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Abstract: TH-PO324

The Effects of Repetitive Transcranial Magnetic Stimulation (rTMS) on Improvement of Mental Health and Clinical Parameters in Hemodialysis Patients – Pilot Study

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Hwang, Jin Ho, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea (the Republic of)
  • Yeo, Seongyup, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea (the Republic of)
Background

The prevalence of major depressive disorder in patients with ESRD is higher than in diabetes or congestive heart failure. However, it is difficult to prescribe antidepressant treatment because of concern about potential adverse effects in CKD patients. Here, we studied the therapeutic effect of rTMS as a nonpharmacologic treatment in depressed hemodialysis patients.

Methods

The patients with more than 5 points in Patient health Questionnair-9 were randomized to rTMS group and sham group. The rTMS group was stimulated on the left dorsolateral prefrontal cortex for 20 minutes, three times a week. We collected and analyzed the clinical indices before and after TMS treatment, and also collected data of quantitative electroencephalogram (qEEG), and the results of various psychiatric questionnaires (Beck's depression index-II [BDI-II], Beck's anxiety index [BAI] and SCL-90R-Somatization subscales [SCL-90R-SOM]).

Results

In this study, a total of 13 patients were randomized, 7 patients assigned to the sham group and 6 were assigned to the rTMS group. When laboratory findings were compared 1 month after TMS, hemoglobin A1c was significantly improved in rTMS group (8.3% to 7.1%, P=0.046 by pared t-test, P=0.032 by mixed ANOVA). Although there was no statistical significance, serum potassium and intact PTH also showed an improving tendency. The frontal alpha asymmetry (FAA) F4-F3 (P=0.009), and F8-F7 (P=0.027) values in qEEG was significantly improved in the rTMS group than the others. The BDI-II score was improved both with sham (24.0 to 18.4, P=0.009) and rTMS group (21.2 to 13.8, P=0.005), the BAI (rTMS: 11.2±6.1 vs. sham: 16.9±13.0; F 6.7, P=0.025) and SCL-90R-SOM scores (rTMS: 20.2±5.4 vs. sham: 22.4±5.6; F 4.9, P=0.048) showed prominent improvement after rTMS.

Conclusion

In hemodialysis patients, rTMS may improve depression, anxiety, and somatization symptoms, which may lead to improvements in clinical measures.