Depression and All-Cause Mortality in Hemodialysis Patients

Abstract

Background: There are limited data regarding the relationship between depression and mortality in hemodialysis (HD) patients. Methods: Among 323 patients receiving maintenance HD, depression symptoms were assessed using the Center for Epidemiologic Studies Depression (CES-D) scale, with a score of ≥16 consistent with depression. Adjusted Cox proportional-hazards models with additional analyses incorporating antidepressant medication use were used to evaluate the association between depression and mortality. Baseline CES-D scores were used for the primary analyses, while secondary time-dependent analyses incorporated subsequent CES-D results. Results: The mean age was 62.9 ± 16.5 years, 46% of the subjects were women and 22% were African-American. The mean baseline CES-D score was 10.7± 8.3, and 83 (26%) participants had CES-D scores ≥16. During a median (25th, 75th) follow-up of 25 (13, 43) months, 154 participants died. After adjusting for age, sex, race, primary cause of kidney failure, dialysis vintage and access, baseline depression was associated with an increased risk of all-cause mortality (HR 1.51 and 95% CI 1.06-2.17). This attenuated with further adjustment for cardiovascular disease, smoking, Kt/V, serum albumin, log C-reactive protein and use of antidepressants (HR 1.21 and 95% CI 0.82-1.80). When evaluating time-dependent CES-D, depression remained associated with increased mortality risk in the fully adjusted model (HR 1.44 and 95% CI 1.00-2.06). Conclusions: Greater symptoms of depression are associated with an increased risk of mortality in HD patients, particularly when accounting for the most proximate assessment. This relationship was attenuated with adjustment for comorbid conditions, suggesting a complex relationship between clinical characteristics and depression symptoms. Future studies should evaluate whether treatment for depression impacts mortality among HD patients.

Prevalence and related factors of depressive symptoms in hemodialysis patients in northern China

“…Patients with CKD on hemodialysis (HD) have to endure physical discomforts related to their illness and have to face various stresses, family problems, which increasing the risk of depression [6]. The prevalence of depression is higher among patients receiving HD, with estimated rates ranging from 23 to 42% in the USA and Europe, and 45.9% in Taiwan [7–11]. Furthermore, clinical depression and subthreshold depressive symptoms are strongly associated with poor adherence to treatment, increased mortality and rates of hospitalization [12–16].…”

Determinants and prevalence of depression in patients with chronic renal disease, and their caregivers

“…It has been documented that depression worsens the perceptions of patients for their well-being, which ultimately affects their compliance with treatment regimens. [20][21][22] Depression in CKD patients may be undertreated. Watnick et al reported that just 16% of HD patients with depression were receiving treatment.…”

The effects of lavender essential oil aromatherapy on anxiety and depression in haemodialysis patients

“…Items are scored on a 4-point scale ranging from 0 to 3, with a total score of 21. The scores are categorized as normal (0-7), borderline (8)(9)(10), and abnormal (11-21) (34). The validity and reliability of the HADS scale has been established in a number of studies.…”

“…Factors associated with depression include transplant history, duration of haemodialysis, level of income, and occupation (3). Depression could reduce health-related quality of life (9) and increase risk of mortality in hemodialysis patients (10). Antidepressants can cause a number of complications in haemodialysis patients, as these medications can bind to proteins, do not have a favorable renal clearance and can produce toxic metabolites (11).…”