Abstract

The hemodialysis patient is at risk for a high inflammatory state as evidenced by the elevation of the pro-inflammatory cytokine, interleukin-6 which has been linked to lower serotonin levels and development of depression. The biological and psychological stress of living with End Stage Renal Disease on hemodialysis increases the risk for depression which is the leading psychological disorder affecting these patients which is also underdiagnosed and under-treated. The phenomenon of depression can manifest itself in the maladaptive behavior of non-adherence which has been associated with increased mortality, morbidity and decreased quality of life for the hemodialysis patient. The purpose of this study is to determine if there is relationship between inflammation, depression and non-adherence among persons in End Stage Renal Disease on hemodialysis. Prior studies have shown a link between inflammation and depression and depression and non-adherence, but little is known about the possible relationship between inflammation and non-adherence with depression as a mediating factor. Establishing this relationship may build a framework upon which to develop future interventional studies to understand the links between the phenomena and approaches towards addressing nonadherence in the hemodialysis population. This study examined the relationship between inflammation, depression, and non-adherence in Hemodialysis (HD) patients. A total of 67 subjects on HD at least three times a week, 3 hours per treatment with a minimal vintage of 12 months were included. Interleukin-6, a twelve- month average of phosphorous and potassium levels, intradialytic weight gains (IDWG) and number of missed/shortened treatments, Beck Depression Inventory II (BDI-II) scores, and End Stage Renal Disease Adherence Questionnaire (ESRD-AQ) scores were collected. Depression prevalence was 48%. There were significant relationships between IL-6 and BDI-II scores (p=0.001); BDI-II as a predictor of IDWG(p=0.048); Il-6 and IDWG, ESRD-AQ total and Diet, Medication and Treatment score percentages (p=0.002-0.05). IL-6 was not a significant predictor of IDWG with BDI-II scores as a mediating factor.

LLU Discipline

Nursing

Department

Nursing

School

School of Nursing

First Advisor

Ellen D'Errico

Second Advisor

Fayette Nguyen Truax

Third Advisor

Jack Rubin

Degree Name

Doctor of Philosophy (PhD)

Degree Level

Ph.D.

Year Degree Awarded

2019

Date (Title Page)

9-2019

Language

English

Library of Congress/MESH Subject Headings

Kidney Failure, Chronic; Quality of Life; Renal Dialysis; Depression; Inflammation

Type

Dissertation

Page Count

xv, 136 p.

Digital Format

PDF

Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.

Collection

Loma Linda University Electronic Theses and Dissertations

Collection Website

http://scholarsrepository.llu.edu/etd/

Repository

Loma Linda University. Del E. Webb Memorial Library. University Archives

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Nursing Commons

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