SP669
RELATIONSHIP BETWEEN DEPRESSION AND MALNUTRITION-INFLAMMATION STATUS IN PATIENTS ON MAINTENANCE HEMODIALYSIS - A MULTICENTRIC STUDY

INTRODUCTION AND AIMS: Patients with end-stage renal disease receiving maintenance dialysis suffer from a multitude of somatic and psychological symptoms. Uremia causes malnutrition, which, in turn, predisposes them to pro-inflammatory status. Depression is associated with poor oral intake, increased cytokine levels and inflammatory response. The purpose of this study was to assess the prevalence of depression and its relationship with malnutrition-inflammation status, according to malnutrition-inflammation scores (MIS), in hemodialysis (HD) patients.

METHODS: This cross-sectional study included 307 (181 males and 126 females, age range 20 - 85 years, time on dialysis 6 - 324 months) randomly selected individuals out of 350 stable HD patients from five HD centers. Standard blood analyses, Kt/V, body mass index (BMI) and MIS were determined in all patients. Depression was assessed by the self-administered Beck Depression Inventory questionnaires. Other relevant demographic and clinical data were obtained from patients medical records. The results were analyzed with independent sample T test, the χ² statistic and Pearson correlation test.

RESULTS: The average BDI was 15,18±11,03. Almost half of the patients (45,6%) had depressive symptoms (BDI≥14). No statistically significant differences were found in the prevalence of depression in relation to sex, age, marital/employment status, smoking habit, comorbidites (diabetes, hepatitis B and C), dialysis type, dialysis shift and type of vascular access. Patient with inadequate HD (Kt/V<1,20) more often had depressive symptoms (p=0,036). No statistically significant difference was found in neither BMI or the standard laboratory values between patients with and without depressive symptoms. MIS≥6, indicating presence of significant malnutrition and inflammation, as reported in previous researches, was present in 49,7% of the patients. Patients with MIS≥6 had significantly longer dialysis vintage (75,97±69,83 vs 46,22±42,24 months; p=0,001), lower BMI (23,24 ± 3,58 vs 27,16 ± 4,38; p <0,01) and higher ferritin (610,11 ± 414,80 vs 406,36 ± 330,03 ng/ml; p<0,05). Significantly higher MIS was found in smokers (7,84±4,07 vs 6,31±3,41; p=0,016), diabetic patients (8,77±4,08 vs 6,27±3,40; p=0,001) and patients on low-flux compared to high-flux dialysis (7,28±3,96 vs 6,35±3,06; p=0,05). MIS did not differ significantly in relation to age, sex, dialysis type, adequacy, type of vascular access and other laboratory values. A significant positive correlation was found between MIS and BDI (p<0,01).

CONCLUSIONS: Both patients with depressive symptoms and those with malnutrition and inflammation are highly prevalent on maintenance HD. Depression is closely related to malnutrition-inflammation syndrome in HD patients. Further studies are needed to examine the extent to which regulating malnutrition and inflammation and treating depression might improve patients' quality of life.