Received 24 October 2008; accepted 9 March 2009. published online 04 June 2009.
Refers to article:
Quality of Life and Depression in CKD: Improving Hope and Health
Suzanne Watnick
American Journal of Kidney Diseases
September 2009 (Vol. 54, Issue 3, Pages 399-402) Full Text |
Full-Text PDF (142 KB)
Background
Depression is prevalent in long-term dialysis patients and is associated with death and hospitalization. Whether depression is present through all chronic kidney disease (CKD) stages or appears after dialysis therapy initiation is not clear. We determined the prevalence of a major depressive episode and other psychiatric illnesses by using a structured gold-standard clinical interview and demographic and clinical variables associated with major depressive episode in patients with CKD.
Study Design
Observational cross-sectional study using a Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition)–based structured interview administered by trained persons to 272 consecutive participants. Multivariable logistic regression was used to determine demographic and clinical variables associated with major depressive episode.
Setting & Participants
Patients with stages 2 to 5 CKD not treated by using dialysis were consecutively approached and enrolled from a Veterans Affairs CKD clinic.
Predictors
Demographic and clinical variables.
Outcome
Major depressive episode diagnosed by using a structured Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition)–based interview, the Mini International Neuropsychiatric Interview.
Results
The cohort had a mean age of 64.5 ± 12.0 years. Thirty-eight percent were African American, and 55% had diabetes mellitus. Percentages of patients with stages 2, 3, 4, and 5 CKD were 6%, 38%, 41%, and 14%, respectively. Mean hemoglobin level was 12.5 ± 2.0 g/dL. The prevalence of a major depressive episode was 21% and did not vary significantly among different CKD stages. Variables associated with a major depressive episode were diabetes mellitus, comorbid psychiatric illness, and history of drug or alcohol abuse.
Limitations
Single-center study composed of primarily male veterans.
Conclusions
One in 5 patients with CKD had a major depressive episode. Patients with CKD should be screened routinely for depression given this high prevalence and the independent association of depression with poor outcomes in patients with end-stage renal disease receiving maintenance dialysis.
1Department of Medicine, Division of Nephrology, Veterans Affairs North Texas Health Care System, Dallas, TX
2Department of Medicine, Division of Nephrology, University of Texas Southwestern Medical Center, Dallas, TX
3Department of Clinical Sciences, Division of Biostatistics, University of Texas Southwestern Medical Center, Dallas, TX
4Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX
5Division of Clinical Sciences, Duke-NUS, Singapore
Address correspondence to S. Susan Hedayati, MD, VA North Texas Health Care System, Nephrology Section, MC 111G1, 4500 S Lancaster Rd, Dallas, TX 75216-7167
ABSTRACT