Depressive Affect and Hospitalization Risk in Incident Hemodialysis Patients

Abstract

Background and objectives Recent studies demonstrated an association between depressive affect and higher mortality risk in incident hemodialysis patients. This study sought to determine whether an association also exists with hospitalization risk.Design, setting, participants, & measurements All 8776 adult incident hemodialysis patients with Medical Outcomes Study Short Form 36 survey results treated in Fresenius Medical Care North America facilities in 2006 were followed for 1 year from the date of survey, and all hospitalization events lasting .24 hours were tracked. A depressive affect score was derived from responses to two Medical Outcomes Study Short Form 36 questions ("down in the dumps" and "downhearted and blue"). A high depressive affect score corresponded with an average response of "some of the time" or more frequent occurrence. Cox and Poisson models were constructed to determine associations of depressive affect scores with risk for time to first hospitalization and risk for hospitalization events, as well as total days spent in the hospital, respectively.Results Incident patients with high depressive affect score made up 41% of the cohort and had a median (interquartile range) hospitalization event rate of one (0, 3) and 4 (0, 15) total hospital days; the values for patients with low depressive affect scores were one (0, 2) event and 2 (0, 11) days, respectively. For high-scoring patients, the adjusted hazard ratio for first hospitalization was 1.12 (1.04, 1.20). When multiple hospital events were considered, the adjusted risk ratio was 1.13 (1.02, 1.25) and the corresponding risk ratio for total hospital days was 1.20 (1.07, 1.35). High depressive affect score was generally associated with lower physical and mental component scores, but these covariates were adjusted for in the models.Conclusions Depressive affect in incident hemodialysis patients was associated with higher risk of hospitalization and more hospital days. Future studies are needed to investigate the effect of therapeutic interventions to address depressive affect in this high-risk population.

The Relevance of Geriatric Impairments in Patients Starting Dialysis: A Systematic Review

“…Of the remaining publications, 13,083 were excluded for reasons listed in Figure 1; 106 potentially relevant articles were subsequently screened as full text. Ultimately, 27 full-text publications were considered relevant to our search ( Eight studies focused on hemodialysis (27,28,31,33,(35)(36)(37)(38), and three studies focused on peritoneal dialysis only (24,29,43). Fifteen studies performed the screening for impairments at dialysis initiation, and 12 studies performed the screening for impairments within 3 months after initiation.…”

“…Hospitalization days after dialysis initiation were assessed in three studies (Table 3) showing that malnutrition (43), depression (36), and performance status (37,43) were associated with more days in hospital. However, the association between performance status and hospitalization duration was lost after adjustment for potential confounders in one of the two studies (P=0.50) (37).…”

“…However, the association between performance status and hospitalization duration was lost after adjustment for potential confounders in one of the two studies (P=0.50) (37). Depressive symptoms were related to hospitalization rate (HR, 1.13; 95% CI, 1.02 to 1.25) (36). One study assessed the association of frailty and time to first hospitalization (19), and another study focused on the combined outcome time to first hospitalization or death or time to first nonvascular hospitalization and death (32).…”

Lower Physical Activity and Depression Are Associated with Hospitalization and Shorter Survival in CKD

“…In a second report focused on depressive affect, Lacson et al (12) retrospectively evaluated 8776 incident adult hemodialysis patients from a large United States cohort. Using the SF-36 survey administered shortly after dialysis inception, they observed that approximately 40% of patients had depressive symptoms and that depression was associated with a higher risk of hospitalization and more hospitalization days during the subsequent 12 months of treatment.…”

“…If we could aggregate these three studies, we would find that elderly patients with CKD would have higher risk of depressive symptoms (11), depression is associated with more hospitalization when patients start MD (12), and greater physical activity during hemodialysis is associated with better quality of life and fewer depressive symptoms. These finding suggest that physical activity should be enforced in all dialysis facilities.…”