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العنوان
Depression, sleep disorders and fathigue in early diabetic kidney disease/
المؤلف
Emam, Hend Abdelmonem Abdelhamid Elsayed.
هيئة الاعداد
باحث / هند عبد المنعم عبد الحميد السيد أمام
مشرف / ياسمين صلاح سعيد نجا
مشرف / جيداء فاروق مكي
مناقش / هشام كمال توفيق الصايغ
مناقش / محمد مجدى عبد القادر
الموضوع
Internal medicine.
تاريخ النشر
2018.
عدد الصفحات
60 p. :
اللغة
الإنجليزية
الدرجة
ماجستير
التخصص
الطب
تاريخ الإجازة
15/11/2018
مكان الإجازة
جامعة الاسكندريه - كلية الطب - Internal Medicine
الفهرس
Only 14 pages are availabe for public view

from 70

from 70

Abstract

Diabetes is the leading cause of end-stage renal disease (ESRD) in the United States. DKD accounts for 40% of all cases of ESKD. The classical definition of DKD is CKD due to diabetes mellitus (DM). DKD is characterized by glomerular hypertrophy, thickness of basement, tubular and glomerular membranes, and accumulation of extracellular matrix in these membranes that finally cause tubulointerstitial and glomerular fibrosis and sclerosis.
DKD is the most common microvascular complication of diabetes mellitus and the cause of almost half of all new cases end-stage renal disease in the US. The general progression of DKD starts with increasing urinary albumin excretion rate, leading to severe proteinuria, reduced estimated glomerular filtration rate, and ESRD. Therefore, UAER is the most important criterion for early diagnosis for DKD.
Patients with chronic kidney disease (CKD) exhibit a high prevalence of neuropsychiatric alterations, including depression and behavioral changes. CKD is also associated with decreased physical activity not fully explained by co-morbidities. The prevalence of depression increases in parallel with the severity of CKD. The presence of depression and anxiety in diabetic patients worsens the prognosis of diabetes, increases the non-compliance to the medical treatment, decreases the quality of life, and increases mortality. Patients with chronic kidney disease often experience depression, which has been associated with increased risk of rapid decline in glomerular filtration rate, reaching ESRD and mortality after the start of dialysis. In contrast, patients who have undergone kidney transplantation have been shown to be less frequently associated with depression than those undergoing dialysis.
Sleep disorders are prevalent in patients with chronic kidney disease (CKD) in particular those with end stage renal disease (ESRD), 80% of ESRD patients receiving dialysis report sleep complaints. Sleep disorder is a novel risk factor for diabetes. People suffering from a sleep disorder, whether in sleep quality or sleep quantity, may experience a reduction in the insulin sensitivity and consequently, elevated blood glucose, aggravating the progress of diabetes.
Fatigue may also be related to such lifestyle issues as lack of physical activity or being overweight especially common in people with type 2 diabetes. One likely reason for fatigue in diabetes is alterations in blood glucose levels. Anemia, the major side effect of impaired kidney function, results in increased fatigue. Among patients undergoing dialysis for treatment of ESRD, fatigue negatively affected quality of life and were significantly worse among the patients with diabetes than those without diabetes.
The aim of the present study was to assess depression, sleep disorders and fatigue in diabetic patients with or without DKD in Alexandria main university hospital.
This study included 60 patients from Alexandria main university hospital, who were divided into the following groups, group I: 30 patients with type 2 diabetes without evidence of DKD and group II: 30 patients with type 2 diabetes with evidence of DKD in the form of micro or macroalbuminuria and/or an eGFR >30 ml/min/1.73 m2 (CKD stages 1-3). Exclusion criteria included Known lung or liver disease, collagenic disease, and malignant disease. All patients were subjected to full history taking, full clinical examination and laboratory investigations, Beck’s Depression Inventory to assess the presence of depression, Pittsburgh sleep questionnaire to assess sleep and Fatigue severity scale to evaluate fatigue.
The results showed that Beck’s depression score was significantly higher in DKD patients compared to diabetic patients. Diabetic patients had mainly mild depression while DKD patients were mainly in moderate depression range. The score of Pittsburg sleep quality index showed that all patients in both groups had poor sleep quality. Still, the sleep index was significantly higher in DKD patients. Fatigue was prevalent in diabetic patients, but it was not more marked in early DKD. Pittsburg sleep index was positively correlated with fatigue scale in diabetic patients. In DKD, Becks depression was positively correlated with Pittsburg sleep and fatigue scale. Pittsburg sleep index was positively correlated with fatigue scale.