P1512THE RELATIONSHIP AMONG ANXIETY, DEPRESSION AND FRAILTY IN MAINTENANCE HEMODIALYSIS PATIENT
Authors: Yao Lirong , Yin Lianghong , Liu Fanna 
Published: June 2020

Abstract

Background and Aims
The population undergoing maintenance hemodialysis (MHD) is increasing dramatically worldwide, particularly in China. MHD patients have a high prevalence of frailty, which can cause increased vulnerability to adverse health outcomes, such as psychological disorders and reduced health-related quality of life. Both psychological disorders and frailty are prevalent and burdensome in MHD patient. However, the relationships between these entities are unclear. The aim of this study was to investigate the prevalence and associations between frailty and psychological disorders in Southern Chinese MHD patients.

Method
A multicenter, cross-sectional and observational investigation was conducted at 4 hemodialysis centers. Frailty was evaluated with the Tilburg Frailty Indicator (TFI) and it was used as the self-reported questionnaire. Anxiety symptoms was assessed by the Self-Rating Anxiety Scale (SAS), depressive symptoms was assessed by the Self-Rating Depressive Scale(SDS). The sociodemographic and clinical characteristics of the patients who complete the scales were collected. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) software version 20.0 for Windows.

Results
Of the 623 patients visiting each institution, 300 were enrolled in this study. The mean age was 61.95±13.64 years, with mean duration of HD 30.7 (43.39±2.36) months.116 patients (38.7%) were female and 133 (44.3%) had diabetic kidney disease. In total, there were 225 patients (75%) were evaluated as frailty (Fig 2). The prevalence of frailty increased steadily with age and was more prevalent in the diabetes mellitus patients.
A multivariate logistic regression analysis revealed that the factors independently associated with frailty were the following: age (odds ratio [OR] =1.053, 95% confidence interval [CI] 1.026∼1.08), Charlson comorbidity index (CCI) (OR = 1.705, 95% CI 1.378∼2.109, P&lt;0.001), diabetes mellitus (DM) (OR =2.107, 95% CI 1.035∼4.288), SAS (OR = 1.157, 95% CI 1.062∼1.26), SDS(OR = 1.094, 95% CI 1.028∼1.165).
The number of subjects with frailty increased steadily with age. Among the elderly subjects, the population ≥ 75 years old had the highest prevalence of frailty (Fig 1). Furthermore, 50% of ≤45 years old patients were frailty, even though frailty is a geriatric syndrome. There was no relationship between the duration of HD and frailty status.
Anxiety and depression symptoms by SAS and SDS were identified in 52.6% and 72.0% of MHD patients. MHD patients with both anxiety and depression generally had higher frailty score. The coexisting frailty and psychological disorder were present in 45.0% patients (Fig 2). There was an additive effect of psychological disorder and frailty on nutritional status. For the groups with frail and psychological conditions and no frail and no psychological conditions, both serum albumin (36.27±3.66, 37.76±3.51 g/L, respectively, p=0.02) and creatinine (842.94±282.97, 1028.84±332.64, respectively, p&lt; 0.0001) decreased; overall SAS score was 55.36±3.87, 42.59±3.69, respectively (p&lt; 0.0001), and SDS score was 65.05±6.50,58.50±9.03, respectively (p&lt; 0.0001).

Conclusion
This study demonstrated that anxiety and depressive symptoms are associated with prevalent frailty in Southern Chinese MHD patients. Older age, diabetes mellitus, CCI and lower serum albumin were associated with frailty among patients on MHD. anxiety and depressive symptoms are independent risk factors of frailty. In addition, age and diabetes are also independent risk factors for frail. And physical frailty should receive more attention in mental health care planning for Chinese MHD patients.