PURPOSE: Patients with chronic kidney disease frequently show cognitive dysfunction. The association of depression and cognitive function is not well known in maintenance dialysis patients. We evaluated cognitive impairment and depression, as well as their relationship in regards to methods of dialysis, maintenance hemodialysis (MHD) and chronic peritoneal dialysis (CPD). MATERIALS AND METHODS: Fifty-six maintenance dialysis patients were recruited and their clinical and laboratory data were collected. The Korean version of the mini-mental state exam (K-MMSE) was applied to screen the patient's cognitive function, while the Korean version of the Beck Depression Inventory (K-BDI) was used for depression screening. RESULTS: The average age of the participants was 54.2+/-10.2 years; 29 (51.8%) were female. The average dialysis vintage was 4.2+/-3.8 years. The CPD group showed significantly higher K-MMSE score (27.8+/-2.9 vs. 26.1+/-3.1, p=0.010) and lower K-BDI score (12.0+/-8.4 vs. 20.2+/-10.4, p=0.003) compared with the MHD group. The percentage of patients with depression symptoms was higher in the MHD group (51.7% vs. 18.5%). There was a negative correlation between cognitive function and prevalence of depressive symptoms. Depression and education level were shown to be independent predictors for cognitive impairment in multivariate analysis. CONCLUSION: Cognitive impairment was closely correlated with depression. It is important to detect cognitive impairment and depression early in maintenance dialysis patients with simple bedside screening tools.
Adult ; Cognition Disorders/etiology/*physiopathology ; Depression/etiology/*physiopathology ; Female ; Humans ; Kidney Failure, Chronic/physiopathology/psychology/therapy ; Male ; Middle Aged ; Renal Dialysis/*adverse effects/*psychology

PURPOSE: This study examined the characteristics of fatigue and the relationship between fatigue and its related factors in Korean patients on hemodialysis. METHODS: A cross-sectional correlational study was conducted with 104 patients on hemodialysis in Seoul, Korea. FINDING: Of a total of 104 subjects, eighty-one (77.9%) complained of fatigue. Fatigue severity was measured by the self-rating Visual Analogue Scale-Fatigue (VAS-F) with a mean score of 36.5 (SD=17.49, range 2 - 81). The mean duration of fatigue was 3.8 hours (SD=5.3, range 0 - 24). Depression was most significantly correlated with fatigue (beta=.43, p<.00), with interdialytic weight gain (beta=.25, p<.05) being the second most significant correlate. CONCLUSION: This study shows that nursing interventions for patients who experience fatigue while on hemodialysis should be focused on both psychological problems, such as depression, as well as on physiological problems, such as interdialytic weight gain.
Risk Factors ; Renal Dialysis/*adverse effects ; Regression Analysis ; Multivariate Analysis ; Male ; Korea ; Humans ; Female ; Fatigue/*etiology/physiopathology/psychology ; Depression/complications ; Cross-Sectional Studies ; Adult

PURPOSE: This study was done to provide fundamental data for developing a depression prediction model by discovering main factors that affect depression in patients who do maintenance hemodialysis. METHOD: The subjects were 191 patients doing maintenance hemodialysis selected from outpatient dialysis clinics at 9 major general hospitals, The Instrument tools utilized in this study were adapted from depression, fatigue, sleep disturbance, stress, adaptation,symptoms, daily activities, and role limitation and thoroughly modified to verify reliability and validity. The collected data was analyzed with a SPSS-PC 11.0 Window Statistics Program for real numbers, percentage, average, standard deviation, and multiple regression. RESULTS: The correlation factor for depression was (M=2.54) fatigue(M=3.12), sleep disturbance (M=2.82), stress(M=3.04), adaptation(M=2.53), daily activities(M=2.24), symptoms(M=2.37), and role limitation(M=2.24). The strongest factor that affected depression was explained by symptoms of the patients who performed hemodialysis. The analysis of the factors that affected depression revealed a 58.4% prediction in symptoms, stress, role limitation, and adaptation. CONCLUSION: It has been confirmed that the regression equation model(Depression=7.351 + .266*symptoms + .260*stress -.189*adaptation + .057*fatigue) of this research may serve as a prediction factor for depression in Hemodialysis Patients.
Stress, Psychological/etiology ; Sleep Disorders/etiology ; Risk Factors ; Renal Dialysis/adverse effects/*psychology ; Middle Aged ; Male ; Humans ; Female ; Fatigue/etiology ; Depressive Disorder/diagnosis/*etiology ; Adult

We conducted a study to determine whether the hemocontrol biofeedback system (HBS) can improve intradialytic hypotension (IDH) in hypotension-prone hemodialysis (HD) patients compared with conventional HD. In this multicenter prospective crossover study, 60 hypotension-prone patients were serially treated by conventional HD for 8 weeks (period A), by HD with hemoscan blood volume monitoring for 2 weeks (period B0), and by HBS HD for 8 weeks (period B1). The number of sessions complicated by symptomatic IDH during 24 HD sessions (14.9+/-5.8 sessions, 62.1% in period A vs 9.2+/-7.2 sessions, 38.4% in period B1, P<0.001) and the number of IDH-related nursing interventions in a session (0.96+/-0.66 in period A vs 0.56+/-0.54 in period B1, P<0.001) significantly decreased in period B1 than in period A. Recovery time from fatigue after dialysis was significantly shorter in period B1 than in period A. The patients with higher post-dialysis blood pressure, lower difference between pre- and post-dialysis blood pressure, less frequent IDH, and higher pre- and post-dialysis body weight in period A responded better to HBS in period B1 in regard to the reduction of IDH. In conclusion, HBS may improve the patient tolerability to HD by reducing the IDH frequency and promoting faster recovery from fatigue after dialysis.
Adolescent ; Adult ; Aged ; *Biofeedback, Psychology ; Blood Pressure ; Blood Volume ; Body Weight ; Cross-Over Studies ; Fatigue ; Female ; Humans ; Hypotension/etiology/*prevention & control ; Kidney Failure, Chronic/*therapy ; Male ; Middle Aged ; Prone Position ; Prospective Studies ; Renal Dialysis/adverse effects ; Young Adult