1.Abbas Tavallaii S, Ebrahimnia M, Shamspour N, Assari S. Effect of depression on health care utilization in patients with end-stage renal disease treated with hemodialysis. Eur J Intern Med 2009;20:411-4.  Back to cited text no. 1
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2.House A. Psychiatric referrals from a renal unit: A study of clinical practice in a British hospital. J Psychosom Res 1989;33:363-72.  Back to cited text no. 2
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3.Elhassan EA, Kaballo B, Fedail H, et al. Peritoneal dialysis in the Sudan. Perit Dial Int 2007;27:503-10.  Back to cited text no. 3
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4.Kimmel PL, Thamer M, Richard CM, Ray NF. Psychiatric illness in patients with end-stage renal disease. Am J Med 1998;105:214-21.  Back to cited text no. 4
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5.Cukor D, Peterson RA, Cohen SD, Kimmel PL. Depression in end stage renal disease hemodialysis patients. Nat Clin Pract Nephrol 2006;2:678-87.  Back to cited text no. 5
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6.Wuerth D, Finkelstein SH, Finkelstein FO. The identification and treatment of depression in patients maintained on dialysis. Semin Dial 2005;18:142-6.  Back to cited text no. 6
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7.Kadri N, Agoub M, El Gnaoui S, Alami KhM, Hergueta T, Moussaoui D. Moroccan Colloquial Arabic version of the Mini-International Neuropsychiatric Interview (M.I.N.I): Qualitative and Quantitative validation. Eur Psychiatry 2005;20:193-5.  Back to cited text no. 7
    
8.Kimmel PL. Psychosocial factors in dialysis patients. Kidney Int 2001;59:1599-613.  Back to cited text no. 8
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9.Kimmel PL. Depression in patients with chronic renal disease: What we know and what we need to know. J Psychom Res 2002;53:951-6.  Back to cited text no. 9
    
10.Psychiatric evaluation of adults. American Psychiatric Association, Practice guidelines for the treatment of psychiatric disorders. 2000 p. 7-26.  Back to cited text no. 10
    
11.First MB, Spitzer RL, Gibbon M, Williams JB. Structured clinical interview for DSM-IV-TR axis I disorders. Research version. Biometrics Research, New York State Psychiatric Institute, New York (2001) Non-patient edition, (SCID-I/NP).  Back to cited text no. 11
    
12.Wittchen HU. Interrater reliability of the Composite International Diagnostic Interview (CIDI): Results of the Multicenter WHO/ ADAMHA Field Trials (Wave I). In: Stefanis CN, Rabavilas AD, Soldatos CR, eds. Psychiatry: A world perspective, Vol. 1. Amsterdam: Excerpta Medica; 1990. p. 125-32.  Back to cited text no. 12
    
13.Sheehan DV, Lecrubier Y, Harnett SK, et al. The MINI-International Neuropsychiatric Interview for DSM-IV and ICD-10. J Clin Psychiatry 1998;59 Suppl 20:22-3.  Back to cited text no. 13
    
14.Chen CK, Tsai YC, Hsu HJ, et al. Depression and suicide risk in hemodialysis patients with chronic renal failure. Psychosomatics 2010;51: 528-8.  Back to cited text no. 14
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15.Graven JL, Rodin GM, Johnson L, Knnedy SH. The diagnosis of major depression in renal dialysis patients. Psychosom Med 1987;49: 482-92.  Back to cited text no. 15
    
16.Kimmel PL, Peterson RA, Weihs KL, et al. Aspects of quality of life in hemodialysis patients. J Am Soc Nephrol 1995;6:1418-26.  Back to cited text no. 16
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17.Taskapan H, Ates F, Kaya B, et al. Psychiatric disorders and large interdialytic weight gain in patients on chronic haemodialysis. Nephrology 2005;10:15-20.  Back to cited text no. 17
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18.Dogan E, Erkoc R, Eryonucu B, Sayarlioglu H, Agargun MY. Relation between depression, some laboratory parameters, and quality of life in hemodialysis patients. Ren Fail 2005;27: 695-9.  Back to cited text no. 18
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19.Koo JR, Yoon JW, Kim SG, et al. Association of depression with malnutrition in chronic hemodialysis patients. Am J Kidney Dis 2003; 41:1037-42.  Back to cited text no. 19
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Correspondence Address:
Wafaa Fadili
Nephrology-Hemodialysis Division, UHC Mohammed VI, Cadi Ayyad University, Marrakech
Morocco
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DOI: 10.4103/1319-2442.118075

PMID: 24029272

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