Assessing the Association between Depression and End Stage Kidney Disease for African American patients on dialysis. Restricted; Files Only

Manishimwe, Exaucee (Summer 2022)

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Background: The prevalence of diabetic retinopathy is estimated to increase to 14 million from the current rate of 7 million Americans. Many researchers have demonstrated that depression and diabetic retinopathy are correlated and affect each other. African Americans are affected by diabetes more than any other racial group in the U.S. Diabetes is the main leading cause of diabetic retinopathy. The objective of this study is to assess the association between depression, diabetic retinopathy, and selected social determinants of health for 100 African Americans that have been diagnosed with end-stage kidney disease and that are on dialysis at the Emory dialysis centers. 

Methods: We conducted a cross-sectional study of 100 African Americans with end-stage kidney disease on dialysis. We administrated 3 surveys, collecting information such as demographics, comorbidities, kidney burden of disease, and Impact of Vision Impairment. A visual acuity test was then administrated using the Rosenbaum pocket visual acuity test, followed by pictures to obtain eye images with the Optomed Aurora portable camera that were to be analyzed for diabetic retinopathy by an Emory Ophthalmologist and an AI software (AEYE in collaboration with Optomed Aurora portable camera) engineer.

Results: Of the ninety-eight participants who completed the surveys, the ratio of males to females was 1:1.  On all the screened patients, only 55 images were successfully captured for analysis. The mean age for this population was 59.17 years old, with a standard deviation of ±12.178. Of the 55 participants who had sufficient images, the mean age and standard deviation were 59.26 ±12.20, respectively. The ratio of male to female was 26: 29 (n= 55). Out of the ninety-nine (n=99) participants who responded to the questionnaire, 11 (11.11%) have low food security. The average substance abuse score was 5.71, with a range of 1 to 11, suggesting a very high possibility of substance abuse in this population. The average depression score for this cohort was 6.02 with a standard deviation of ±5.20, suggesting a mild level of depression.

Discussion: From our findings, the correlation between a positive diagnosis of diabetic retinopathy and depression was not statistically significant (p=.830). The average value of depression was higher than the negative DR diagnosis, 5.91 vs 5.0. This probably affected the significance of the findings and therefore screening patients further is needed to conclude the impact of depression on diabetic retinopathy on African Americans. Based on the kidney burden of disease questionnaire, we found no statistically significant difference between participants assessed to have diabetic retinopathy and those who did not have diabetic retinopathy (p=.65). Based on the visual impact assessment, it was found that vision impacted a DR diagnosis, with most of the DR+ participants reporting a higher number of an impact than their DR- participants counterparts, with a significance level (P=.0329).

Conclusion: Depression is a disease correlated with diabetes and diabetic retinopathy. Diabetic retinopathy is a disease that is expected to rise by double its current number, therefore, increasing the burden of the disease on many communities, especially underserved communities.

Table of Contents

Chapter 1: Introduction 1

1.1 Background 1                

Chapter 2: Literature Review 2

            2.1. Depression 2

            2.2. Diabetes 4 

2.3. Social determinants of health 8

2.4. Purpose Statement 9

Chapter 3: Methods 10

            3.1. Recruitment Process 10   

            3.2. Data Collection 13                   

            3.3. Data Storage and Confidentiality 14

            3.4. Phase 1 Survey 14

            3.5. Phase 2 Survey 16

            3.6. Phase 3 Survey 16

            3.7. Eyes Clinical Assessment 17

            3.8. Diabetic Retinopathy (DR) Imaging 18

3.9. Data storage 18

3.10. Statistical Analysis 18


Chapter 4: Results 20 

            4.1. Phase 1 20

            4.2. Phase 2 22

            4.3. Phase 3 22

Chapter 5: Discussion, Conclusion, Limitations and Recommendations 23

5.1, Discussion            23

5.2, Conclusion 26

5.3Limitations 27

5.4. Recommendations 28

References 29

Tables and Figures 32

Appendices 40

A.    Eye Photographs 40 

B.    Survey tools 43

C.     Informed Consent 52

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