International Journal of Nephrology Table 2: Correlation of depressive symptoms (score above 13 ac- cording to Birleson Scale) and no depressive symptoms with clinical and demographic variables. Kt/V hemodialysis Depressive No depressive Variable symptoms symptoms P < 0.05 x ± σ x ± σ Patient’s age 14.67 ± 2.89 14.10 ± 2.78 0.33 Age of patient’s guardian 43.38 ± 7.0 40.16 ± 7.44 0.1 Dialysis time 1.91 ± 1.47 2.47 ± 2.41 0.25 Hematocrit (%) 26.52 ± 6.88 28.28 ± 6.44 0.14 Parathormone (pg./mL) 277.37 ± 245.11 309 ± 385.86 0.68 1.45 ± 0.19 1.39 ± 0.28 0.43 Kt/V peritoneal dialysis 2.15 ± 0.68 2.52 ± 0.65 0.01 impact on the patient’s quality of life, greater than biological or therapy factors [8, 11]. The principal objective of this study was to determine the frequency of levels of depressive symptoms in children with terminal chronic renal insuﬃciency undergoing chronic hemodialysis and chronic peritoneal dialysis and further to ascertain whether there was a relationship with clinical, demographic, or social factors. We used The Modiﬁed Birleson Scale validated in Peru [10]. The adaptation of the original test, Birleson Scale made by Peterson Birleson in England in 1981, used in several studies, was made, and it was evaluated for expert council. It has discharge trustworthiness. 2. Materials and Methods The investigation was a descriptive, case series study. We evaluated children with terminal chronic renal insuﬃciency undergoing dialytic treatment for three months, at the dialysis unit of the nephrology service of the Cayetano Heredia Peruvian University. We selected 84 patients with an average age of 14.76 ± 2.71 years, from which we excluded 14 because they were under 8 years old, two who had Down’s syndrome, and one who declined to participate in the study. Sixty-seven patients (40 female and 27 male) fulﬁlled the inclusion criteria (age between 8 and 18 years, duration of illness ≥3 months, no chronic comorbidities, accepted consent and assent, stable clinically with no psychiatric or psychological comorbidity diagnosed at that time, and knowledge of writing). 43 (64.13%) chronic peritoneal dialysis patients and 24 (35.82%) chronic hemodialysis patients were selected. The Birleson Scale was used to determine the presence of depression and depressive symptoms, being the value 13 as the cut-oﬀ score, where a score of 13–21 evidenced the presence of depressive symptoms and a value of more than 21 demonstrated depression. While the Birleson Scale has been used in disease states, it still has not been validated in ESRD patients, and therefore high scores are suggestive but not diagnostic of clinical depression. For this reason, those variables were recategorized as high and low occurrence of depressive symptomatology in terms of depression and depressive symptoms, respectively, as well as, an absence of 120 100 80 ()%60 40 20 0 Correlation between depressive symptomatology and gender P < 0.04 3 Absence of depressive symptomatology Female Male Low occurrence of depressive symptomatology High occurrence of depressive symptomatology Birlenson scale modiﬁed Figure 1: Correlation between depression symptomatology and gender. depressive symptoms if the score was <13 and the presence of depressive symptoms ≥13. Clinical data were collected from the patient charts and sociodemographic data from the patients and their caregivers. Statistical Procedure. The statistical program Stata v.10 was used for the data analysis. Chi2 and Student’s t were employed to determine statistical signiﬁcance for continuous and categorical variables, and variance analysis was used to compare means. 3. Results The frequency of high depressive symptomatology was 10.45% (n = 7), low depressive symptomatology 43.28% (n = 29), and no depressive symptoms 46.27% (n = 31). Of the children with high occurrence of depressive symptoma- tology, ﬁve (11.63%) were undergoing chronic peritoneal dialysis and two (8.33%) were undergoing hemodialysis. All (100%) of the children with high occurrence of depressive symptomatology were female (P = 0.04), and none of the seven (0%) had a friend to conﬁde in (P = 0.03) (Table 1 and Figure 1). The occurrence of depressive symptomatology in patients with CPD was associated with a lower weekly Kt/V compared to those with absence of depressive symptomatol- ogy (2.15 ± 0.68 versus 2.52 ± 0.65; P = 0.01) (Table 2). Twenty (83.33%) of the children undergoing hemodial- ysis were from Lima, and 25 (58.14%) of the children undergoing chronic peritoneal dialysis were from a province outside the capital (P = 0.02). Of the patients undergoing chronic peritoneal dialysis, 35 (81.40%) had both parents, but ﬁve (11.63%) had only one parent, giving a P = 0.027 (Table 3). We found some relationship between high occurrence of depressive symptomatology and feelings, as follows: not