Depressed Dialysis Patients Do Worse

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Depression increases the risk of hospitalization and death approximately twofold, researchers find.

 
Hemodialysis patients who are diagnosed with depression are nearly twice as likely to be hospitalized or die within one year compared with non-depressed hemodialysis patients, researchers found.

They monitored 98 dialysis patients for up to 14 months and found that more than a quarter of them received a physician diagnosis of some form of depression based on the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV).

More than 80% of the depressed dialysis patients died or were hospitalized compared with 43% of non-depressed patients, according to a report in Kidney International (2008; published online ahead of print). Cardiovascular events, which previously have been linked to depression, led to 20% of the hospitalizations.

“Twenty percent of patients who start dialysis will die by the end of the first year,” said lead author Susan Hedayati, MD, assistant professor of medicine at The University of Texas Southwestern Medical Center in Dallas and staff nephrologist at the Dallas Veterans Affairs hospital. “What we don't know yet is if their depression is treated, could it extend dialysis patients' survival and im-prove their quality of life.”

Depression-like symptoms, such as loss of energy, poor appetite, and sleep disturbances, often are observed in patients with chronic disease, so it is important for clinicians to get a scientifically valid diagnosis of clinical depression based on DSM-IV criteria, she said.

With each comorbidity, a patient's risk of being hospitalized or dying rose by 30%. Depression increased the risk of these outcomes by 100%.

“Since depression is so prevalent and can negatively affect dialysis patients, we need to ask about it,” Dr. Hedayati said. “Now that we know depression in dialysis patients is associated with adverse outcomes, such as death and hospitalization, we need to take another step forward and figure out if treating it [depression] will make a difference.”

In a previous study of 1,588 men receiving hemodialysis at Veterans Affairs facilities, Dr. Hedayati and colleagues found that physician-diagnosed depression by ICD-9 coding, which was present in 14.6% of subjects, was significantly asso-ciated with both increased number of hospitalizations and length of stay, according to a report in the American Journal of Kidney Diseases (2005;46:642-649). [Editors note: abstract only; subscription needed for full text]

Depression was not significantly associated with death or the composite of death or hospitalization after adjusting for confounders.

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