title: Depression in hemodialysis patients: the role of dialysis shift.
abstract: OBJECTIVE
  Depression is the most important neuropsychiatric complication in chronic kidney disease because it reduces quality of life and increases mortality. Evidence demonstrating the association between dialysis shift and depression is lacking; thus, obtaining such evidence was the main objective of this study.
  
  
  METHODS
  This cross-sectional study included patients attending a hemodialysis program. Depression was diagnosed using Beck's Depression Inventory. Excessive daytime sleepiness was evaluated using the Epworth Sleepiness Scale.
  
  
  RESULTS
  A total of 96 patients were enrolled (55 males, age 48±14 years). Depression and excessive daytime sleepiness were observed in 42.7% and 49% of the patients, respectively. When comparing variables among the three dialysis shifts, there were no differences in age, dialysis vintage, employment status, excessive daytime sleepiness, hemoglobin, phosphorus levels, or albumin levels. Patients in the morning shift were more likely to live in rural areas (p<0.0001), although patients in rural areas did not have a higher prevalence of depression (p = 0.30). Patients with depression were more likely to be dialyzed during the morning shift (p = 0.008). Independent risk factors for depression were age (p<0.03), lower levels of hemoglobin (p<0.01) and phosphorus (p<0.01), and dialysis during the morning shift (p = 0.0009). The hospitalization risk of depressive patients was 4.5 times higher than that of nondepressive patients (p<0.008).
  
  
  CONCLUSIONS
  These data suggest that depression is associated with dialysis shift, higher levels of phosphorus, and lower levels of hemoglobin. The results highlight the need for randomized trials to determine whether this association occurs by chance or whether circadian rhythm disorders may play a role.
authors.affiliation: School of Medicine, State University of Health Sciences of Alagoas, Renal Division, MaceióAL, Brazil, State University of Health Sciences of Alagoas, School of Medicine, Renal Division, Maceió/AL, Brazil.
authors.forename: Flavio
authors.initials: F
authors.lastname: Teles
authors.affiliation: School of Medicine, State University of Health Sciences of Alagoas, Renal Division, MaceióAL, Brazil, State University of Health Sciences of Alagoas, School of Medicine, Renal Division, Maceió/AL, Brazil.
authors.forename: Vega Figueiredo Dourado de
authors.initials: VF
authors.lastname: Azevedo
authors.affiliation: Federal University of Alagoas, School of Medicine, MaceióAL, Brazil, Federal University of Alagoas School of Medicine, Maceió/AL, Brazil.
authors.forename: Claudio Torres de
authors.initials: CT
authors.lastname: Miranda
authors.affiliation: Federal University of Alagoas, School of Medicine, MaceióAL, Brazil, Federal University of Alagoas School of Medicine, Maceió/AL, Brazil.
authors.forename: Milma Pires de Melo
authors.initials: MP
authors.lastname: Miranda
authors.affiliation: School of Medicine, State University of Health Sciences of Alagoas, Renal Division, MaceióAL, Brazil, State University of Health Sciences of Alagoas, School of Medicine, Renal Division, Maceió/AL, Brazil.
authors.forename: Maria do Carmo
authors.initials: Mdo C
authors.lastname: Teixeira
authors.affiliation: School of Medicine, University of Sao Paulo, Renal Division, São PauloSP, Brazil, University of Sao Paulo School of Medicine, Renal Division, São Paulo/SP, Brazil.
authors.forename: Rosilene M
authors.initials: RM
authors.lastname: Elias
mesh_terms: D000328:Adult; D015415:Biomarkers; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010758:Phosphorus / Q000097:blood; D011594:Psychometrics; D011788:Quality of Life; D006435:Renal Dialysis / Q000523:psychology*; D051436:Renal Insufficiency, Chronic / Q000523:psychology* / Q000628:therapy; D012307:Risk Factors; D012424:Rural Population; D012893:Sleep Wake Disorders / Q000503:physiopathology; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013997:Time Factors
chemical_list: D015415:Biomarkers; D006454:Hemoglobins; D010758:Phosphorus