Depression Impairs Level of Functioning in Chronic Kidney Disease Inpatients: A Case-Control Study

Abstract

To evaluate the difference in demographics and clinical correlates during hospitalization for chronic kidney disease (CKD) between patients with depression and those without depression, and its impact on the severity of illness and in-hospital mortality. MethodsWe conducted a case-control study and included 2,296 adult inpatients (age ≥18 years) with a primary discharge diagnosis of CKD using the nationwide inpatient sample (NIS). We used propensity score matching to extract the cases i.e., CKD inpatients with depression (N = 1,264) and the controls i.e. CKD inpatients without depression (N = 1,032). The matching was done based on demographic characteristics of age at admission, sex, race, and median household income. Our outcomes of interest are the severity of illness and all-cause in-hospital mortality. All patient refined drg (APR-DRG) are allocated using health information systems software by the NIS and the severity of illness within each base APR-DRG was classified into minor, moderate, or major loss of body functions. Binomial logistic regression analysis was conducted to find the odds ratio (OR) of association for major loss of function in CKD inpatients with depression, and this model was adjusted for potential confounders of congestive heart failure (CHF), coronary artery disease (CAD), diabetes, hypertension, obesity, and tobacco abuse, and utilization of hemodialysis. ResultsA higher proportion of CKD inpatients with depression had a statistically significant higher prevalence of major loss of function (49.8% vs. 40.3% in non-depressed). There was a statistically significant difference with higher utilization of hemodialysis in CKD inpatients with depression (76.2% vs. 70.7% in nondepressed). The all-cause in-hospital mortality rate was lower in CKD inpatients with depression (2.1% vs. 3.5% in non-depressed). After controlling the logistic regression model for potential comorbidities and utilization of hemodialysis, depression was associated with increased odds (OR 1.46; 95% CI 1.227 -1.734) for major loss of function versus in non-depressed CKD inpatients ConclusionComorbid depression increases the likelihood of major loss of functioning in CKD inpatients by 46%. Treating depression can allow patients to better cope emotionally and physically with CKD and other comorbidities and significantly improve the patient's quality of life (QoL) and health outcome.

Depression in Patients on Hemodialysis: A Dilapidated Facet

“…This contrasts with a previous study that showed a strong association between disease comorbidities and depression in CKD [20]. A similar study also found an association between depression in CKD and comorbidities and suggested that depression can lead to the exacerbation of comorbid conditions [21]. Patients with CKD are known to experience depression at higher rates when they have diabetes.…”

Depression in internal medicine inpatients at the time of hospital discharge and referral to primary care

“…2,37 Moreover, the prevalence estimate in this study is conservative, since a proportion of patients excluded by protocol might also be depressed at discharge: a) those surviving patients who were very ill at the time of admission; and b) those excluded because of low cognitive performance or substance abuse since both these clinical conditions have been associated with depression. 38,39 In relation to the clinical significance of the findings, a number of previous reports reviewed in the introductory section have documented the negative consequences of depression in medical patients, 3,36,8,21,40 which may be worse in older individuals such as those predominating in our particular study. 5,21 Complications in the patients' management have also been reported.…”

Depression among patients with chronic kidney disease, associated factors, and predictors: a cross-sectional study

“…These findings differ from those of Silva et al [ 46 ] and Bapat et al [ 47 ]. Depression can lead to poorer health outcomes [ 48 ], increased hospitalisation [ 49 ], and lower quality of life [ 50 ]. Additionally, it was discovered that medication nonadherence is linked to worsening of CKD [ 51 ].According to Meng et al, depression and worsening CKD together increase the risk of both cardiovascular and all-cause death.…”