The correlation between depression and adequacy in chronic haemodialysis patients in South Africa

Abstract

Introduction Chronic Kidney Disease (CKD) is a global public health concern, contributing to a wide range of social, physical, psychological and economic burdens. CKD is one of the most prevalent non-communicable diseases worldwide. Survival rates for CKD patients remain poor, with annual mortality exceeding 10%, and five-to-ten-year survival at approximately 50%. Methods This prospective analytic study was conducted across five in-centre haemodialysis centres located in the Free State and Northern Cape provinces of South Africa. The study included 78 adults aged 18 to 65 years, all diagnosed with CKD and undergoing in-centre haemodialysis. Depression levels were assessed using the Beck Depression Inventory (BDI) questionnaire, while clinical pathology markers (urea and creatinine) were evaluated using blood samples. Online dialysis adequacy was determined by recording the calculated Kt/V on the dialysis machines. Data were collected over three months, with Kt/V values measured during each session. Descriptive statistics were analyzed using frequencies, percentages, and averages. Shapiro-Wilk tests were applied to determine p-values, with a significance threshold of 0.05. Spearman Correlation Coefficients were used to assess relationships between variables. Results The median BDI total score was 17, with an interquartile range of 13 to 22, and a maximum score of 50. The overall median Kt/V value was 1.04. A significant correlation was observed between BDI total scores and the overall average Kt/V value, with a p- value of 0.0231. However, no significant relationship was identified between BDI total scores and overall creatinine or urea levels. Conclusion The findings confirm that achieving minimum Kt/V targets is associated with improved morbidity and mortality outcomes for haemodialysis patients. This study highlights the potential of psychosocial interventions to alleviate depression symptoms. It is strongly recommended to raise awareness of the psychological well-being of CKD patients.