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      Call for Papers: Green Renal Replacement Therapy: Caring for the Environment

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      About Blood Purification: 3.0 Impact Factor I 5.6 CiteScore I 0.83 Scimago Journal & Country Rank (SJR)

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      Depression and all-cause mortality in hemodialysis patients.

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          There are limited data regarding the relationship between depression and mortality in hemodialysis (HD) patients.

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          Depression is an important contributor to low medication adherence in hemodialyzed patients and transplant recipients.

          Saurabh Jindal, D. Rosenthal, Paul L Kimmel … (2009)
          End-stage renal disease (ESRD) is a growing public health concern and non-adherence to treatment has been associated with poorer health outcomes in this population. Depression, likely to be the most common psychopathology in such patients, is associated with increased morbidity and mortality. We compared psychological measures and self-reported medication adherence of 94 kidney transplant recipients to those of 65 patients receiving hemodialysis in a major medical center in Brooklyn, New York. Compared to the transplant group, the hemodialysis cohort was significantly more depressed as determined by the Beck Depression Inventory score. They also had a significantly lower adherence to medication as reported on the Medication Therapy Adherence Scale. Using hierarchical multiple regression analysis, the variance in depression was the only statistically significant predictor of medication adherence beyond gender and mode of treatment, accounting for an additional 12% of the variance. Our study strongly suggests that a depressive affect is an important contributor to low medication adherence in patients with ESRD on hemodialysis or kidney transplant recipients.
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            The predictive value of self-report scales compared with physician diagnosis of depression in hemodialysis patients.

            Paul L Kimmel, H Bosworth, Lynda Szczech … (2006)
            The prevalence of depression in end-stage renal disease (ESRD) patients on hemodialysis has not been definitively determined. We examined the prevalence of depression and the sensitivity, specificity, positive, and negative likelihood ratios (+LR and -LR) of self-report scales using the physician-administered Structured Clinical Interview for Depression (SCID) as the comparison. Ninety-eight consecutive patients completed the Beck Depression Inventory (BDI) and the Center for Epidemiological Study of Depression (CESD) scales. A physician blinded to BDI and CESD scores administered the SCID. Receiver/responder operating characteristic curves determined the best BDI and CESD cutoffs for depression. Depressed patients had more co-morbidities and lower quality of life, P<0.05. The prevalence of depression by SCID was 26.5% and of major depression was 17.3%. The CESD cutoff with the best diagnostic accuracy was 18, with sensitivity 69% (95% confidence interval (CI) (51%, 87%)), specificity 83% (95% CI (74%, 92%)), positive predictive value (PPV) 60%, negative predictive value (NPV) 88%, +LR 4.14, and -LR 0.37. The best BDI cutoff was 14, with sensitivity 62% (95% CI (43%, 81%)), specificity 81% (95% CI (72%, 90%)), PPV 53%, NPV 85%, +LR 3.26, and -LR 0.47. Self-report scales have high +LR but low -LR for diagnosis of depression. When used for screening, the threshold for depression should be higher for ESRD compared with non-ESRD patients. Identifying depression using physician interview is important, given the low -LR of self-report scales.
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              Death or hospitalization of patients on chronic hemodialysis is associated with a physician-based diagnosis of depression.

              Paul L Kimmel, Annette Briley, Hayden B Bosworth … (2008)
              Depressive symptoms, assessed using a self-report type of questionnaire, have been associated with poor outcomes in dialysis patients. Here we determined if depressive disorders diagnosed by physicians are also associated with such outcomes. Ninety-eight consecutive patients on chronic hemodialysis underwent the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders administered by a physician. Depression was diagnosed in about a quarter of the patients. Associations adjusted for age, gender, race, time on dialysis and co-morbidity were determined using survival analysis. Using time to event (death or hospitalization) models of analysis the hazard ratios were 2.11 and 2.07 in unadjusted and adjusted models respectively. The finding of poor outcome using a formal structured physician interview suggests that a prospective study is needed to determine whether treatment of depression affects clinical outcomes.
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                Author and article information

                Journal
                Journal ID (iso-abbrev): Am. J. Nephrol.
                Title: American journal of nephrology
                ISSN (Electronic): 1421-9670
                ISSN (Print): 0250-8095
                Publication date (Electronic): 2014
                Volume: 40
                Issue: 1
                Affiliations
                [1 ] Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, Mass., USA.
                Article
                Publisher Item ID: 000363539 Mid ID: NIHMS598199
                DOI: 10.1159/000363539
                PMC ID: 4128686
                PubMed ID: 24969267
                SO-VID: 32801a2b-6628-4d3f-b043-12332cdb6519
                Copyright © © 2014 S. Karger AG, Basel.
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