ASN: Depression Predicts Poorer Outcomes in Chronic Kidney Disease
PHILADELPHIA, Nov. 11 -- In patients with chronic kidney disease, a diagnosis of major depression was associated with worse outcomes, according to an observational study.
Those who had a major depressive episode at baseline were nearly twice as likely as those who did not to begin dialysis, be hospitalized, or die within a year (HR 1.85, 95% CI 1.22 to 2.81).
However, it was unclear how depression should be treated in these patients and whether treating the depression would improve outcomes. The researchersthen asked, "Is it dialysis itself that causes these patients to be more depressed or does it start some time before dialysis?"
To answer that question, they prospectively evaluated 272 predominantly male patients at the Dallas VA Medical Center who had stage 2-5 chronic kidney disease and had not been started on dialysis.
According to screening with the Mini International Neuropsychiatric Interview, 21% of the patients met criteria for major depressive disorder. Depressed patients were younger (mean age 61.0 versus 65.5, P=0.02), less likely to be employed (7% versus 21.6%, P=0.01), and more likely to have diabetes (68.4% versus 52.3%, P=0.03) or a history of drug or alcohol abuse (42.1% versus 25.6%, P=0.02).
Overall, 46% of patients were started on dialysis, were hospitalized, or died within 12 months. Depressed patients were significantly more likely to experience at least one of those events (63% versus 45%, P=0.02). And they experienced them more quickly -- mean time to the composite endpoint was 206.5 days for the depressed patients and 273.3 days for the non-depressed patients (P=0.003).
When looking at hospitalization alone, depressed patients had a 2.9-fold increased risk (OR 2.9, 95% CI 1.28 to 6.56). Depression at baseline predicted initiation of dialysis at 6 and 12 months with odds ratios of (95% CI) 4.35 (1.73 to 10.91) and 3.37 (1.60 to 7.10) in univariate analyses.
After controlling for comorbidity and estimated glomerular filtration rate, depression was still significantly associated with dialysis initiation, odds ratios for 6 and 12 months were 6.87 (1.80 to 26.21) and 7.82 (2.40 to 25.44), respectively.
Depression was also independently associated with the composite endpoint after controlling for age, race, employment status, disease stage, comorbidity, drug or alcohol abuse, albumin, and hemoglobin with odds ratios of 2.87 (1.31 to 6.29) and 2.60 (1.17 to 5.78) for 6 and 12 months.

Primary source: American Society of Nephrology Source reference: Hedayati S, et al "Depression predicts initiation of dialysis, hospitalization, and death in chronic kidney disease patients" ASN 2009; Abstract SA-PO2907.