Temporal Relation among Depression Symptoms, Cardiovascular Disease Events, and Mortality in End-Stage Renal Disease

Boulware, L. Ebony; Liu, Yongmei; Fink, Nancy E.; Coresh, Josef; Ford, Daniel E.; Klag, Michael J.; Powe, Neil R.

doi:10.2215/cjn.00030505

Cited by 169 publications

(197 citation statements)

References 57 publications

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“…Our findings extend the findings in the work by Boulware et al (11), which showed that MHI scores used for screening for depressive affect predict survival and CVD deaths in incident HD patients when assessed in a time-varying analysis but not when assessed only at baseline. The work by Kimmel et al (30) showed the importance of following the course of depressive affect, because there was no significant association between baseline depressive affect and mortality in prevalent dialysis patients.…”

Section: Discussionsupporting

confidence: 89%

“…It was interesting to note that, despite the numerous biases in using the time-varying Cox model, we found approximately the same trends of results in time-varying Cox regression analysis (data not shown). We also got the same trends of results when we analyzed with cutoff of 52, which was used in another study (11).…”

Section: Sensitivity Analysissupporting

confidence: 54%

“…Although physical component summary and MCS scores from the SF-36 are representative of physical and mental wellbeing separately and are associated with various clinical outcomes, MCS is known to be imperfect for diagnosing accurate mental health problems (37)(38)(39). The MHI, meanwhile, has been validated to detect mental health, such as mood and anxiety disorders, in the general population (24,40), and also, it has good specificity and sensitivity for the detection of depressive symptoms in chronic medical illness and dialysis patients (10,11,25,26,41). Patients with poor mental health had significantly lower KDQOL sleep quality scores, and sleep medication use was significantly associated with poor mental health in our study.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, it had good sensitivity and specificity for diagnosing depression in general population and chronic medical illness patients (22)(23)(24)(25). MHI has also been used for detecting depressive symptoms in dialysis patients (10,11), and it was well correlated with the Beck Depression Inventory in a study of dialysis patients (26).…”

Section: Mental Health Assessmentmentioning

confidence: 99%

“…Low HRQOL has been associated with increased rates of hospitalization and death in dialysis patients (3)(4)(5)(6)(7)(8)(9). Among the components of HRQOL, self-reported mental health has been linked with higher mortality in dialysis patients in several studies (4)(5)(6)10,11). Most of these studies have only investigated the relationship between mortality and mental health at baseline and not mental health over time, although deterioration in HRQOL over time has been observed in dialysis patients (12,13).…”

Section: Introductionmentioning

confidence: 99%

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The Association of Mental Health over Time with Cardiac Outcomes in HEMO Study Patients

Kang

Pike

Ramer

et al. 2012

Clinical Journal of the American Society of Nephrology

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Summary Background and objectives Poor mental health over time is significantly associated with cardiovascular morbidity and mortality in the general population, which is the leading cause of death in dialysis patients. Most studies of dialysis patients, however, have investigated the relationship between baseline mental health measurements and all-cause mortality and not mental health measured longitudinally throughout a study and cause-specific mortality. Design, setting, participants, & measurements This study examined the association of changes in mental health over time with all-cause and cause-specific deaths and cardiac hospitalizations in the Hemodialysis study patients. Mental health was assessed at baseline and annually during the study with short form 36 mental health index scores. Poorer mental health was defined by a mental health index score≤60. Results Patients with poorer mental health at baseline were more likely to have less than a high school education and be unmarried, have significantly higher index of coexistent disease scores, and report taking β-blockers and sleep medications. Low mental health scores over time were independently associated with a decrease in survival time from all-cause mortality by −0.06 (−0.10, −0.03; P<0.001), and they also significantly hastened time to first cardiac hospitalization by −0.08 (−0.13, −0.02; P=0.01) and composite of first cardiac hospitalization or cardiac death by −0.04 (−0.07, −0.02; P<0.001). Conclusions This study found an independent association between poor mental health over time and all-cause mortality, cardiac hospitalization, and the composite of cardiac death or cardiac hospitalization in hemodialysis patients. The results underscore the importance of attention to mental health related to cardiac complications and even death in dialysis patients.

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Section: Discussionsupporting

confidence: 89%

Section: Sensitivity Analysissupporting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Section: Mental Health Assessmentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Association of Mental Health over Time with Cardiac Outcomes in HEMO Study Patients

Kang

Pike

Ramer

et al. 2012

Clinical Journal of the American Society of Nephrology

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Association Between Major Depressive Episodes in Patients With Chronic Kidney Disease and Initiation of Dialysis, Hospitalization, or Death

