Prevalence and impact of anxiety and depression in Chinese peritoneal dialysis patients: A single centre study
Psychological problems are prevalent in patients suffering from end stage renal disease (ESRD), especially those requiring dialysis. Patients with end stage renal failure (ESRF), when compared with the general population, had approximately four times higher risk of depression.1 A meta‐analysis showed that the point prevalence of depression was approximately 23% among patients receiving chronic dialysis.2 Depression is also common in Chinese patients with chronic kidney disease (CKD). In a Taiwanese study, the crude and age‐standardized prevalence of depression among Chinese pre‐dialysis CKD patients were 22.6% and 20.6% respectively.3 In Hong Kong, the point prevalence of depression in patients receiving peritoneal dialysis (PD) was 16%, using the Chinese bilingual version of the Structured Clinical Interview for Diagnostic and Statistical Manual IV for diagnosis.4 In addition, previous studies showed that the prevalence of anxiety was as high as 30–45% in the dialysis population.5 There are many causes of psychological problems in ESRD patients, including the process of dialysis, stresses related to the disease, complicated medication regimen, hospitalization and multiple potential medical complications. These psychological problems should not be overlooked because they could affect the mortality and morbidity among patients receiving dialysis. Lopes et al. demonstrated that depression was a predictor of mortality and hospitalization in patients on haemodialysis.8
Peritonitis is one of the leading causes of morbidity and mortality among PD patients. Recent studies suggested that psychological factors could play an important role in the subsequent development of peritonitis.9 According to the K/DOQI guidelines, the psychological status of each dialysis patient should be evaluated by a social worker upon initiation of dialysis and then at least biannually, with specific focus on the presence of depression, anxiety, and hostility.11
However, there were only limited studies concerning the influence of psychological factors on the clinical outcome among PD patients, especially in the Chinese population. In this study, we would like to use the Hospital Anxiety Depression Scale (HADS) to examine the prevalence of anxiety and depression in our Chinese PD patients and its association with subsequent clinical outcome. In addition, we were also interested in identifying whether any baseline characteristics would be associated with the development of anxiety and depression in the patients on PD.