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Depression and quality of life among Chronic Kidney Disease Patients on
Hemodialysis at selected Stand-alone Renal Facilities in Manila: A crosssectional study
Article in Asian Journal of Nursing Education and Research · April 2019
DOI: 10.5958/2349-2996.2019.00053.3
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Asian Journal of Nursing Education and Research. 9(2): April- June, 2019
2231-1149 (Print)
2349-2996 (Online)
DOI: 10.5958/2349-2996.2019.00053.3
Available online at
ISSN
Vol. 09| Issue-02|
April- June 2019
www.anvpublication.org
Asian Journal of
Nursing Education and Research
Home page www.ajner.com
RESEARCH ARTICLE
Depression and quality of life among Chronic Kidney Disease Patients on
Hemodialysis at selected Stand-alone Renal Facilities in Manila: A crosssectional study
John Rommel P. Cunanan, Christian R. Navarro, Peter Angelo J. Robles, Danielle Mary B.
Sanchez, Gerard Josef H. Tuazon, and 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:
Received on 18.01.2019
Accepted on 06.03.2019
Modified on 15.02.2019
©A&V Publications All right reserved
Asian J. Nursing Education and Research. 2019; 9(2):251-255.
DOI: 10.5958/2349-2996.2019.00053.3
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 20134. 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
name a few5. According to Malindretos6, CKD especially
end-stage renal disease (ESRD) have a detrimental effect
on both patients’ life expectancy, and health related
251
Asian Journal of Nursing Education and Research. 9(2): April- June, 2019
quality of life. Health-related quality of life (HRQOL) is
an essential indicator of disease problem and effectively
used to treat and determine the risks for adverse
outcomes7. HRQOL has the notion that quality of life is
a highly individual construct that must contemplate the
expectations
and
attainments
of
individual8.
Understanding the abstract model of HRQOL enables
the clinician to decide if HRQOL evaluation will be
helpful being taken care of by an individual patient8. The
frailty and burden of CKD symptoms and comorbidities
greatly affect the psychological status of patients which
may lead to depression9.
METHODS:
Design overview and sampling technique:
The study utilized a descriptive cross-sectional research
as the design of the study and convenience sampling for
the selection of participants. The minimum sample size
for the study were 220 patients diagnosed with chronic
kidney disease (CKD) on hemodialysis which was
computed based on the total population of patients with
CKD in Manila (1,780 individuals) It was computed
using the formula for estimating the population
proportion based on the following information: (1)
confidence level is set at 95%; (2) expected population
of CKD patients with depression at 23.7% (Amira,
Depression is known to influence adults with ESRD and 2011); and (3) a margin of error of 5%. Open Epi
ascribed to psychosocial and biologic changes that website was utilized in this sample size calculation.
compliment with dialysis. Recent examination has
demonstrated that patients with CKD who are not Setting of the Study:
receiving dialysis have rates of depression up to three The study was conducted in six (6) standalone renal
times higher than those in the local community10. As a facilities in Manila. This were chosen setting due to the
rule, depressed patients are at higher risk for suicide and proximity of the area to the researchers. According to the
resistance with treatment. They additionally have higher Philippine Society of Nephrology11, there were 8
morbidity and mortality caused by renal disease.
accredited renal facilities in Manila. Standalone dialysis
centers were able to provide the best and accurate data
Chronic kidney disease is an arduous process wherein collection among CKD patients.
the patient will take time, commitment and compliance
to medical treatment in order to prevent the progression Instrumentation:
of the disease. Quality of life has been very significant to The researchers were able to utilized two instrumental
a chronically ill individual, considering and knowing the tools which include Kidney-Disease Quality of Life-36
level of their quality of life will help the healthcare SF (KDQOL) Filipino Version to determine the health
providers to determine their basic and most important related quality of life and Beck’s Depression Inventoryneeds. Through this study, the researchers aim to fulfill Filipino Version to determine the level of depression
the answer the relation between quality of life and the among patients with CKD.
coping mechanisms among CKD patients and other
chronically ill individuals1. The casual pathways of Data Collection Procedures:
depression in CKD and ESRD together with the Prior to the collection of data, a letter of approval to
evaluation of interventions to prevent and treat conduct the study were obtained from the selected standdepression10.
alone renal facilities. After approval of ethics and from
the standalone renal facilities the researchers screened
These are the realities that prompted the researchers to the participants following the inclusion and exclusion
conduct the study of quality of life and depression criteria set in the study.
among patient with CKD in selected stand-alone renal
facilities. It is hoped that the relationship between the Before administering the questionnaire to the
HRQOL and level of depression would be understood.
participants, scheduled were arranged with the respective
standalone renal facilities for data gathering. A
Purpose:
facilitated questionnaire was given to the participants
The objectives of the study were to:
and was given 30 minutes to answer the BDI and
1. Determine the demographic profile, quality of life and KDQOL Filipino version questionnaire.
the level of depression among chronic kidney disease
patients.
Data Analysis:
The data gathered were analyzed using IBM SPSS
2. Correlate the demographic profile of the respondents Statistics for Windows, Version 23.0. Armonk, NY:
with the quality of life and level of depression.
IBM Corp. with a p-value of 0.05 was considered
statistically
significant.
