Depression is the most common psychological complication and may increase mortality
in chronic hemodialysis patients. Because depression could be associated with poor
oral intake and activation of proinflammatory cytokines that could further increase
mortality by malnutrition, we investigated the relation between depression and nutritional
status in chronic hemodialysis patients.
Sixty-two Korean patients completed the Beck Depression Inventory (BDI) questionnaire,
and the diagnosis of depression was confirmed by Diagnostic and Statistical Manual
of Mental Disorders, Fourth Edition (DSM-IV) criteria for major depressive disorder.
Nutritional status was evaluated using serum albumin level, normalized protein catabolic
rate, subjective global assessment (SGA), and anthropometric measurement.
Mean BDI score was 22.7 +/- 11.4, and 35 patients (56.5%) had a BDI score greater
than 21, which is the suggested cutoff score for the diagnosis of depression for the
Korean population. Of 40 patients who had a score higher than 18 on the BDI, 34 patients
met DSM-IV criteria for major depressive disorder. BDI score correlated negatively
with a variety of nutritional parameters: serum albumin level (r = -0.47; P < 0.001),
normalized protein catabolic rate (r = -0.32; P < 0.05), SGA (r = -0.47; P < 0.01),
triceps skinfold thickness (r = -0.40; P < 0.05), midarm muscle circumference (r =
-0.57; P < 0.01), and body mass index (r = -0.28; P < 0.05). Multiple regression analysis
also identified BDI score as an independent determinant for all kinds of nutritional
parameters.
In patients on chronic hemodialysis therapy, depression is related closely to nutritional
status and could be an independent risk factor for malnutrition.