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RESEARCH ARTICLE
Depression and quality of life among Chronic Kidney Disease Patients on
Hemodialysis at selected Stand-alone Renal Facilities in Manila: A cross-
sectional study
Gil P. Soriano, RN, MHPEd
College of Nursing, San Beda University, Manila, Philippines
*Corresponding Author Email: gil.p.soriano@gmail.com
ABSTRACT:
Background: Chronic Kidney Disease (CKD) is a progressive disease that causes a gradual impairment of the
renal function and has risen in the past years. As its prevalence increase, its impact on the emotional aspect of
the patient may also be escalated in a negative way which can lead to the various types of depression. Objective:
This research examined the relationships of personal profile, level of depression, Physical Composite Score
(PCS), Mental Composite Score (MCS) and Kidney Disease Component Score (KDCS) among chronic kidney
disease patients in stand-alone renal facilities. Methods: A descriptive cross-sectional method was used as the
design of the study and a convenience sample of 220 participants with chronic kidney disease were included in
the study. The Filipino version of Kidney Disease Quality of Life Short Form-36 (KDQOL SF-36) and Beck’s
Depression Inventory (BDI) were used to assess the quality of life and level of depression. Data were analyzed
using descriptive and inferential statistics. Results: The findings revealed a significant negative correlation
between the respondent’s age and physical composite score. On the other hand, a significant negative correlation
was noted between the kidney disease component and mental composite score with the level of depression.
Conclusions: The study concluded that CKD patients with a higher quality of life have a lower level of
depression.
KEYWORDS: Chronic kidney disease, depression, quality of life.
INTRODUCTION:
According to the International Society of Nephrology1,
Chronic Kidney Disease (CKD) is a public health
problem affecting 10% of the world’s population. In
2013, the Philippines, experienced an increase of
incidence of CKD annually in comparison to 2004 and at
present it accounts to an estimated 20% of the Philippine
population2-3. Concurrently, the Department of Health
(DOH) conducted a census on the number of Filipinos
undergoing dialysis which likewise increased from 4000
cases per year in 2004 to 23,000 cases in 2013 4. Since
CKD affects an individual’s overall health, symptoms
such as high blood pressure, anemia, weak bones, poor
nutritional health and nerve damage may develop, just to
Received on 18.01.2019 Modified on 15.02.2019 name a few5. According to Malindretos6, CKD especially
Accepted on 06.03.2019 ©A&V Publications All right reserved end-stage renal disease (ESRD) have a detrimental effect
Asian J. Nursing Education and Research. 2019; 9(2):251-255.
DOI: 10.5958/2349-2996.2019.00053.3
on both patients’ life expectancy, and health related
quality of life.
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Asian Journal of Nursing Education and Research. 9(2): April- June, 2019
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Asian Journal of Nursing Education and Research. 9(2): April- June, 2019
Table 3. Relationship of Demographic Profiles with Level of Depression and Subscales of KDQOL
Profiles PCS MCS KDCS BDI
r p r p r p r p
Age -0.169 0.012* -0.051 0.454 0.032 0.633 0.027 0.695
Gender 0.014 0.835 0.068 0.316 0.126 0.061 -0.007 0.915
Level of Education 0.092 0.175 0.126 0.062 0.022 0.744 -0.027 0.691
Civil Status -0.028 0.678 0.001 0.988 0.031 0.651 0.015 0.124
*p value is significant at <0.05 level
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Asian Journal of Nursing Education and Research. 9(2): April- June, 2019
Table 4 Relationship of subscales of KDQOL with level of which means the lower the age of the respondents, the
depression
higher their level of physical functioning. This finding
R p
Kidney disease component Score (KDCS) -0.178 0.008* was supported by Soni et al.15 which found that older
SF-12 Mental Composite Score (MCS) -0.212 0.002* patients (>65 years) had a poor physical performance
SF-12 Physical Composite Score (PCS) -0.123 0.069 thus having a lower PCS score.
