Prevalence and treatment gap of comorbid depression and anxiety in elderly patients with hemodialysis

Table 1 Univariate analysis of comorbid depression and anxiety disorders among elderly hemodialysis patients, n (%)/mean ± SD/median (interquartile range)

Variable	Depression and anxiety group (n = 114)	Non-depressed/non-anxious group (n = 186)	Statistic	P value
Age (years)	73.1 ± 6.0	72.0 ± 5.6	t = 1.613	0.108
Female	62 (54.4)	60 (32.3)	χ² = 15.237	< 0.001
Married	76 (66.7)	139 (74.7)	χ² = 2.354	0.125
Living alone	38 (33.3)	29 (15.6)	χ² = 13.576	< 0.001
Education ≤ primary school	68 (59.6)	74 (39.8)	χ² = 11.856	0.001
Medical payment: Insurance	105 (92.1)	176 (94.6)	χ² = 0.749	0.387
Primary renal disease			χ² = 4.212	0.239
Diabetic nephropathy	46 (40.4)	62 (33.3)
Hypertensive nephropathy	33 (28.9)	64 (34.4)
Chronic glomerulonephritis	14 (12.3)	31 (16.7)
Other/unknown	21 (18.4)	29 (15.6)
Dialysis vintage (years)	3.2 (1.5, 5.5)	2.1 (1.0, 4.0)	Z = -3.362	0.001
Dialysis vintage ≥ 3 years	68 (59.6)	75 (40.3)	χ² = 11.213	0.001
Body mass index (kg/m2)	22.1 ± 3.2	22.6 ± 3.5	t = -1.215	0.225
Charlson Comorbidity Index ≥ 5	78 (68.4)	82 (44.1)	χ² = 17.632	< 0.001
Comorbidities
Hypertension	102 (89.5)	159 (85.5)	χ² = 0.974	0.324
Diabetes mellitus	58 (50.9)	95 (51.1)	χ² = 0.001	0.970
Coronary heart disease	51 (44.7)	72 (38.7)	χ² = 1.116	0.291
Cerebrovascular disease	29 (25.4)	38 (20.4)	χ² = 1.056	0.304
Hemoglobin (g/L)	104.3 ± 13.1	106.4 ± 11.8	t = -1.430	0.154
Serum albumin (g/L)	35.5 ± 4.0	37.6 ± 4.1	t = -4.437	< 0.001
Albumin < 35 g/L	49 (43.0)	45 (24.2)	χ² = 12.115	0.001
Serum creatinine (μmol/L)	678.5 (555.8, 812.3)	712.0 (580.5, 845.5)	Z = -1.105	0.269
Blood urea nitrogen (mmol/L)	24.8 ± 6.1	25.5 ± 5.7	t = -1.013	0.312
Estimated glomerular filtration rate (mL/minute/1.73 m2)	6.5 ± 1.8	6.7 ± 1.6	t = -1.007	0.315
Serum calcium (mmol/L)	2.18 ± 0.21	2.21 ± 0.19	t = -1.265	0.207
Serum phosphorus (mmol/L)	1.98 ± 0.52	1.84 ± 0.48	t = 2.428	0.016
Intact parathyroid hormone (pg/mL)	325.0 (188.5, 486.8)	268.0 (156.0, 398.0)	Z = -2.149	0.032
Serum potassium (mmol/L)	4.7 ± 0.6	4.6 ± 0.5	t = 1.538	0.125
Single-pool Kt/V	1.38 (1.25, 1.52)	1.41 (1.28, 1.55)	Z = -1.486	0.137

Independent-samples t-test, Mann-Whitney U test, or χ² test were applied as appropriate.

Table 2 Multivariate logistic regression analysis of comorbid depression and anxiety disorders among elderly hemodialysis patients

Variable	β	SE	Wald χ²	P value	Odds ratio	95%CI
Sex (female vs male)	0.765	0.248	9.524	0.002	2.15	1.32-3.51
Living status (living alone vs living with others)	1.061	0.264	16.143	< 0.001	2.89	1.72-4.85
Education (primary school or below vs secondary school or above)	0.312	0.231	1.824	0.177	1.37	0.87-2.15
Dialysis vintage (≥ 3 years vs < 3 years)	0.683	0.248	7.589	0.006	1.98	1.21-3.24
Charlson Comorbidity Index (≥ 5 vs < 5)	0.982	0.250	15.426	< 0.001	2.67	1.63-4.38
Serum albumin (< 35 g/L vs ≥ 35 g/L)	0.880	0.255	11.914	0.001	2.41	1.45-4.01
Serum phosphorus (per 1 mmol/L increase)	0.285	0.198	2.071	0.150	1.33	0.90-1.96
Intact parathyroid hormone (per 100 pg/mL increase)	0.103	0.074	1.937	0.164	1.11	0.96-1.28
Constant	-3.521	0.452	60.673	< 0.001	0.030

