The Relationship Between Depression and Quality of Life in Patients Undergoing Hemodialysis in Indonesia
Patients undergoing hemodialysis (HD) must spare four hours a day, three days a week, irrespective of the patient’s schedule. Thus, it is common for chronic kidney disease (CKD) patients to be depressed, and with the progression of CKD, their overall quality of life (QOL) could decrease. Therefore, this study aimed to examine the relationship between depression and QOL among patients undergoing hemodialysis in Indonesia. This cross-sectional research was conducted at a West Java Province, Indonesia, public health center, from August to December 2020. The inclusion criteria of participants were over the age of 20 and having been undergoing HD for at least six months. Depression was evaluated using the Beck Depression Inventory-II (BDI-II) and QOL was measured using The Kidney Disease and Life Quality-SFTM v1.3 Survey (The KDQOL-SFTM v1.3). Pearson’s correlation analysis was used to investigate the correlation between depression and QOL. There were 190 respondents out of 225 (response rate: 84.4%), including 100 patients with CKD stages 1-3 (response rate: 75.6%). No correlation was found between demographic characteristics and QOL in HD patients (p > 0.05). The Indonesian KDQOL-SFTM v1.3 was associated with the BDI-II, and r ranged from 00.354 to 0.486. In order to increase QOL, it is recommended that depression is treated with routine follow-up in a collaborative care approach because intensive treatment is not normally reproduced in real-world practices.
Keywords: quality of life, depression, hemodialysis, cross-sectional, Indonesia
 Kassebaum NJ, Arora M, Barber RM, et al. Global, regional, and national disabilityadjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990–2015: A systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388(10053):1603–58.
 Bikbov B, Perico N, Remuzzi G. Disparities in chronic kidney disease prevalence among males and females in 195 countries: Analysis of the Global Burden of Disease 2016 study. Nephron. 2018;139(4):313–8.
 Jain D, Haddad DB, Goel N. Choice of dialysis modality prior to kidney transplantation: Does it matter? World journal of nephrology. 2019;8(1):1–10.
 Kementerian Kesehatan RI Badan Penelitian dan Pengembangan. Hasil utama riset kesehatan dasar. Kementrian Kesehat Republik Indonesia; 2018.
 IRR. 9th report of Indonesian Renal Registry 2016. Indonesian Renal Registry. Jakarta. 2018.
 Lee SW, Lee A, Yu MY, et al. Is frailty a modifiable risk factor of future adverse outcomes in elderly patients with incident end-stage renal disease? Journal of Korean medical science. 2017;32(11):1800–6.
 Shin SJ, Lee JH. Hemodialysis as a life-sustaining treatment at the end of life. Kidney Research and Clinical Practice. 2018;37(2):112–118.
 Park JI, Baek H, Jung HH. CKD and health-related quality of life: The Korea national health and nutrition examination survey. American Journal of Kidney Diseases,. 2016;67(6):851–60.
 Ju A, Tong A. Considerations and challenges in selecting patient-reported outcome measures for clinical trials in nephrology. Clinical Journal of the American Society of Nephrology. 2017;12(11):1882–4.
 Zamanian H, Kharameh ZT. Translation and psychometric properties of the Persian version of the dialysis symptom index in hemodialysis patients. Nephrourol Mon. 2015;7(1):1–6.
 Ganu VJ, Boima V, Adjei DN, et al. Depression and quality of life in patients on long term hemodialysis at a national hospital in Ghana: A cross-sectional study. Ghana medical journal. 2018;52(1):22–8.
 Bonenkamp AA, van Eck van der Sluijs A, Hoekstra T, et al. Health-related quality of life in home dialysis patients compared to in-center hemodialysis patients: A systematic review and meta-analysis. Kidney medicine. 2020;2(2):139–54.
 Kim K, Kang GW, Woo J. The quality of life of hemodialysis patients is affected not only by medical but also psychosocial factors: A canonical correlation study. Journal of Korean medical science. 2018;33(14):e111–e111.
 Teles F, de Azevedo VFD, de Miranda CT, de Melo Miranda MP, Teixeira MDC, Elias RM. Depression in hemodialysis patients: The role of dialysis shift. Clinics. 2014;69(3):198–202.
 Shirazian S, Grant CD, Aina O, Mattana J, Khorassani F. Depression in chronic kidney disease and end-stage renal disease: Similarities and differences in diagnosis, epidemiology, and management. Kidney international reports. 2017;2(1):94–107.
 de Alencar SBV, Dias LA, Dias VA, de Lima FM, Montarroyos UR, de Petribú KCL. Quality of life may be a more valuable prognostic factor than depression in older hemodialysis patients. Quality of Life Research.. 2020;1-10
 Chan L, Tummalapalli SL, Ferrandino R, et al. The effect of depression in chronic hemodialysis patients on inpatient hospitalization outcomes. Blood purification. 2017;43(1–3):226–34.
 Khan A, Khan AH, Adnan AS, Sulaiman SAS, Mushtaq S. Prevalence and predictors of depression among hemodialysis patients: A prospective follow-up study. BMC Public Health. 2019;19(1):531.
 Hedayati SS, Yalamanchili V, Finkelstein FO. A practical approach to the treatment of depression in patients with chronic kidney disease and end-stage renal disease. Kidney international,. 2012;81(3):247–55.
 de Brito DCS, Machado EL, Reis IA, de Freitas do Carmo LP, Cherchiglia ML. Depression and anxiety among patients undergoing dialysis and kidney transplantation: A cross-sectional study. Sao Paulo Medical Journal. 2019;137(2):137– 47.
 Garg AX, Suri RS, Eggers P, et al. Patients receiving frequent hemodialysis have better health-related quality of life compared to patients receiving conventional hemodialysis. Kidney international. 2017;91(3):746–54.
 Himmelfarb JTAI. Chronic kidney disease, dialysis, and transplantation e-book: A companion to Brenner and Rector’s The Kidney. Elsevier Health Sciences. 2018;6:768.
 Chin AI, Appasamy S, Carey RJ, Madan N. Feasibility of incremental 2-times weekly hemodialysis in incident patients with residual kidney function. Kidney international reports. 2017;2(5):933–42.
 Chan LE. Dietary sodium and blood pressure changes in hemodialysis patients undergoing a liberalized renal diet intervention. Illinois State University. 2018.
 Taraz M, Taraz S, Dashti-Khavidaki S. Association between depression and inflammatory/anti-inflammatory cytokines in chronic kidney disease and endstage renal disease patients: A review of literature. Hemodialysis International. 2015;19(1):11–22.
 Ghazavi Z, Rahimi E, Yazdani M, Afshar H. Effect of cognitive behavioral stress management program on psychosomatic patients’ quality of life. Iranian