Prevalence of Major Depressive Episode in CKD

Abstract

Background Depression is prevalent in long-term dialysis patients and is associated with death and hospitalization. Whether depression is present through all chronic kidney disease (CKD) stages or appears after dialysis therapy initiation is not clear. We determined the prevalence of a major depressive episode and other psychiatric illnesses by using a structured gold-standard clinical interview and demographic and clinical variables associated with major depressive episode in patients with CKD. Study Design Observational cross-sectional study using a Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition)-based structured interview administered by trained persons to 272 consecutive participants. Multivariable logistic regression was used to determine demographic and clinical variables associated with major depressive episode. Setting & Participants Patients with stages 2 to 5 CKD not treated by using dialysis were consecutively approached and enrolled from a Veterans Affairs CKD clinic. Predictors Demographic and clinical variables. Outcome Major depressive episode diagnosed by using a structured Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition)-based interview, the Mini International Neuropsychiatric Interview. Results The cohort had a mean age of 64.5 ± 12.0 years. Thirty-eight percent were African American, and 55% had diabetes mellitus. Percentages of patients with stages 2, 3, 4, and 5 CKD were 6%, 38%, 41%, and 14%, respectively. Mean hemoglobin level was 12.5 ± 2.0 g/dL. The prevalence of a major depressive episode was 21% and did not vary significantly among different CKD stages. Variables associated with a major depressive episode were diabetes mellitus, comorbid psychiatric illness, and history of drug or alcohol abuse. Limitations Single-center study composed of primarily male veterans. Conclusions One in 5 patients with CKD had a major depressive episode. Patients with CKD should be screened routinely for depression given this high prevalence and the independent association of depression with poor outcomes in patients with end-stage renal disease receiving maintenance dialysis.

Psychiatric Comorbidity, Sexual Dysfunction, and Quality of Life in Patients Undergoing Hemodialysis: A Case-Control Study

“…In our study, as a result of interviews with SCID-I, any psychiatric disorder was diagnosed in 49% of patients, and major depressive disorder was diagnosed in 28.6%, and these rates were significantly higher than control group. Results of our study are consistent with the results of other studies pointing out to the frequent existence of comorbid psychiatric disorders in patients with chronic renal impairment (19,20,33,35). Parallel to this finding, the depression subscale score of HADS is significantly higher in patient group than in the control group.…”

“…A review of studies using different scales and strategies for diagnosis shows that the frequency of comorbid psychiatric disorders in ESRD ranges from 5% to 50% (19,32,33). In a study, it was reported that according to Beck Depression Inventory, 47% of the patients with ESRD have a score above the cutoff point, but major depression is diagnosed in only 5% of them as a result of structured interviews (32).…”

Protective effect of regular physical activity on major depressive episodes in patients with early stages of chronic kidney disease

“…In the present study, we found that 22.7% of patients with early stages of CKD had a current MDE, which is consistent with previous studies [1,15]. Our results also demonstrated that diabetes mellitus were significantly associated with an MDE.…”

“…Depression is prevalent in patients with chronic kidney disease (CKD), affecting up to 21% of patients even before receiving maintenance dialysis [1]. The presence of depression is associated with increased risk of progression to dialysis, reduced quality of life, hospitalization, and death [2][3][4].…”

Five Policies to Promote Palliative Care for Patients with ESRD

“…Half of the patients who start dialysis in the United States are aged .65 years and the majority have multiple chronic conditions in addition to ESRD. Although dialysis therapy extends life for most patients with ESRD, it often fails to restore health, and despite frequent contact with the healthcare system, many patients suffer from unrecognized and untreated distressing symptoms, functional and cognitive disability, and high caregiver burden before death (2)(3)(4)(5)(6)(7).…”