Physician-Diagnosed Depression as a Correlate of Hospitalizations in Patients Receiving Long-Term Hemodialysis

doi:10.1053/j.ajkd.2005.07.002

American Journal of Kidney Diseases

Volume 46, Issue 4, October 2005, Pages 642-649

https://doi.org/10.1053/j.ajkd.2005.07.002 Get rights and content

Background: Hospital admissions consume a large proportion of costs for the end-stage renal disease (ESRD) program in the United States. We investigated whether a physician diagnosis of depression increases the risk for hospitalization or death in patients with ESRD receiving long-term hemodialysis (HD), independent of medical comorbidities. Methods: Centralized Veterans Affairs (VA) databases were used to identify a population-based prevalence cohort of 1,588 male patients with ESRD receiving long-term HD in VA facilities between September 1, 2000, and September 30, 2000. International Classification of Diseases, Ninth Revision, codes were used to identify comorbidities and depression diagnosis. Negative binomial regression models were used to examine the association between depression diagnosis and number of hospitalizations and cumulative hospital days in a 2-year observation period. Logistic regression models were used to investigate the association between depression diagnosis and hospitalization, death, and death or hospitalization. Results: The prevalence of physician-diagnosed depression was 14.7%. Patients with a depression diagnosis were more likely to be white and have more comorbidities. Depression diagnosis was associated with increased hospital days (rate ratio for adjusted model, 1.31; 95% confidence interval, 1.04 to 1.66) and increased number of hospitalizations (rate ratio for adjusted model, 1.30; 95% confidence interval, 1.11 to 1.52). Depression diagnosis was not statistically associated with death or the composite of death or hospitalization in adjusted models. Conclusion: Physician-diagnosed depression was associated significantly with both increased hospitalization rate and length of stay in patients with ESRD receiving outpatient HD in VA facilities, independent of demographics and comorbidities. Prospective studies should be conducted to assess whether treatment of depression will decrease hospitalization in these patients.

Section snippets

Participants and Explanatory Variables

This study is a retrospective cohort study of 1,588 prevalent males with ESRD receiving outpatient long-term HD who were identified by using the Outpatient Care Files of centralized Department of VA administrative data sets.¹⁵ Patients were included if they had at least 1 outpatient HD Current Procedural Terminology (CPT) code (version 2003)¹⁶ of 90935, 90936, 90937, or 90999 between September 1, 2000, and September 30, 2000. To include only patients on long-term HD therapy and exclude patients

Patients

One thousand five hundred eighty-eight patients were studied, of whom 233 patients (14.7%) had a physician diagnosis of depression. Mean age was not statistically significantly different among patients based on depression diagnosis (Table 1). Patients with a depression diagnosis were more likely to be white and have hypertension, ischemic heart disease, peripheral vascular disease, liver disease, and substance abuse (Table 1). Mean number of outpatient encounters during October 1, 1999, and

Discussion

Of male patients with ESRD receiving outpatient long-term HD in the VA health care system, approximately 15% had a physician diagnosis of depression. The prevalence of depression reported here is similar to that reported by Lopes et al⁸ in a prospective cohort of HD patients from the United States and Europe. In general, patients with a depression diagnosis were more likely to be white and have more medical comorbidities than those without a depression diagnosis. Although a physician diagnosis

