A comparative study of psychosocial determinants and mental well-being in chronic kidney disease patients: A closer look

BACKGROUND: Depressive illness in chronic kidney disease (CKD) is an independent risk factor for morbidity and mortality. The relation between depressive illness and quality of life (QoL) in this vulnerable group is complex. We attempted to study the burden of depressive illness, the QoL in patients of CKD on hemodialysis (HD), and peritoneal dialysis (PD) as well as those who were not on any dialysis but on conservative medical management only. MATERIALS AND METHODS: Observational study with cross-sectional analytical controlled design. STATISTICAL METHODS USED: Chi-square statistic or Fisher's exact test for categorical variables and t-test and ANOVA for continuous variables. Correlational analysis was done using Spearman's correlation coefficient. P <0.05 was considered as statistically significant. RESULTS: Depressive symptoms were present significantly across all 3 groups of CKD patients. Depressive disorder was significantly higher in the HD group. Mean QoL was significantly better in patients of CKD on PD. DISCUSSION: There is huge hidden burden of depressive symptoms and depressive illness in patients of CKD whether on dialysis or on conservative medical management. The study found significantly higher burden of depressive illness and lower QoL among the HD vis a vis PD patients, even though the majority of our CKD who require dialysis are on HD. CONCLUSION: Depressive burden is the hidden factor behind poor QoL, poor overall satisfaction as well as treatment outcome in patients of CKD whether or not on dialysis. To address this hidden depressive burden comprehensively, close cooperation between nephrologist and psychiatrist is called for.