Investigation Of Anxiety And Depression In Maintenance Hemodialysis Patients And Relevant Factors

Research background:The incidence of chronic kidney disease(CKD)is relatively high,and has a increasing trend in the global scope.And the number of patients in End stage renal disease(ESRD)depending on maintenance hemodialysis have increased these years.Due to the particularity of the condition and the treatment method,(Maintenance hemodialysis)MHD patients are more prone to mental disorders,of which anxiety and depression are the most common symptoms.Incidence rates are markedly higher in patients with MHD,compared to the general population and patients with other chronic illness.MHD patients with comorbid anxiety and depression are like to have poor quality of life,mortality,and worse clinical outcomes.Therefore,in order to effectively reduce the incidence rate and control the risk factors of anxiety and depression,improve psychological endurance and health of patients with maintenance hemodialysis,we initially studied the risk factors of anxiety and depression.Research objectives:To explore the incidence and related risk factors of anxiety and depression in patients with maintenance hemodialysis.Research methods:A total of 148 patients with maintenance hemodialysis were recruited in the first hospital of Jilin University Blood Purification Centre from October 2016 to October 2017,and we got the consent from all the patients before the study began.The ordinary materials such as age,sex,education,employment,marital status,financial situation,smoking,sleep quality and urine volume of the patients were recorded by self-made questionnaire.We used Hamilton anxiety rating scale(HAMA)and Hamilton depression rating scale(HAMD)to assess the psychological status of the patients.Access to medical records,defined the original incidence of patients and hemodialysis starting point,and whether patients suffered from diabetes.Collected the laboratory index such as blood calcium(Ca),blood phosphorus(P),serum parathyroid hormone(PTH),total cholesterol(TC),triglycerides(TG),high-density lipoprotein cholesterol(HLD-C),low density lipoprotein cholesterol(LDL-C),serum albumin(Alb),hemoglobin(Hb),creatinine(Cr)and blood urea nitrogen(BUN).According to HAMA and HAMD scores,the 148 patients were devided into two groups,including score-anxiety group and depression group.Indexes of the patients of two groups were compared.The above statistical methods using SPSS 22 statistical software for analysis.All of the date were processed by SPSS 22 statistical software.Statistical methods include t test,rank test,chi-square test and Logistic regression analysis.The test standard was bilateral ?=0.05.Research results:1.Anxiety and depression: A total of 148 patients with MHD were included in this study,there were 82 patients with anxiety,accounting for 55.4%,and 55 cases with depression,accounting for 37.2%,the incidence rate of anxiety and depression is high.2.Correlation analysis between general information and anxiety and depression:Anxiety and depression of MHD patients was associated with whether smoking,sleep quality and primary disease.Among the smoking patients,46 cases with anxiety,accounting for 72.4%,and 35 cases with depression,accounting for 56.5%.However,In non-smoking population,36 cases were anxious,accounting for 42.4%,19 cases were depressed,accounting for 22.4%,there was significant difference between the two groups by?2 test(P < 0.01).The incidence of anxiety(31.0% vs 87.6%)and depression(7.1 % vs76.6%)was lower in the patients with good sleep quality than that in the patients with poor sleep quality.Among the patients with primary hypertension nephropathy,there were10 cases of anxiety(90.9%)and 9 cases of depression(81.8%),the incidence of the anxiety and depression was significantly higher than that of patients with other types of primary disease.There was no significant difference between the two groups in sex,age,employment,education,whether had diabetes and renal transplantation(P > 0.05).3.Correlation analysis between laboratory index and anxiety and Depression: Hband Alb levels were negatively correlated with anxiety and depression.The average level of Hb in anxiety and depression group was lower than that in non-anxiety and non-depression group(P < 0.01).The average level of Alb in anxiety group is lower than that in non-anxiety group(36.1g/l vs 38.0g/l,P=0.039),The average level of Alb in depression group is lower than that in non-depression group(35.2g/l vs 38.0g/l,P=0.003).The level of TG was associated with depression(P=0.059)and the median level of TG in depression group was lower than that in non-depression group.But Ca?P?PTH?TC?HLD-C?LDL-C?Cr?BUN were founded have no correlation with anxiety and depression.4.Relevant factors: Univariate Logistic regression analysis results showed that anxiety and depression of MHD patients were associated with whether smoking,sleep quality and primary disease,Hb and Alb levels,TC and TG levels.Multiple Logistic regression analysis results showed smoking and poor sleep quality were independent risk factors of anxiety(P<0.05).Smoking,poor sleep quality and low albumin levels are independent risk factors of depression(P<0.05).5.The results of this study also suggest that the type of primary disease is a risk factor for anxiety and depression,but it's 95% confidence interval had a wide range of changes,which need further verification and research.Research conclusions:1.The incidence of anxiety and depression in MHD patients was 55.4% and 37.2%respectively in our center.2.Our study suggests that anxiety and depression in MHD patients are associated with smoking,sleep quality,hemoglobin levels,albumin levels and the type of primary disease.Smoking and poor sleep quality are independent risk factors of anxiety.Smoking,poor sleep quality and low albumin levels are independent risk factors of depression.