Prevalence of depression in chronic kidney disease: systematic review and meta-analysis of observational studies

Psychosocial issues are an understudied yet important concern in the overall health of hemodialysis (HD) patients. Stress is a concomitant of chronic illness and its treatment, and may have meaningful influences on psychological and medical outcomes. This article reviews the influences of psychopathology, social support, family issues, dialysis unit culture, and socioeconomic status on patients treated with center HD. Depressive affect and decreased perception of social support have been linked with mortality in several studies of ESRD patients. Decreased marital satisfaction, disturbances in family dynamics, and lower socioeconomic status (SES) have been associated with poorer health outcomes and can affect patients' perception of social support and depressive affect. Chronically ill ESRD patients who undergo treatment with constant interaction and observation by medical staff are potentially an ideal group for evaluation of the effects of stress and psychosocial factors on outcomes in those with chronic disease, as well as an excellent patient population for intervention to reduce morbidity and mortality. These interactions between potentially modifiable psychosocial risk factors for disease and medical aspects of illness form a paradigm for the study of interventions related to adjustment to chronic illness in the ESRD population.

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Psychosocial Aspects of Chronic Disease: ESRD as a Paradigmatic Illness

BACKGROUND
Depression is common in patients with end-stage renal disease (ESRD) and is associated with increased mortality, but little is known about depression in patients just after they start dialysis therapy. We sought to assess the prevalence of depressive symptoms in patients with ESRD starting dialysis therapy, identify patient characteristics associated with depression, and determine whether patients with serious depressive symptoms were receiving treatment.


METHODS
We implemented a multicenter prospective cohort study at 14 dialysis centers in Connecticut. Patients with ESRD who were 18 years and older were interviewed within 10 days of initiating dialysis therapy between November 2000 and July 2001. The Beck Depression Inventory (BDI) was used to assess depressive symptoms. Chi-square tests were used to evaluate associations between several patient characteristics and depression, and multivariable logistic regression models were used to determine odds ratios (ORs) for depression, with adjustment for baseline variables.


RESULTS
Among 123 patients, 44% (54 of 123 patients) had scores above the validated cutoff value in the BDI for depression. In logistic regression analysis, depression was statistically significantly associated with Caucasian race (OR, 3.4; P = 0.02), lower self-rated quality of life (OR, 2.2; P = 0.003), and no previous acquaintances on dialysis therapy (OR, 10.2; P = 0.03). Only 16% (9 of 54 patients) of depressed patients were being treated at enrollment; 13% (5 of 38 patients) of those with mild symptoms and 25% (4 of 16 patients) with more severe symptoms were being treated.


CONCLUSION
Our results show that depressive symptoms are very common at the start of dialysis therapy, and specific characteristics are associated with a greater burden of depressive symptoms. Despite a high prevalence, treatment rates are low, even among patients with moderate to severe symptoms of depression.

The Prevalence and Treatment of Depression Among Patients Starting Dialysis

https://www.kidney-international.org/article/S0085-2538(15)55291-5/pdf

A practical approach to the treatment of depression in patients with chronic kidney disease and end-stage renal disease

Is rising rapidly worldwide 

T he number of patients with chronic kidney disease worldwide is rising markedly.1 In the United Kingdom, the annual incidence of end stage renal disease is around 100 per 1 000 000 population.2 This incidence has doubled over the past decade and is expected to continue to rise by 5-8% annually, but it remains well below the European average (around 135/1 000 000) and that of the United States (336/1 000 000).3

Disparities in the incidence of end stage renal disease within and between developed countries reflect racial and ethnic diversity. In the US, the annual incidence is 256/1 000 000 in white people compared with 982/1 000 000 in African-Americans.3 In Australia, the incidence in white people is comparable to that in the UK (94/1 000 000), but the incidence in aboriginals is 420/1 000 000.

The rise in end stage renal disease worldwide most probably reflects the global epidemic of type 2 diabetes and the ageing of the populations in developed countries, with a higher incidence in elderly people (the annual incidence in people over 65 in the …

/pdf/the-burden-of-chronic-kidney-disease-5bu7u8c8cv.pdf

The burden of chronic kidney disease

http://research.kaums.ac.ir/uploadedfiles/mirhosseini/treatment of depression in haemodialysis patients-kashan.pdf

Jong-Yoo Yoon

Papers

Treatment of Depression and Effect of Antidepression Treatment on Nutritional Status in Chronic Hemodialysis Patients