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

Abstract

Background: Chronic kidney disease (CKD) is a global health concern projected to be the fifth most prevalent chronic disease by 2040, associated with high mortality and significant psychosocial burdens.
Aim: This study aimed to explore and describe the correlation between depression and haemodialysis adequacy in CKD patients.
Setting: Research was conducted across five units in the Free State and Northern Cape provinces, South Africa.
Methods: This quantitative, cross-sectional, prospective analytic study included 78 patients selected via convenience sampling, and trustworthiness and ethical principles were adhered to throughout the study. A biostatistician analysed the raw data using the statistical analysis system (SAS). Data collected over 3 months involved objective measurements of online dialysis adequacy (Kt/V) and pathology (creatinine, urea), alongside subjective depression assessments using the Beck Depression Inventory (BDI).
Results: The median BDI score was 17 (Interquartile range [IQR]: 13–22), reflecting mild-to-severe depressive symptoms. The median online Kt/V was 1.04. A significant inverse association was found between BDI scores and Kt/V (p = 0.0231), indicating that higher depressive symptoms correlate with lower adequacy. No significant relationships were observed between depression and creatinine or urea levels.
Conclusion: Lower dialysis adequacy is significantly associated with increased depressive symptoms. Findings highlight the urgent need to integrate mental health screening and psychosocial support into routine renal care to improve patient outcomes.
Contribution: The findings highlight the necessity of psychosocial support, patient compliance, and education to improve employment and nutritional security, and advocate for comprehensive medical insurance coverage.