The effect of psychiatric disorders on serum pro-ntbnp, blood pressure,life and sleep quality at peritoneal dialysis patients

Aim: Psychiatric and social disorders are common among dialysis patients and chronic renal failure (CRF) affects life quality of patients negatively. The aim of our study is to evaluate the effect of psychiatric disorders on fluid retention, nutritional status, sleep quality and life quality. Material and methods: Thirty three patients who were followed at peritoneal dialysis outpatient clinic of Inonu University Medicine Faculty were enrolled into the study. Patients' age, gender, profession, sociodemographıcal features, duration of peritoneal dialysis (PD) and CRF , primary reason for renal disease were recorded. Hemoglobin, hemotocrit, urea, creatinine, albumin, phosphore, N terminal brain natriuretıc peptid (proNTBNP), calcium, parathormone levels, urine volume, systolic and diastolic blood pressure during peritoneal dialysis were recorded from follow up files at the clinical psychiatric evaluation and at the monthly controls during the past six months. Short form-36 (SF-36) was used in order to evaluate life quality of patients, beck depression scale (BDS) was used to in order to evaluate depression, beck anxiety scale(BAS) was used in order to evaluate level of anxiety, pittsburgh sleep quality index was used in order to evaluate sleep quality. Findings: Of all patients, 19(57,5%) patients were female 14(42,5) were male, mean age was 59,9±14,4 years,mean CRF duration was 116,5±76,2 months,mean PD duration was 70,5±56,3 months. We found that 33,3% of all PD patients had depression disorder, 81,8% had anxiety disorder, 69,9% had bad sleep quality. There was no difference in terms of depression, anxiety disorder and bad sleep quality between genders. There was no significant difference in terms of age, continuous ambulatory peritoneal dialysis(CAPD) duration CRF duration between patients with or without depression according to Beck depression scale at our study. At patients with depression, anxiety (p=0,026) and PUKI (p=0,012) scores were significantly higher compared to those of patients without depression. When life quality scales were evaluated, general health (p=0,012),, vitality (p=0.007), menthal health (p=0.015) and menthal scala (p=0.036) were significantly lower at the group of with depression. There was no significant difference at life quality components such as physical function,body pain,social function,emotional role, physical scale between patients with or without depression (p>0.05). There was no significant difference in terms of age, CAPD and CRF durations, depression and sleep disorder between patients with or without anxiety according to BAS (p>0.05). At patients with anxiety, life quality scales such as physical function(p=0.021), body pain (p=0.040) general health(p=0.024), vitality (p=0.001) and menthal health (p=0.040) scores according to anxiety status were significantly low. There was no significant difference in terms of life quality components such as physical role, social function,emotional role, physical scale between patients with or without anxiety (p>0.05). General health , vitality and menthal health score were low both in patients with depression and with anxiety. In our study there was a statistically significant difference in terms of life quality components such as social function and physical scale between PD patients with good sleep quality (Pittsburgh Sleep Quality Index(PUKI) score ≤ 5) and PD patients with bad sleep quality(PUKİ > 5) according to Pittsburgh Sleep Quality Index(PUKI) (p=0,038 and p:0,010). Social function and physical scale scores were lower at PD patient wih bed sleep quality. There was no significant difference in terms of age,CAPD and CRF durations,depression,anxiety, and other life quality components (physical function, physical role,body pain, general health ,vitality, emotional role, emotional health, menthal scale) between patients with or without bed sleep quality (p>0.05). There was no significant difference when mean change (slope) at laboratory measurements ( Hemoglobin, , albumin, phosphore, proNTBNP, parathormone, weight change,urine volume, systolic and diastolic blood pressure) of the last six months were calculated with regression analysis at PD patients with or without good sleep quality, with or without depression, with or without anxiety. Hemoglobin and hematocrite levels at the patients with anxiety were significantly lower than those of patients without anxiety at the last control where Beck anxiety scales were performed (p=0.004, p=0.004, respectively). Pro NTBNP and systolic blood pressure levels were significantly higher at the patients with anxiety, compared to those of the patients without anxiety (p=0.024, p=0.035, respectively). There was no difference at laboratory values at the moment when Beck depression scale was performed and at the moment when PUQI test was performed between groups with good or bad sleep quality according to Pittsburg Sleep Quality Index (p>0.05). Conclusion: Conclusively, sleep quality disorder, anxiety, depression are common problems among periton dialysis patients. These problems affect the life quality of patients negatively. Low levels of hemoglobin, and increase at parameters suggesting fluid retention like pro-NT BNP and systolic blood pressure are observed more frequently at patients with anxiety