[Association between extracellular-to-intracellular water ratio and depression in maintenance hemodialysis patients]

Objective: To investigate the relationship between the extracellular-to- Methods: A multicenter cross-sectional study was conducted. The clinical data of adult patients receiving MHD treatment at 18 hemodialysis centers in Guizhou Province from June to August in 2021 and the same period in 2022 were collected. Physical measurements, body composition measurements, and questionnaire surveys were performed. Psychological assessment was conducted using the Beck Depression Inventory, with a score of 14 or above indicating the presence of depressive symptoms. Patients were divided into four groups based on the quartiles of the ECW/ICW ratio, and the relationship between the ECW/ICW ratio and depressive symptoms in MHD patients was explored using logistic regression analysis. Subgroup analyses were further conducted to assess the stability of the results. Results: A total of 3 195 patients were included in the study, consisting of 1 979 males and 1 216 females, with a median (Q₁, Q₃) age of 55 (45, 65) years. According to the Beck Depression Inventory, approximately 11.1% (355/3 195) had depressive symptoms. Multivariable logistic regression analysis revealed that, in the unadjusted model, the risk of depression for patients in the highest ECW/ICW quartile (Q4) was 2.24 times higher than that of the lowest quartile (Q1) (OR=2.24, 95%CI: 1.62-3.08, P<0.001). After further adjustment for covariates such as gender, age, hypertension, and diabetes, the risk of depression for patients in Q4 remained 1.75 times higher than that of Q1 group (OR=1.75, 95%CI: 1.20-2.54, P=0.003). The independent association between a high ECW/ICW ratio and the risk of depression was stable across different age groups, genders, education levels, and in the presence of comorbidities such as hypertension, diabetes, and stroke history (all P for interaction>0.05). Conclusion: An increased ECW/ICW ratio is associated with an increased risk of depression in MHD patients.