*p value is significant at <0.05 level
The study also revealed that the level of education, as
DISCUSSION: well as civil status, were not relatively significant in
The study aims to determine the relationship of the determining their coping function to their situation. This
demographic profile with the quality of life and level of finding was also supported by Ottaviani et al. (2016)
depression among CKD patients. Health-related quality which stated that civil status and level of education did
of life (HRQOL) plays an important role as a marker on not have any significant relationship to the occurrence of
treating chronic diseases. Its evaluation allows the disease.
measuring the disease consequences according to the
subjective perception of CKD patients. In KDQOL it shows that the lower the KDCS and MCS
leads to a higher level of depression among CKD
Based on the overall KDQOL of the respondents, it was patients. These patients are more expected to report
found that KDCS has the highest score, followed by burden symptoms, physical limitation, and diminished
MCS while PCS has the lowest score. According to quality of life and they were also more like to report fair
Mujais et al.9, PCS was the most affected sub-scale in or poor overall health. These findings were supported by
KDQOL among CKD patients which results to the need Piriano et al16 which stated that a strong correlation
for assistance in performing normal daily routines. The between depression and poor health-related quality of
findings were further supported by Masina, Chimeral, life. Depression was associated with decrements in
Kampondal and Dreyer12 which stated that the scores for multiple domains, including but not limited to kidney-
the PCS were lower as compared to scores in the KDCS disease-related symptoms, the perception of kidney
and MCS domains. The low scores of the study recorded disease as a burden and patients’ self-rated health.
in the domains of energy/fatigue and role physical are
likely to be multi-factorial but may specifically reflect KDQOL is a critical predictor in depression since
untreated anemia. Failure of a patient’s kidneys also KDQOL sums up an individuals’ perception of mental,
limits their physical functioning and energy since their physical and social health. Perception of a patient may
bodies would accumulate toxins that would have been change over time and may suggest a critical predictor in
excreted with normal kidney function. This greatly the overall wellness and how it will or will not affect the
diminishes their functioning the longer their interval of quality of life of an individual.
hemodialysis, hence the low scores as reflected in the
study. Similar to other studies, the dimension of quality of life
which has the lowest score was the occupational status,
In the study the level of depression falls under mild whereas the majority of the respondents have higher
depression, this can be attributed to the culture of scores in the cognitive function and quality of social
Filipinos as family-centered and all around positivism. interaction. In the current study, the effects of daily life,
According to Medina (2001) and Miralao (1994) as cited social support satisfaction, sleep, sexual function, staff
by Morillo, Capuno and Mendoza13 familism is encouragement and satisfaction were higher in women;
embedded in the Filipino culture, translating its however, gender had no effect on HRQOL as cited by
relational quality outside the family. Being family- Rostami17.
centered, child-centric, having close ties, and a large
family size some basic elements of families in the CONCLUSIONS:
Philippines. This provides social support wherein The study concluded that younger patients with CKD
Filipinos tend to deviate their depressive symptoms have a higher level of physical functioning as compared
because of the inherent support and availability of family to older patients. Furthermore, CKD patients with a
members. Furthermore, according to Salikha14 the higher quality of life have a lower level of depression.
Philippines ranked 4th out of 9 countries in a survey
related to the happiest countries in South East Asia and
REFERENCES:
ranked 71st out of 156 countries. 1. Kidney Care UK (2017). An estimated 1 in 10 people worldwide
have chronic kidney disease. Retrieved from
In terms of the relationship of the demographic profiles https://www.kidneycareuk.org/news-and-
with the sub-scales of KDQOL, it was found that the age campaigns/news/estimated-1-10-people-worldwide-have-chronic-
kidney-disease/
showed a significant negative correlation with PCS 2. Magtubo, C.A., (2016). Philippines Struggles with Renal Disease.
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Asian Journal of Nursing Education and Research. 9(2): April- June, 2019
255