Relation between anxiety, depression, and physical activity and performance in maintenance hemodialysis patients.
OBJECTIVE
Maintenance hemodialysis (MHD) patients have a high prevalence of anxiety and depression and decreased daily physical activity (DPA) and exercise capacity. Because affective disorders may affect DPA and physical performance, we investigated possible relationships between anxiety or depression and DPA and physical performance in relatively healthy MHD patients.


METHODS
This cross-sectional study included 72 relatively healthy MHD patients and 39 normal adults. DPA was measured for 7 days with an Actigraph Activity Monitor®. Physical performance was assessed using the 6-minute walk (6-MWT), sit-to-stand (STS), and stair-climbing tests. Subjects completed the Beck Anxiety Inventory (BAI), the Beck Depression Inventory-II (BDI), and the Hospital Anxiety and Depression Scale (HADS). Main outcome measures were physical activity counts (expressed as vector magnitude), in the 6-MWT, STS, stair-climbing test, BAI, BDI, and HADS scores.


RESULTS
Anxiety and depression by BAI and BDI were identified in 43% and 33% of MHD patients and 2.5% and 5% of normals, respectively (P < .0001 for each comparison). MHD patients without anxiety or depression had decreased DPA and physical performance compared with normals, indicating that these disorders were also independent of anxiety or depression. MHD patients with anxiety and depression generally had the most impaired DPA and physical performance. Higher BAI and BDI scores were each associated with impaired physical performance. In fully adjusted analyses, DPA in MHD patients was negatively correlated with the BDI (r = -0.33, P = .01) but not with the BAI. DPA on the day of hemodialysis (P = .01), and day 1 (P = .03) and day 2 (P = .03) after dialysis each correlated negatively with degree of depression by BDI. In MHD patients, BAI was negatively correlated with 6-MWT (P = .03) and STS (P = .04).


CONCLUSIONS
In relatively healthy adult MHD patients, anxiety and depression are common and are associated with impaired physical performance. There was a trend toward stronger negative associations between BDI scores and DPA than between BAI scores and DPA.
Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California; Division of Nephrology, Tianjin Union Medical Center, Tianjin, People's Republic of China.
Min
M
Zhang
Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California; Division of Nephrology, CHA Gumi Medical Center, CHA University, Daegu, South Korea.
Jun Chul
JC
Kim
Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California; Department of Nephrology, the First Affiliated Hospital of Xiamen University, People's Republic of China.
Yinan
Y
Li
Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California.
Bryan B
BB
Shapiro
Rehabilitation Clinical Trials Center, Division of Respiratory and Critical Care Physiology and Medicine Los Angeles Biomedical Research Institute at Harbor- University of California-Los Angeles Medical Center, Torrance, California.
Janos
J
Porszasz
University of California-Los Angeles Clinical and Translational Science Institute, Los Angeles Biomedical Research Institute at Harbor-University of California-Los Angeles Medical Center, Torrance, California; Harold Simmons Center for Kidney Disease Research and Epidemiology, Los Angeles Biomedical Research Institute at Harbor-University of California-Los Angeles Medical Center, Torrance, California.
Rachelle
R
Bross
Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California; VA Boston Health Care system/Harvard South Shore Psychiatry Residency Program, Brockton, Massachusetts.
Usama
U
Feroze
Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California.
Rajeev
R
Upreti
Division of Psychology, Department of Psychiatry, Harbor-University of California-Los Angeles Medical Center, Torrance, California.
David
D
Martin
Harold Simmons Center for Kidney Disease Research and Epidemiology, Los Angeles Biomedical Research Institute at Harbor-University of California-Los Angeles Medical Center, Torrance, California; Division of Nephrology and Hypertension, University of California at Irvine, Orange, California; University of California Los Angeles Fielding School of Public Health, Los Angeles, California.
Kamyar
K
Kalantar-Zadeh
Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California; University of California Los Angeles Fielding School of Public Health, Los Angeles, California; David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California. Electronic address: jkopple@labiomed.org.
Joel D
JD
Kopple
D015502:Absorptiometry, Photon; D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000453:epidemiology* / Q000503:physiopathology; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D006435:Renal Dialysis; D055815:Young Adult