The association between vascular access type and depressive symptoms in geriatric hemodialysis population

A well-functioning vascular access is crucial for hemodialysis treatment, and arteriovenous fistula is the recommended vascular access type. Arteriovenous fistula is superior to other vascular access types in many aspects, but the effect of arteriovenous fistula on patients' psychiatric state is not well described yet. The aim of this study is to determine whether there is an association between vascular access type and depression scores.

This cross-sectional study was conducted at two hemodialysis centers. Geriatric Depression Scale-15 was administered to geriatric hemodialysis patients, using ≥5 score as the cut-off value for the presence of depressive symptoms. Descriptive tests, Kolmogorov-Smirnov test, Pearson's Chi-square test, Mann-Whitney test, Kruskal-Wallis test, Spearman's rank correlation calculation, and multiple logistic regression analysis were performed accordingly to analyze the data.

Of 75 participants, 34 (45.3%) were female and the mean age was 73.4 ± 5.9 years (range: 65-92). The prevalence of depressive symptoms in the geriatric hemodialysis population was 53.3%. Central venous catheter, hypertension, and increased time on hemodialysis have been found to be risk factors for higher depression scores (aOR 10.505 (95% CI 1.435-76.900), p = 0.021; aOR 9.783 (95% CI 2.508-38.169), p = 0.001; aOR 1.019 (95% CI 1.003-1.035), p = 0.017, respectively). Among patients with arteriovenous fistula, those with hypertension had higher depression scores (p = 0.008).

Geriatric hemodialysis patients were found to have depressive symptoms commonly, and central venous catheter, hypertension, and increased time on hemodialysis have been found to be risk factors for presence of depressive symptoms. To the best of our knowledge, this is the first study highlighting that arteriovenous fistula is associated with lower depression scores and lower prevalence of depressive symptoms.