The study was carried out in the department of nephrology and hemodialysis unit of the CHU Sylvanus Olympio in Lomé, with a total capacity of 16 beds for 11 functional dialysis stations. This structure is the only state hemodialysis center in Togo.

The sample under study had an average age of 46.51 years with a standard deviation of 14.41 and extremes of 11 and 84 years. The age group from 40 to 59 was predominantly represented to 48.35%, or 44 patients, followed by that of 20 to 39 years to 30.77%, or 28% dialyzed. The male sex predominated with 56 patients (61.54%) versus 35 women (38.46%), a sex ratio of 1.6. The majority of hemodialysis patients, 71.43% were in couples (65 patients married or in cohabitation). Of the 93.41% educated (85 respondents) in this series, 40% (46 respondents) had secondary education level and 32.97% (30 respondents). In the professional domain, executives, retirees, liberal professions and traders/dis- tributors were respectively accounted for 26.37 percentage (24 hemodialysis), 15.38 (14 hemodialysis), 14.29 (13 hemodialysis) and 13.19 (12 hemodialysis). Workers, unemployed, housewives, soldiers and students constituted other professional profiles. Sixty-eight point thirteen percent or 62 patients lost their jobs with the disease. About health insurance, 60 hemodialysis (65.93%) did not have insurance. Concerning the number of dependent children, 43 patients (47.25%), 29 patients (31.87%), 17 patients (18.68%) and 2 patients (2.20%), had respectively 1 to 3 patients, 0, 4 to 6 and over 7 dependent children. Relative to the way of life, 87.91% or 78 people lived in family. The attitude of the family was an acceptance and support to 80.22% (75 cases), an indifference to 13.19% (12 cases) and a rejection in 6.59% (6 cases).

The duration of the Chronic Renal Failure (CRF) before hemodialysis was on average 9.16 months with extremes of 0 to 84 months. The average duration of life in hemodialysis was 44.44 months with extremes of 1 and 151 months.

The backgrounds were dominated by high blood pressure to 68.13% and the practice of self-medication was noted to 37.36%. Initial nephropathy was essentially vascular in the sample to 48.35%. The causes of nephropathy were mainly arterial high blood pressure up to 50.55%. These results are highlighted in Table 1.

Anxiety (A3) was to 52.8% of women and depressed (D3) to 63.2% of men. Levels of secondary and university education were more strongly represented in the

*Valvulopathy, Vasculo-Cerebral Accident, Polyarthritis Rheumatoid, Cataract, Myeloma, Lupus Erythematosus Disseminated; µ Possibility of several etiologies that can explain the CRF.

anxiety group, with rates of 50% and 27.8%, respectively, than in the depressed group, with 47.4% and 34.2%, respectively. Compared to those who lived together, 75% were anxious (A3) and 65.8% of the depressed (D3) were in a couple. The majority of hemodialysis patients without health insurance were in the anxiety group (77.8%) and the depressed group (73.7%). These results are explained in Table 2.

Female sex was associated with the occurrence of anxiety disorders (p = 0.03) with hemodialysis patients. The relative risk of anxiety was increased threefold in female dialysis patients (RR = 2.6). The profession of trader/reseller was associated with the occurrence of anxiety disorders (p = 0.04). The risk of developing anxiety with hemodialysis was multiplied by 4 with traders or resellers (RR = 3.6). The absence of social security increases the risk of anxiety disorders among respondents by three (RR = 2.6, p = 0.04). Among the clinical factors studied, neither the existence of chronic disease nor the duration of renal disease progression and nor the duration of life by hemodialysis had any influence on the occurrence of anxiety (p > 0.05). Table 3 highlights the details of these assertions.

¹: relative risk, ²: confidence interval, ³: chance.

No demographic factor influenced the onset of depression. The differences observed were random (p > 0.05). The socio-professional characteristics of the subjects did not significantly affect the occurrence of depression (p > 0.05), although the loss of employment was associated with more depressive episodes (p = 0.06). A period of evolution of the CRF under 6 months was associated with the occurrence of depression (p = 0.04) with hemodialysis patients. The relative risk of depressive episodes increased three-fold by these (RR = 2.7). These results are explained in Table 4.

The mean age of hemodialysis patients was 46.5 years, with a greater representation of the 40 - 59 age group at 48.35%. There was also a male predominance of 61.54%; or a sex-ratio of 1.6. The youth of the study population shows that renal insufficiency affects the economically active social strata. These results are similar to those of Maiga et al. [6] in Niamey (Niger) who found a mean age of 45.49 and a male predominance of 71.1%. This male predominance was also noted by

¹: relative risk, ²: confidence interval, ³: chance.

