JNRT 5(1): 2013

11

Journal of Nephrology and

Renal Transplantation
(JNRT)
JNRT 5(1) 2013 : 11 16

COMPARISON OF MOOD DEPRESSION DISORDER

(MDD) IN DIALYSIS PATIENTS VERSUS KIDNEY
TRANSPLANT PATIENTS
Ali Momeni, Mostafa Najafi, Hengameh Seidaie
Abstract

[Keywords]
Hemodialysis,
Kidney Transplant,
Mood Depression
Disorder, Anxiety.

Background: Based on WHO, MDD is the fourth main health problem

worldwide. Prevalence of MDD in male and female is 5-12 and 15-25
percent respectively. MDD could tend to decreasing of the quality of life
and increasing mortality of dialysis patients. Dialysis patients with MDD
have less cooperation in drug consumption and improvement of their
quality of life. There are a few studies in regard to kidney transplant
patients and MDD. The aim of this study was the evaluation and
comparison of MDD in hemodialysis patients versus kidney transplant
patients.
Methods: In a cross-sectional study 160 patients (80 hemodialysis and 80
kidney transplant) were enrolled. For evaluation of anxiety and
depression, Hamiltons check list was used and demographic criteria of
patients were mentioned. The data were evaluated with Chi square and tstudent test in SPSS (version 18).
Results: Mean age of hemodialysis (group 1) and transplant patients
(group 2) were 53.713.8 and 52.314.4 (P=0.6) and BMI were 23.46.6
and 25.26.2 respectively. In hemodialysis patients 63 (78.8%) and in
transplant patients 28 (35%) cases had depression (P<0.001). Apparent
anxiety score in transplant patients and hemodialysis patients were
44.236.12 and 40.174.35 respectively (P<0.001).
Conclusion: In hemodialysis patients, major depression, and in kidney
transplant patients, anxiety was more common; therefore in these patients,
family and social support or psychotherapy may be important in
improvement of quality of life and compliance in drug consumption.
2013 Journal of Nephrology and Renal Transplantation. All rights reserved

1.

Background and Aim

Depression is determined by depressed mood, lack of pleasure in activity and

periods of mood instability (1). Based on WHO, MDD is the fourth main health
problem worldwide. Prevalence of MDD in male and female is 5-12 and 15-25

12

percent respectively (2). Neurobiologic symptoms of depression are disturbance

in sleep and appetite, loss of energy, decrease libido and change in psychomotor
activity (3, 4). Prevalence of major depression in outpatients and admitted
patients are 10% and 15% respectively. Prevalence of suicide in MDD patients is
about 15% which is more common in male and young patients (5). Medical
problems such as renal failure may increase incidence of MDD (6). One third to
half of hemodialysis patients have MDD (7, 8). MDD could tend to decreasing of
the quality of life and increasing mortality of dialysis patients (9, 10, and 11). In
hemodialysis patients, MDD may be tending to discontinuation of dialysis
session (12). Dialysis patients with MDD have less cooperation in drug
consumption and improvement of their quality of life (13). Several studies have
been carried out on the prevalence of MDD in dialysis patients and its effects on
their life; however, there are a few studies in regard to kidney transplant patients
and MDD. The aim of this study was the evaluation and comparison of MDD in
hemodialysis patients versus kidney transplant patients.

2.

Methods and Materials

In a cross-sectional study 160 patients (80 hemodialysis and 80 kidney

transplant) were enrolled in Shahrekord city. Patients who had been registered in
hemodialysis center and nephrology clinic of Hajar Hospital from 2008 to 2010
were selected. From 96 hemodialysis and 100 kidney transplant patients, 80 cases
with inclusion criteria were selected at each group. Inclusion criteria include age
greater than 18 years, hemodialysis and transplant duration more than 12 months
and cooperation during study. Patients with consumption of antipsychotic or
antidepressive drugs or history of MDD before beginning of renal replacement
therapy were excluded. They were asked to fill in a written consent for the tests.
This study was approved by Ethics Committee of Shahrekord University of
Medical Sciences. For evaluation of anxiety and depression, Hamiltons checklist
(14) was used and demographic criteria of patients were mentioned. The data
were evaluated with Chi square and t-student test in SPSS (version 18).
Group
Variable
Male
Female
Total

3.

