This study investigated the relationship between frailty, depression, and health outcomes in haemodialysis patients. Researchers assessed 485 patients using various tools to measure frailty and depression and tracked them for nearly two years. They found that frailty was linked to higher mortality, increased hospitalisations, and lower quality of life. Depression was also associated with lower quality of life, but not with higher mortality or hospitalisations. Interestingly, when considering both frailty and depression, moderate depression was linked to fewer hospitalisations. The study highlights the complex relationship between frailty and depression, suggesting the need for further research to understand their combined impact on patient outcomes.

Abstract

Background

Frailty and depression are highly prevalent in haemodialysis recipients, exhibit a reciprocal relationship, and are associated with increased mortality and hospitalization, and lower quality of life. Despite this, there has been little exploration of the relationship between depression and frailty upon patient outcomes. We aimed to explore the relationship between depression and frailty, and their associations with mortality, hospitalization and quality of life.

Methods

We performed a prospective cohort study of prevalent haemodialysis recipients linked to national datasets for outcomes including mortality and hospitalization. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9), frailty using the Clinical Frailty Scale (CFS) and quality of life using the EuroQol 5-Dimension (EQ-5D) Summary Index.

Results

A total of 485 prevalent haemodialysis recipients were recruited, with 111 deaths and 1241 hospitalizations during follow-up. CFS was independently associated with mortality [hazard ratio (HR) 1.31; 95% confidence interval (CI) 1.08, 1.59; P = .006], hospitalization [incidence rate ratio (IRR) 1.13; 95% CI 1.03, 1.25; P = .010] and lower quality of life (Coef. −0.401; 95% CI −0.511, −0.292; P < .001). PHQ-9 score was independently associated with lower quality of life (Coef. −0.042; 95% CI −0.063, −0.021; P < .001), but not mortality (HR 1.00; 95% CI 0.96, 1.04; P = .901) or hospitalization (IRR 0.99; 95% CI 0.97, 1.01; P = .351). In an adjusted model including CFS, moderate depression was associated with reduced hospitalization (IRR 0.72; 95% CI 0.56, 0.93; P = .013).

Conclusions

With the addition of frailty, depression was associated with lower hospital admissions, but poorer quality of life. The relationship between frailty and depression, and their influence on outcomes is complex, requiring further study.

Author: Benjamin M Anderson, Muhammad Qasim, Gonzalo Correa, Felicity Evison, Suzy Gallier, Charles J Ferro, Thomas A Jackson, Adnan Sharif