Depression is associated with frailty and lower quality of life in haemodialysis recipients, but not with mortality or hospitalization

Benjamin M Anderson; Muhammad Qasim; Gonzalo Correa; Felicity Evison; Suzy Gallier; Charles J Ferro; Thomas A Jackson; Adnan Sharif

doi:10.1093/ckj/sfac241

Depression is associated with frailty and lower quality of life in haemodialysis recipients, but not with mortality or hospitalization

Clin Kidney J. 2022 Oct 31;16(2):342-354. doi: 10.1093/ckj/sfac241. eCollection 2023 Feb.

Authors

Benjamin M Anderson^{1

2}, Muhammad Qasim^{1

3}, Gonzalo Correa⁴, Felicity Evison⁵, Suzy Gallier^{5

6}, Charles J Ferro^{1

7}, Thomas A Jackson^{2

8}, Adnan Sharif^{1

3}

Affiliations

¹ Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham, UK.
² Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.
³ Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.
⁴ Department of Nephrology, Hospital del Salvador, Santiago, Chile.
⁵ Department of Health Informatics, Queen Elizabeth Hospital, Birmingham, UK.
⁶ PIONEER: HDR-UK hub in Acute Care, Edgbaston, Birmingham, UK.
⁷ Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.
⁸ Department of Healthcare for Older People, Queen Elizabeth Hospital, Birmingham, UK.

Abstract

Background: Frailty and depression are highly prevalent in haemodialysis recipients, exhibit a reciprocal relationship, and are associated with increased mortality and hospitalization, and lower quality of life. Despite this, there has been little exploration of the relationship between depression and frailty upon patient outcomes. We aimed to explore the relationship between depression and frailty, and their associations with mortality, hospitalization and quality of life.

Methods: We performed a prospective cohort study of prevalent haemodialysis recipients linked to national datasets for outcomes including mortality and hospitalization. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9), frailty using the Clinical Frailty Scale (CFS) and quality of life using the EuroQol 5-Dimension (EQ-5D) Summary Index.

Results: A total of 485 prevalent haemodialysis recipients were recruited, with 111 deaths and 1241 hospitalizations during follow-up. CFS was independently associated with mortality [hazard ratio (HR) 1.31; 95% confidence interval (CI) 1.08, 1.59; P = .006], hospitalization [incidence rate ratio (IRR) 1.13; 95% CI 1.03, 1.25; P = .010] and lower quality of life (Coef. -0.401; 95% CI -0.511, -0.292; P < .001). PHQ-9 score was independently associated with lower quality of life (Coef. -0.042; 95% CI -0.063, -0.021; P < .001), but not mortality (HR 1.00; 95% CI 0.96, 1.04; P = .901) or hospitalization (IRR 0.99; 95% CI 0.97, 1.01; P = .351). In an adjusted model including CFS, moderate depression was associated with reduced hospitalization (IRR 0.72; 95% CI 0.56, 0.93; P = .013).

Conclusions: With the addition of frailty, depression was associated with lower hospital admissions, but poorer quality of life. The relationship between frailty and depression, and their influence on outcomes is complex, requiring further study.

Keywords: depression; frailty; haemodialysis; health-related quality of life; hospitalization; mortality.