The Burden of Depression among Patients with End Stage Renal Disease undergoing Haemodialysis at Kenyatta National Hospital, Nairobi Hospital, and Parklands Kidney Center, Nairobi, Kenya

Abstract

Background: Depression is the commonest psychological disorder in End Stage Renal Disease (ESRD). The presence of depression has been linked with high rates of morbidity and mortality, as well as having an impact on the quality of life. Early diagnosis and treatment of depression in chronic kidney disease improves disease outcome.

Objectives: The main objective of this study was to determine the prevalence of depression in end stage renal disease patients undergoing maintenance haemodialysis at the Kenyatta National Hospital (KNH), Nairobi Hospital (NH), and Parklands Kidney Centre (PKC).

Design: This was a cross sectional descriptive study carried out over a period of two months.

Methods: The study population comprised of adults aged 18 years and above undergoing maintenance haemodialysis. Informed consent was sought from all the participants. A study pro forma was used to collect socio-demographic data. The Patient Health Questionnaire 9 (PHQ - 9) was used to establish presence and severity of depression among participants. The multidimensional scale of perceived social support was used to assess the level of social support among the study participants.

Data management and analysis: The prevalence of depression was calculated as a proportion of patients with any degree of depression and expressed as a percentage. The chi- square test was used to determine the association between presence of depression, and selected social demographic determinants. Analysis was done using SPSS version 21.0 Chicago Illinois.

Results: A total of 170 patients were recruited with a mean age of 56.44 ±13.5 years and a sex ratio (M: F) of 1.2:1. The prevalence of depression was 32.4%, mild depression 24.14%, moderate 7.06% and severe 1.17%. High social support was present for 74.12% of subjects who participated, while 23.53% and 2.35% had moderate and low social support respectively. Age (18 - 29 years, p = 0.005), lack of any formal education (p = 0.048), retirement from formal employment (p = 0.036) and lack of social support (p = 0.001) were significantly associated with depression.

Conclusion: A substantial proportion of subjects undergoing haemodialysis have concomitant depression with the majority having mild depression. Factors that increased the risk of depression were age, lack of formal education, retirement from formal employment and lack of social support. Carrying out of validated questionnaires to assess for the presence of depression in patients initiating haemodialysis may be helpful in early recognition and management. This would improve the quality of life and clinical outcomes in patients diagnosed with end stage renal disease undergoing haemodialysis.