Depression in Hemodialysis Patients

Depression is one of the most and highly
common complications of hemodialysis (HD)
patients that is associated with many various
adverse outcomes, including lower performance
status, increased fatigue, decreased physical
activity, and decreased quality of life.1 Its
prevalence among HD patients may exceed
those of many other patients with severe
chronic condition.2
In recent decades, treatment methods such as
HD have lengthened the life of many patients
with end-stage renal disease, and now widely
accepted that quality of life promotion is an
important outcome of these options.3
Although dialysis as a treatment modality has
been effective at sustaining life in many
patients, it has failed to restore their healthy
condition. Hospitalization is often frequent
and prolonged for them, and many studies
have suggested that patients on HD experience
unacceptable degrees of functional capacity,
health-related quality of life, and morbidity
with their disease.4
On the other hand, shortage of nephrologists,
inadequate health education about preventive
measures, late referral of the patients, a lack of
more cost-effective alternative treatment options
such as or peritoneal dialysis or renal transplantation
are significant issues which contribute to
patients psychological well being. Inadequate
insurance coverage further aggravates the
problems for the patients and their family and
increases psychologic consequences like
depression.5
Depression is as incapacitating as the kidney
disease itself and should be given more consideration.
Depression that is not treated may
lead to poor prognosis of kidney disease and
should be manage to prevent its complications
and costs.6
It is obvious that health providing setting are
seeking a way to decrease readmissions, improve
medication reconciliation and patients’ safety
in their homes. Patients and their families
education for self-care is a useful trend.7
Thus, a major challenge for health care providers
is to develop methods to better management
depression. Recently, consideration has
begun to be focused on kinds of treatment
strategies.8
Even though there is a little evidence for
health benefits from treatment of depression,
treatment should be offered to HD patients.
Unfortunately, depression has stigma, and
many patients are