Specifically,
frequency,
3. Determine the relationship between the quality of life percentage, mean and standard deviation Pearson’s r
and depression among chronic kidney disease
correlation.
patients.
252
Asian Journal of Nursing Education and Research. 9(2): April- June, 2019
FINDINGS:
Demographic Profile of the Respondents:
A total of 220 CKD respondents completed the Filipino
version of KDQOL-SF questionnaire from different
stand-alone renal facilities. The majority of these
respondents have age ranging from 49-58 years old
(28.63%) followed by 19-28 years old (8.21%), 29-38
years old (17.27%), 39-48 years old (20.45%), 59-68
years old (17.27%), 69-78 years old (6.36%) and 79
years old and above (1.81%).
Table 1. Demographic Profiles of the Respondents
Profile (n=220)
Descriptor
n
Age
19-28
18
29-38
38
39-48
45
49-58
63
59-68
38
69-78
14
79-Above
4
Male
109
Gender
111
Female
7
Level of
Elementary Undergraduate
education
High School
13
56
Undergraduate
High School Graduate
58
73
Vocational/College
13
Undergraduate
College Graduate
Post-Graduate
Single
58
Civil Status
162
Married
%
8.21
17.27
20.45
28.63
17.27
6.36
1.81
49.5
50.5
3.2
5.9
25.5
26.4
33.2
5.9
Quality of Life and Level of Depression among
Chronic Kidney Disease Patients:
Table 2 shows the mean scores of BDI and subscales of
KDQOL. Results revealed that the KDCS has the highest
mean score of 53.10 among the three components of
KDQOL followed by MCS (M=51.93, SD= 16.18) and
PCS (M=40.90, SD=17.03).
Table 2. Mean Scores of BDI and Domain and subscales of
KDQOL
Mean
SD
Kidney disease component Score (KDCS)
53.10
8.02
SF-12 Mental Composite Score (MCS)
51.93
16.18
SF-12 Physical Composite Score (PCS)
40.90
17.03
16.94
10.1
Beck’s Depression Inventory
In terms of the level of depression, results revealed that
there was a low depression among the participants based
on the mean score of 16.94. In summary, BDI has an
overall score of 63 and this means the lower the score of
BDI, the lower the level of depression among CKD
patients.
Relationship of the Demographic Profiles with the
Level of Depression and Subscales of KDQOL:
Table 3 shows the relationship of demographic profiles
with the level of depression and subscales of KDQOL. A
Pearson product-moment correlation coefficient was
26.4
calculated to assess the relationship between the
73.6
variables. Results revealed that there was significant
negative correlation between the age and the PCS (r= In terms of their civil status, 162 were married
0.169, n=220, p= 0.012). This means that the lower the
respondents (73.6%) while 58 (26.4%) were single. age of the respondents, the higher the level of physical
There were also 109 male respondents (49.5%) and 111 functioning. However, no significant correlation was
female respondents (50.5%).
noted with the other demographic profiles with regards
to MCS, KDCS, and BDI.
Majority of the respondents received formal education
(73 or 33.2%) while 7 (3.3%) reached elementary, 13
Relationship of subscales of KDQOL with level of
(5.9%) were high school undergraduate, 56 (25.5%) depression:
were high school graduate, 58 (26.4%) were vocational/ Table 4 shows the relationship of subscales of KDQOL
college undergraduate while 13 (5.9%) have post- with level of depression. Out of the three components of
graduate degree.
KDQOL, significant negative correlation in the
subscales of KDCS and MCS with the level of
depression were noted as proven by p value of <0.05.
This means that the higher the score of KDCS and MCS,
the lower the level of depression.
Table 3. Relationship of Demographic Profiles with Level of Depression and Subscales of KDQOL
PCS
MCS
KDCS
Profiles
r
p
r
p
r
Age
-0.169
0.012*
-0.051
0.454
0.032
Gender
0.014
0.835
0.068
0.316
0.126
Level of Education
0.092
0.175
0.126
0.062
0.022
Civil Status
-0.028
0.678
0.001
0.988
0.031
*p value is significant at <0.05 level
253
p
0.633
0.061
0.744
0.651
BDI
r
0.027
-0.007
-0.027
0.015
p
0.695
0.915
0.691
0.124
Asian Journal of Nursing Education and Research. 9(2): April- June, 2019
which means the lower the age of the respondents, the
higher their level of physical functioning. This finding
was supported by Soni et al.15 which found that older
patients (>65 years) had a poor physical performance
thus having a lower PCS score.
Table 4 Relationship of subscales of KDQOL with level of
depression
R
p
Kidney disease component Score (KDCS)
-0.178
0.008*
SF-12 Mental Composite Score (MCS)
-0.212
0.002*
SF-12 Physical Composite Score (PCS)
-0.123
0.069
*p value is significant at <0.05 level
The study also revealed that the level of education, as
well as civil status, were not relatively significant in
determining their coping function to their situation. This
finding was also supported by Ottaviani et al. (2016)
which stated that civil status and level of education did
not have any significant relationship to the occurrence of
the disease.
DISCUSSION:
The study aims to determine the relationship of the
demographic profile with the quality of life and level of
depression among CKD patients. Health-related quality
of life (HRQOL) plays an important role as a marker on
treating chronic diseases. Its evaluation allows
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 kidneythe 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
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