Relations Of Depression And MIA Syndrome Among Maintenance Hemodialysis Patients

Background Maintenance hemodialysis is the main renal replacement therapy for patients with end-stage kidney disease,In recent years,with hemodialysis equipment improvement and technological progress, hemodialysis patients significantly prolong their life. Then the complications and mental health problems are more outstanding, especially depression status. Depressed mood is the main characteristic of deprssion, its clinical manifestations can be divided into the core symptoms, the psychological symptoms and somatic symptoms. Depressive hemodialysis patients compared with other chronic conditions have higher incidence of depression, which can obviously affect the prognosis of patients and survival rate.The incidence of depression is 2%--5% among general population,otherwise it is 20%--30% among patients of chronic kidney disease. It is obviously higher than other chronic conditions,such as congestive heart failure(14%), and acute myocardial infarction was 16%. In chronic renal failure patients, it is very common to see that patients have malnutrition,inflammation,atherosclerosis,and it is named MIA syndrome.The components of MIA syndrome can interact each other and can influence the quality of life and surial.Meanwhile,depression also can influence malnutrition,inflammation,atherosclerosis,and there must be some relations between depression and MIA syndrome.Objective To investigate the relations of depression and the components of MIA syndrome among Maintenance Hemodialysis patients.Method Fifty-seven patients with ESRD, who were on maintenance hemodialysis MHD), were evaluated the depression status using Self-Rating Depression Scale (SDS), the nutrition ststus by Modified Subjective Global Assessment of Nutrition(MSGAN) and the atherosclerosis by intima media thickness (IMT).The biochemical parameters including high sensitivity C—reactive protein(hs—CRP) serum albumin(Alb), hemoglobin(Hb), Serum creatinine(SCr)and urea nitrogen(BUN) were measured in ESRD patients. The patients were divided into depression group (SDS scale≥40)and control group (SDS scale<40)according to the SDS scale to compare with the level of hs—CRP, malnutrition score(MS), intima media thickness (IMT) and some other biochemical parameters.Results Nineteen patients (33.3%)had SDS scale higher than or equal to 40, which is recommended for the diagnosis of depression. The mean values of hs-CRP,MS and IMT in the depression group were significantly greater than those in control group (P<0.01). The levels of serum Alb and Hb were significantly lower than those in control group(P<0.01). There were no significant diferences in serum BUN,SCr,Age,Gender and Dialysis duration in two groups(P >0.05).The SDS scale showed a significant positive correlation with MS,hs-CRP and IMT (P<0.05).Conclusion Depression is observed highly in MHD patients,which is related closely to Malnutrition,inflammation and atherosclerosis.The patients with the components of MIA syndrome should be evaluated for depression status..