2018 Volume 30 Issue 4 Pages 341-348
Even hemodialysis (HD) patients who are able to perform basic activities of daily living (ADL) and instrumental ADL tasks show high rates of ADL difficulty, i.e., difficulty carrying out routine self-care activities. ADL difficulty is reportedly associated with poor physical function in HD patients. However, the relationship between ADL difficulty and psychological function remains unclear. This study aimed to examine depressive symptoms in HD patients who have perceived difficulty in performing ADL related to mobility. Subjects included 186 Japanese outpatients (mean age, 66.5 years) undergoing maintenance HD three times a week. Clinical characteristics, ADL difficulty related to lower-limb function such as mobility issues, physical function (walking speed), and depressive symptoms (four dimensions of the 10-item CES-D: Depressed Affect, Positive Affect, Somatic and Retarded Activity, and Interpersonal) were measured and compared across three difficulty groups (higher, middle, and lower) as classified according to tertiles of ADL difficulty score. Differences in four dimensions of the CES-D10 were assessed using an analysis of covariance model adjusted for age, albumin, comorbidity index, and walking speed. A significant difference in “Depressed Affect” was observed between higher and middle vs. lower difficulty groups. Moreover, a significant difference in “Somatic and Retarded Activity” was observed between higher vs. middle and lower difficulty groups. No significant differences were observed in the other dimensions between the three groups. These findings suggest that an effective intervention for not only physical function but also the psychological dimension may be needed in order to prevent deterioration of ADL in patients undergoing maintenance HD.
