Associação de depressão e ansiedade com qualidade de vida, eficiência de hemodiálise, sonolência, síndrome de pernas inquietas e prurido em pessoas em hemodiálise diária

Abstract

Introduction: Individuals diagnosed with chronic kidney disease (CKD) experience a significant burden of symptoms, including psychiatric comorbidities such as depression and anxiety, which are often linked to sleep disturbances, pruritus, and restless legs syndrome (RLS). The predisposition to mental health issues, compounded by the physical complications of CKD, can severely impair the quality of life (QOL) for these individuals. Objective: The objective of this study is to evaluate the association between depression and anxiety with quality of life, somnolence, restless legs syndrome, and pruritus in individuals with chronic kidney disease undergoing daily hemodialysis. Methods: This analytical cross-sectional study involved the administration of a questionnaire to all individuals with CKD receiving renal replacement therapy (RRT), specifically daily hemodialysis (HDD), at a private nephrology clinic in the Federal District, Brazil, from June to November 2023. The questionnaire collected demographic information, clinical data, and laboratory test results from the clinic's electronic records. The following validated questionnaires were utilized: Kidney Quality of Life Short Form (KDQOL-SF), Hospital Anxiety and Depression Scale (HADS), Edmonton Symptom Assessment System (ESAS-r: Renal) adapted for CKD, the Epworth Sleepiness Scale (ESS), and the International Study Group on RLS Grading Scale (EIGSPI). Results: The sample comprised 50 participants, with a mean age of 61.3 ± 28 years, predominantly male (26 out of 50 participants, or 52%). Glomerulopathy was the most common cause of renal disease (26%, 13/50), followed by hypertensive nephrosclerosis (22%, 11/50). The prevalence of depression was 30% (15/50) according to the HADS-Depression scale, and the same prevalence was observed for anxiety (30%, 15/50) via the HADS-Anxiety scale. The prevalence of RLS was 64% (32/50), while 46% (23/50) of participants reported suffering from pruritus. The analysis revealed that for each one-year increase in age, anxiety decreased by 1.5% (Effect 0.985; 95% CI 0.970–0.999; p=0.042). Conversely, for each one-unit increase in C-Reactive Protein (CRP), the prevalence of depression increased by 4.7% (Effect 1.047; 95% CI 1.007–1.089; p=0.021). Additionally, for each one-unit increase in the stdKt/V value, depression decreased by 27.4% (Effect 0.726; 95% CI 0.557–0.947; p=0.018). Furthermore, an increase in CRP was associated with a 4.3% rise in the total ESAS-renal score (Effect 1.043; 95% CI 1.007–1.081; p=0.020). Participants without pruritus experienced higher scores in daytime sleepiness (ESS), with an increase of 82% (Effect 1.827; 95% CI 1.279–2.611; p=0.001) compared to those with pruritus. Additionally, an increase in hemoglobin was associated with a decrease in daytime sleepiness, with a reduction of 1.5% for each one-unit increase in hemoglobin (Effect 0.985; 95% CI 0.971–0.999; p=0.046). Conclusion: The results indicate that the prevalence of depression and anxiety among individuals with CKD is 30%, with depression associated with increased levels of C-reactive protein, suggesting a potential role of inflammation in depressive symptoms. Anxiety was inversely correlated with age, while improved hemodialysis adequacy (as measured by stdKt/V) was linked to reduced depression levels. The high prevalence of RLS (64%) negatively impacted mental quality of life, and pruritus was related to decreased daytime sleepiness. Effective management of physical symptoms, alongside rigorous control of hemoglobin levels and anemia, can benefit sleep quality. These findings underscore the importance of addressing physical symptoms and maintaining optimal hemodialysis management to enhance the quality of life for individuals with CKD. Addressing the high prevalence of disorders such as depression, anxiety, pruritus, and RLS in this population is essential for developing mitigation and prevention strategies.