Table 3 Univariate analysis of treatment gaps among elderly hemodialysis patients with comorbid depression and anxiety disorders, n (%)/mean ± SD/median (interquartile range)

Variable	Treatment group (n = 39)	Treatment-gap group (n = 75)	Statistic	P value
Age (years)	70.2 ± 4.8	73.8 ± 6.1	t = -3.415	0.001
Female	20 (51.3)	42 (56.0)	χ² = 0.243	0.622
Married	28 (71.8)	48 (64.0)	χ² = 0.763	0.382
Living alone	10 (25.6)	33 (44.0)	χ² = 4.912	0.027
Education ≤ primary school	15 (38.5)	44 (58.7)	χ² = 5.678	0.017
Medical payment: Insurance	37 (94.9)	68 (90.7)	χ² = 0.703	0.402
Primary renal disease			χ² = 1.892	0.595
Diabetic nephropathy	18 (46.2)	28 (37.3)
Hypertensive nephropathy	10 (25.6)	23 (30.7)
Chronic glomerulonephritis	5 (12.8)	9 (12.0)
Other/unknown	6 (15.4)	15 (20.0)
Dialysis vintage (years)	3.0 (1.3, 5.2)	3.3 (1.6, 5.7)	Z = -0.823	0.411
Dialysis vintage ≥ 3 years	24 (61.5)	44 (58.7)	χ² = 0.094	0.759
Body mass index (kg/m2)	22.3 ± 3.0	22.0 ± 3.3	t = 0.467	0.641
Charlson Comorbidity Index ≥ 5	26 (66.7)	52 (69.3)	χ² = 0.095	0.758
Comorbidities
Hypertension	36 (92.3)	66 (88.0)	χ² = 0.539	0.463
Diabetes mellitus	21 (53.8)	37 (49.3)	χ² = 0.222	0.637
Coronary heart disease	19 (48.7)	32 (42.7)	χ² = 0.402	0.526
Cerebrovascular disease	8 (20.5)	21 (28.0)	χ² = 0.806	0.369
Psychiatrist-confirmed diagnosis	32 (82.1)	40 (53.3)	χ² = 9.782	0.002
Hemoglobin (g/L)	105.8 ± 12.5	103.6 ± 13.4	t = 0.872	0.385
Serum albumin (g/L)	36.8 ± 3.5	34.9 ± 4.1	t = 2.521	0.013
Albumin < 35 g/L	12 (30.8)	37 (49.3)	χ² = 4.115	0.043
Serum creatinine (μmol/L)	665.0 (548.5, 795.5)	685.0 (560.0, 820.0)	Z = -0.538	0.591
Blood urea nitrogen (mmol/L)	24.5 ± 5.8	25.0 ± 6.3	t = -0.427	0.670
Estimated glomerular filtration rate (mL/minute/1.73 m2)	6.6 ± 1.7	6.5 ± 1.8	t = 0.289	0.773
Serum calcium (mmol/L)	2.20 ± 0.20	2.17 ± 0.21	t = 0.734	0.465
Serum phosphorus (mmol/L)	2.01 ± 0.50	1.96 ± 0.53	t = 0.487	0.627
Intact parathyroid hormone (pg/mL)	315.0 (185.0, 455.0)	330.0 (190.0, 495.0)	Z = -0.634	0.526
Serum potassium (mmol/L)	4.7 ± 0.5	4.7 ± 0.6	t = 0.000	1.000
Single-pool Kt/V	1.39 (1.26, 1.53)	1.38 (1.24, 1.51)	Z = -0.315	0.753

Independent-samples t-test, Mann-Whitney U test, or χ² test were applied as appropriate.

Table 4 Multivariate logistic regression analysis of treatment gaps among elderly hemodialysis patients with comorbid depression and anxiety disorders

Variable	β	SE	Wald χ²	P value	Odds ratio	95%CI
Age (per 1-year increase)	0.112	0.041	7.465	0.006	1.12	1.03-1.21
Education (primary school or below vs secondary school or above)	1.102	0.456	5.841	0.016	3.01	1.23-7.36
Psychiatrist-confirmed diagnosis (yes vs no)	-1.562	0.478	10.676	0.001	0.21	0.08-0.53
Living status (living alone vs living with others)	0.654	0.469	1.945	0.163	1.92	0.77-4.82
Serum albumin (per 1 g/L increase)	-0.085	0.058	2.147	0.143	0.92	0.82-1.03
Constant	-10.235	3.252	9.901	0.002	0.000