Table 1 Number of patients in two groups based on gender

Hemodialysis
Transplant
Total
Number Percent Number Percent Number
50
62.5
46
57.5
96
30
37.5
34
42.5
64
80
100
80
100
160

Percent
60
40
100

Methods and Materials

Mean age of hemodialysis (group 1) and transplant patients (group 2) were

53.713.8 and 52.314.4 (P=0.6) and BMI were 23.46.6 and 25.26.2
respectively (P=0.07). In hemodialysis group 59 and in transplant group 63

JNRT 5(1): 2013

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patients live in urban area and there is no difference between two groups based
on living in rural and urban area (P=0.46). Mean duration of hemodialysis in
group 1 was 2.61.9 years and in group 2 before transplantation was 2.71.3
(P=0.62). In hemodialysis patients 63 (78.8%) and in transplant patients 28
(35%) cases had depression (P<0.001) [Figure 1]. Apparent anxiety score in
transplant patients and hemodialysis patients were 44.236.12 and 40.174.35
respectively (P<0.001). Score of inapparent anxiety in group 1 and 2 of patients
were 40.233.8 and 42.124.4 respectively [Figure 2]. There are no significant
differences between 2 groups based on muscular tension (P=0.14), fear (P=0.37),
insomnia (P=0.09), concentration (P=0.61), psychomotor (0.53), gastrointestinal
symptoms (P=0.12) and cardiovascular symptoms (P=0.73). In hemodialysis
patients versus transplant patients, respiratory symptoms (P=0.01), genitourinary
symptoms (P=0.01) and autonomous symptoms (P=0.01) were more common.

Figure 1 Comparison of two group patients based on depression

Figure 2 Comparison of two group patients based on anxiety

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4.

Discussion

The aim of study was evaluation of MDD and anxiety in hemodialysis versus
kidney transplant patients. There is a controversy about prevalence of MDD in
hemodialysis patients in different studies. This prevalence in Dugans study was
34% (15), Lacovides study was 14.7% (16) and Hinrichsens study was 30%
(17) and in our study was 79%. Discrepancy of these results may be due to
difference in social and familial support for patients in different area. There are a
few studies about comparison of MDD and anxiety in hemodialysis versus
kidney transplant patients. Paradoxical depression in kidney transplant patients
was reported by Sugawara (18). Tanriverdi was found that in kidney transplant
patients anxiety score is higher than normal population (19). Pascazio reported
that there is no difference between prevalence of anxiety and depression in
kidney transplant versus hemodialysis patients (20), which is not consistent with
the observed results; depression was more common in hemodialysis patients and
anxiety was more common in kidney transplant patient in our study. Lew
mentioned that in ESRD patients, women were more susceptible for depression
and anxiety than men (21) and in Rosenbergers study, women were more
susceptible of emotional stress than men, whoever dialysis modality before
transplantation, type of immunosuppressant and social support had not
correlation with total score of stress (22) but in present study there is no
difference between men and women of two groups based on depression or
anxiety. Some studies were carried out on quality of life in transplant patients, for
example Sayin showed that there is no difference between ESRD and transplant
patients based on quality of life (23). Improvement of quality of life in kidney
transplant patients was reported by Overbeck (24) and in Virzs study decrease
depressive symptoms and improvement of quality of life in these patients was
reported (25). Cukor reported that depression has an important role in low
medication adherence in hemodialysis and kidney transplant patients (26).
Decrease emotional problems after psychotherapy was reported by Baines (27).
In a review article, Levenson reported that age and depressed mood in ESRD are
better predictors of mortality than modality of treatment (28). In conclusion;
MDD and anxiety are common in hemodialysis and transplant patients. Family
and social support or psychotherapy may be important in improvement of quality
of life and compliance in drug consumption in these patients.

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