Prevalence and Correlates of Depression in Patients With Chronic Kidney Disease Undergoing Maintenance Hemodialysis at a Tertiary Care Center in Kerala

IntroductionChronic kidney disease (CKD) is a disabling illness with significant physical, psychological and social consequences.Patients undergoing hemodialysis are at increased risk of developing depressive disorders.Biochemical derangements associated with kidney disease, compounded by the psychological burden of physical and social disability, are established contributory factors.Data on the prevalence and correlates of depression in CKD patients in Kerala remain scarce.Identification of depression in early stages is important in CKD patients as it is a significant predictor of disease progression, hemodialysis initiation, hospitalization, and death.This study aimed to determine the prevalence of depression in CKD patients on maintenance hemodialysis and to identify any sociodemographic, clinical, or biochemical correlates. Materials and methodsA cross-sectional descriptive study was conducted in the Department of Nephrology, Government T.D. Medical College, Alappuzha, Kerala, over a period of one year.A total of 120 participants were enrolled in the study using consecutive sampling.Sociodemographic, clinical, and biochemical data were collected using a specially designed proforma.Depression was clinically diagnosed by a psychiatrist using ICD-10 Diagnostic Criteria for Research (ICD-10-DCR).The severity of the depressive episode was assessed using the Beck Depression Inventory-II (BDI-II).Data were analyzed using appropriate statistical tests.Multiple linear and binary logistic regression analyses were performed to identify the variables independently associated with the diagnosis of depression and depressive symptom severity. ResultsThe prevalence of depression was 42.5% (51 of 120 patients; 95% CI 34.0-51.4%).Among depressed participants, severity was mild in 18 (35.3%),moderate in 26 (51.0%), and severe in 7 (13.7%).The mean BDI-II score for the whole sample was 17.25 ± 6.59.In univariate analysis, depression was significantly associated with socioeconomic status, low body mass index, shorter duration of dialysis, erythropoietin therapy, hyponatremia, hypocalcemia, lower hemoglobin, lower serum albumin, and higher high-sensitivity C-reactive protein (hs-CRP).In multiple linear regression, lower hemoglobin (β = -0.267,p = 0.002) and lower serum sodium (β = -0.236,p = 0.006) remained independently associated with a higher BDI-II score, with the model accounting for 30.8% of the variance (adjusted R² = 0.271, F = 8.367, p < 0.001).In binary logistic regression, hemoglobin was the only variable independently associated with depression status, with each 1 g/dL lower hemoglobin corresponding to 8.20-fold higher odds of depression (95% CI 2.56-26.32,p < 0.001); hyponatremia fell just short of conventional significance (adjusted OR 2.55, 95% CI 1.00-6.54,p = 0.051). ConclusionThe high prevalence of depression among CKD patients undergoing maintenance hemodialysis suggests that clinicians should actively screen for depressive symptoms in these patients, especially those with the identified biochemical risk factors, to enable early identification and improve quality of life.