Njah et al. [5] to 57.79% in Monastir (Tunisia). In a study carried out in France in 2009, Untas et al. [12] had found a higher mean age at 63.1 years. Indeed, a higher life expectancy, supported by greater accessibility to quality health care and better socio-economic conditions in the West, may explain this difference.

This series recorded a high literacy rate at 93.41%; which was not the case for Maiga et al. [6] where only 51.3% were literate. The occupational profile of this latter study was carried out on a population mainly based on trade and breeding (Niger), sectors of activity that do not necessarily require education. Moreover, the relatively low literacy rate of Niger, which is 28.7% against 60.4% in Togo, confirms this difference [13] .

The mean duration of the CRF of patients before dialysis was 9.16 months. It is 4.6 years or 55.2 months in the Monastir series [5] and 33.85 months in the Niger series [6] . The very low mean among the respondents reflects the delay in the diagnosis and the specialized care of renal disease in this study, resulting in a rapid evolution towards a terminal CRF and therefore to a supply post treatment. The study recorded a mean duration of life in hemodialysis of 44.4 months or 3.7 years; which is similar to the result of Ndiaye-Ndongo et al. [2] in Senegal, which had recovered an average of 3.86 years or 46.32 months. These results contrast with those of Untas et al. [12] who had recorded oldness mean of 8 years’ dialysis with a standard deviation of 6.4 years. The largest average dialysis life of the French series is explained not only by the higher life expectancy of the West, but also by other parameters such as delayed diagnosis, delayed treatment under replacement therapy due to its relatively high cost and no subsidy, and the inadequacy of hemodialysis center in developing countries. This is compounded by the fact that some patients undertook their first dialysis sessions in private centers, which would not have been taken into account in studies targeting national centers.

Among the respondents, 41.76% had a definite depression (group D3) compared with 39.56% of definite anxiety (group A3). However, this difference is not significant (p > 0.05). In a Tunisian series, 44% of depressive symptoms were recorded with or without anxiety [5] . This rate was similar to that of this work even if the scales used were different. Moreover, this rate in its series takes into account both cases of probable anxio-depressive disorders and some cases. A study comparable to the present survey carried out in Niger [6] using the same rating scale (HADS) found that there was less definite depression at 23.7%, and very few subjects definitely anxious at 14.5% [6] . Unlike the study sample, the dialysis patients in this series got a systematic psychological accompaniment, which may explain these observed differences.

The women in this study expressed three times more anxiety than men (RR = 2.6, p = 0.03). A study on anxiety and depression in hemodialysis carried out in France revealed the same finding (RR = 2.6) [12] . Women express more anxiety than men. This result is in line with the literature, where studies show that women are more anxious than men regardless of the measurement tools used [14] . In addition, the profession of trader or reseller who was four times more likely to develop anxiety disorders (RR = 3.6, p = 0.04), was predominantly female at 83.3%.

The prevalence of anxiety disorders did not show a significant effect of sex according to Maiga et al. [6] in Niger. Indeed, in this series, women were mainly housewives, thus without financial income; while in our study, most women or 77.8% had a job, therefore a financial income. The loss of this source of income with chronic renal disease would increase the occurrence of anxiety disorders. The professional activity is also considered as a protective factor while inactivity is often perceived as a source of social demoralization. The work would allow the patient to broaden the scope of his relationships, assume his responsibilities, assert his independence and thus control his situation [15] [16] [17] .

Traders and resellers were the occupational group most affected by anxiety in this series, with a risk multiplied by four (RR = 3.6, p = 0.04). This is due to the relative sedentariness imposed by dialysis when it is known that traders often travel to store supplies or deliver their items. Moreover, the uniqueness of the national dialysis center in Togo constitutes an obstacle to this need for migration, which is implied by trade. The absence of health insurance exposed dialysis patients to three times more risk of anxiety (RR = 2.6, p = 0.04). Social security is an important relief especially in our context of low socio-economic level and especially since the costs of hemodialysis are not borne by the State.

A progression of chronic renal disease of less than 6 months was associated with three times more risk of developing depression (RR = 2.7, p = 0.04). It should be noted that similar studies, notably those of Niger [6] , Tunisia [5] and France [12] , did not find any change in psychiatric morbidity with regard to the duration of development of renal disease. In these series, the mean durations of progression of CRF was significantly higher than the present study, thus the patients would have had time to prepare psychologically for the possible reception of the status of chronic dialysis and also the presence in these studies of psychotherapeutic accompaniment. The shortness of the evolution of the disease due to late diagnosis and specialized care noted in this work could also be at the origin of this divergence. The loss of employment was associated with more depression in this study although not significant (p = 0.06). The finding was the same for Njah M. et al. in Tunisia in 2001 [5] . Indeed, in the Tunisian series, the maintenance of the profession had even proved to be a protective factor with regard to depression. The fact that this event was not significant in this study would be due to the small sample size.