Chronic Kidney Disease (CKD) has emerged as a major public health problem worldwide causing adverse physical, psychological and economic outcomes. Mental health is defined as ‘not merely the absence of disease but a state of well-being in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to her or his community.

Depression is currently the leading cause of disability in the world and is one of the major contributors to the global burden of disease. The prevalence of depression is around 10% which increases to 10–45% in patients with co-morbid medical conditions.

Among various psychiatric disorders, depression is the most common psychiatric disorder among CKD patients, frequently observed as renal function deteriorates. A greater mortality rate observed among CKD patients who are depressed cannot be completely attributed to CKD.

Differentiating clinical depression from some of the symptoms of CKD can be difficult, due to symptom overlap. Lack of energy, loss of appetite and lack of sexual desire are some symptoms that may interfere with differentiating depression from CKD.

Chronic kidney disease has become a major health problem in the North Central Province (NCP) of Sri Lanka during the past two decades and this is mainly due to CKD which cannot be attributed to any known aetiology (CKDu).
There are records of an exponential increase in the number of cases of CKDu in the NCP since the early 1990s. 

A population-based descriptive cross-sectional study was conducted in the district of Anuradhapura in the North Central Province (NCP) of Sri Lanka. The study population consisted of confirmed CKD patients who were over 18 years old with documented evidence of CKD, living in the Anuradhapura district. The diagnosis of CKD was made if the Glomerular Filtration Rate (GFR) was <60 ml/min per 1.73 m2 body surface area in two measurements made three months apart.

The prevalence of depression was found to be 65.2%. The prevalence of psychological distress among the study participants was found to be 75.0% The study assessed depressive symptoms, psychological distress and emotional wellbeing among CKD patients.
Higher education status and being employed were important predictors of higher health-related quality of life (HRQOL), while advanced stages of CKD, being positive for depression and being positive for psychological distress were significantly associated with low HRQOL.

Periodical screening of the CKD patients for depression and psychological distress and measures to alleviate symptom burden seems to be important and practical aspects that can be implemented to improve the overall quality of life of these patients.

References

1. Depression and psychological distress in patients with chronic renal failure: Prevalence and associated factors in a rural district in Sri Lanka-Senanayake- et al – Journal of Psychosomatic research ( Volume 112, September 2018, Pages 25-31)
2. Health related quality of life in chronic kidney disease; a descriptive study in a rural Sri Lankan community affected by chronic kidney disease- Senanayake et al- (Health and Quality of Life Outcomes volume 18, Article number: 106 (2020))