Hedayati¹,

Minhajuddin

Afshar

et al. 2010

JAMA

204

187

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Context Patients with chronic kidney disease (CKD) experience increased rates of hospitalization and death. Depressive disorders are associated with morbidity and mortality. Whether depression contributes to poor outcomes in patients with CKD not receiving dialysis is unknown. Objective To determine whether the presence of a current major depressive episode (MDE) is associated with poorer outcomes in patients with CKD. Design, Setting, and Patients Prospective cohort study of 267 consecutively recruited outpatients with CKD (stages 2–5 and who were not receiving dialysis) at a VA medical center between May 2005 and November 2006 and followed up for 1 year. An MDE was diagnosed by blinded personnel using the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria. Main Outcome Measures The primary outcome was event-free survival defined as the composite of death, dialysis initiation, or hospitalization. Secondary outcomes included each of these events assessed separately. Results Among 267 patients, 56 had a current MDE (21%) and 211 did not (79%). There were 127 composite events, 116 hospitalizations, 38 dialysis initiations, and 18 deaths. Events occurred more often in patients with an MDE compared with those without an MDE (61% vs 44%, respectively, P=.03). Four patients with missing dates of hospitalization were excluded from survival analyses. The mean (SD) time to the composite event was 206.5 (19.8) days (95% CI, 167.7–245.3 days) for those with an MDE compared with 273.3 (8.5) days (95% CI, 256.6–290.0 days) for those without an MDE (P=.003). The adjusted hazard ratio (HR) for the composite event for patients with an MDE was 1.86 (95% CI, 1.23–2.84). An MDE at baseline independently predicted progression to dialysis (HR, 3.51; 95% CI, 1.77–6.97) and hospitalization (HR, 1.90; 95% CI, 1.23–2.95). Conclusion The presence of an MDE was associated with an increased risk of poor outcomes in CKD patients who were not receiving dialysis, independent of comorbidities and kidney disease severity.

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Effect of Sertraline on Depressive Symptoms in Patients With Chronic Kidney Disease Without Dialysis Dependence

Hedayati

Gregg

Carmody

et al. 2017

JAMA

105

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IMPORTANCE Major depressive disorder (MDD) is prevalent among patients with chronic kidney disease (CKD) and is associated with morbidity and mortality. The efficacy and adverse events of selective serotonin reuptake inhibitors in these patients are unknown. OBJECTIVE To determine whether treatment with sertraline improves depressive symptoms in patients with CKD and MDD. DESIGN, SETTING, AND PARTICIPANTS The Chronic Kidney Disease Antidepressant Sertraline Trial (CAST) was a randomized, double-blind, placebo-controlled trial involving 201 patients with stage 3, 4, or 5 non–dialysis-dependent CKD, who were enrolled at 3 US medical centers. The Mini Neuropsychiatric Interview was used to establish MDD. The first participant was randomized in March 2010 and the last clinic visit occurred in November 2016. INTERVENTIONS After a 1-week placebo run-in, participants were randomized to sertraline (n = 102) for 12 weeks at an initial dose of 50 mg/d (escalated to a maximum dose of 200 mg/d based on tolerability and response) or matching placebo (n = 99). MAIN OUTCOMES AND MEASURES The primary outcome was improvement in depressive symptom severity from baseline to 12 weeks determined by the 16-item Quick Inventory of Depression Symptomatology–Clinician Rated (QIDS-C16) (score range, 0–27; minimal clinically important difference, 2 points). Secondary outcomes included improvement in quality of life (Kidney Disease Quality of Life Survey–Short Form; score range, 0–100; higher scores indicate more favorable quality of life) and adverse events. RESULTS There were 201 patients (mean [SD] age, 58.2 [13.2] years; 27%female) randomized. The primary analysis included 193 patients who had at least 1 outcome assessment after randomization. The mean (SD) baseline QIDS-C16 score was 14.0 (2.4) in the sertraline group (n = 97) and 14.1 (2.4) in the placebo group (n = 96). The median participation time was 12.0 weeks and the median achieved dose was 150 mg/d, which was not significantly different between the groups. The QIDS-C16 score changed by −4.1 in the sertraline group and by −4.2 in the placebo group (between-group difference, 0.1 [95%CI, −1.1 to 1.3]; P = .82). There was no significant between-group difference in change in patient-reported overall health on the Kidney Disease Quality of Life Survey (median score, 0 in the sertraline group vs 0 in the placebo group; between-group difference, 0 [95%CI, −10.0 to 0]; P = .61). Nausea or vomiting occurred more frequently in the sertraline vs placebo group (22.7%vs 10.4%, respectively; between-group difference, 12.3%[95%CI, 1.9%to 22.6%], P = .03), as well as diarrhea (13.4%vs 3.1%; between-group difference, 10.3%[95%CI, 2.7%to 17.9%], P = .02). CONCLUSIONS AND RELEVANCE Among patients with non–dialysis-dependent CKD and MDD, treatment with sertraline compared with placebo for 12 weeks did not significantly improve depressive symptoms. These findings do not support the use of sertraline to treat MDD in patients with non–dialysis-dependent CKD. TRIAL REGISTRATION clinica...

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Temporal Relation among Depression Symptoms, Cardiovascular Disease Events, and Mortality in End-Stage Renal Disease

Cited by 169 publications

References 57 publications

The Association of Mental Health over Time with Cardiac Outcomes in HEMO Study Patients

The Association of Mental Health over Time with Cardiac Outcomes in HEMO Study Patients

Association Between Major Depressive Episodes in Patients With Chronic Kidney Disease and Initiation of Dialysis, Hospitalization, or Death

Effect of Sertraline on Depressive Symptoms in Patients With Chronic Kidney Disease Without Dialysis Dependence

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