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Depression, anxiety and quality of life of hemodialysis patients before and during the COVID-19 pandemic
2022, Journal of Psychosomatic Research
To investigate the impact of the coronavirus pandemic on mental health in hemodialysis patients, we assessed depression, anxiety and quality of life with valid mental health measures before and after the start of the pandemic.
Data were used from 121 hemodialysis patients from the ongoing prospective multicenter DIVERS-II study. COVID-19 related stress was measured with the Perceived Stress Scale – 10, depression with the Beck Depression Inventory – second edition (BDI-II)), anxiety with the Beck Anxiety Inventory (BAI) and quality of life with the Short Form – 12 (SF-12). Scores during the first and second COVID-19 wave in the Netherlands were compared to data prior to the pandemic with linear mixed models.
No significant differences were found in BDI-II, BAI and SF-12 scores between before and during the pandemic. During the first wave, 33% of participants reported COVID-19 related stress and in the second wave 37%. These patients had higher stress levels (mean difference (MD) 4.7 (95%CI 1.5; 8.0), p = 0.005) and BDI-II scores (MD 4.9 (95%CI 0.7; 9.0), p = 0.021) and lower SF-12 mental component summary scores (MD -5.3 (95%CI -9.0, −1.6), p = 0.006) than patients who did not experienced COVID-19 stress. These differences were already present before the pandemic.
The COVID-19 pandemic does not seem to influence mental health in hemodialysis patients. However, a substantial subgroup of patients with pre-existent mental health problems may be more susceptible to experience COVID-19 related stress.
Depressive Symptoms at Kidney Transplant Evaluation and Access to the Kidney Transplant Waitlist
2022, Kidney International Reports
Depressive symptoms, even without a clinical diagnosis of depression, are common in kidney failure patients and may be a barrier to completing the complex process of kidney transplant (KT) evaluation. We assessed depressive symptom burden and association between depressive symptoms and access to KT waitlist by age.
In a prospective cohort of 3728 KT patients (aged 18–88 years), the Center for Epidemiologic Studies—Depression (CES-D) scale was used to measure depressive symptoms at evaluation. Depressive symptom severity was defined as follows: none: 0; minimal: 1 to 15; mild: 16 to 20; moderate: 21 to 25; severe: 26 to 60. Hazard ratios (HRs) of active listing within 1 year after evaluation were estimated using Cox proportional hazards models, adjusted for clinical and social factors.
At evaluation, 85.8% of the patients reported at least minimal depressive symptoms; the proportion was lower among older patients: 18 to 29 years = 92.0%; 30 to 39 years = 88.3%; 40 to 49 years = 87.2%; 50 to 59 years = 87.0%; 60 to 69 years = 83.4%; and ≥70 years = 82.0%. Chance of active listing decreased with more severe depressive symptoms (log-rank, P < 0.001). After adjustment, every 5-point higher CES-D score (more depressive symptoms) was associated with a 13% lower chance of listing (HR = 0.87, 95% CI: 0.85–0.90); the strongest association was found among patients aged ≥70 years (adjusted HR [aHR] = 0.73, 95% CI: 0.62–0.86). Furthermore, minimal (HR = 0.69, 95% CI: 0.60–0.79), mild (HR = 0.57, 95% CI: 0.44–0.72), moderate (HR = 0.53, 95% CI: 0.39–0.71), and severe (HR = 0.44, 95% CI: 0.34–0.57) depressive symptoms were all associated with a lower chance of listing.
Older candidates were less likely to report depressive symptoms at KT evaluation. Regardless of age, candidates who did report depressive symptoms, and even minimal symptoms, had a lower chance of listing. Transplant centers should routinely screen patients for depressive symptoms and refer the affected patients to mental health services to improve access to KT.
Internet-based treatment for depressive symptoms in hemodialysis patients: A cluster randomized controlled trial
2022, General Hospital Psychiatry
To investigate the effectiveness of a guided internet-based self-help intervention for hemodialysis patients with depressive symptoms.
Chronic hemodialysis patients from nine Dutch hospitals with a depression score on the Beck Depression Inventory – second edition (BDI-II) of ≥10, were cluster-randomized into a five modules guided internet-based self-help problem solving therapy intervention or a parallel care-as-usual control group. Clusters were based on hemodialysis shift. The primary outcome depression was measured with the BDI-II. Analysis was performed with linear mixed models.
A total of 190 hemodialysis patients were cluster-randomized to the intervention (n = 89) or control group (n = 101). Post-intervention measurement was completed by 127 patients (67%) and more than half of the patients (54%) completed the intervention. No significant differences were found on the BDI-II score between the groups (mean difference − 0.1, 95%CI -3.0; 2.7, p = 0.94). Per protocol sensitivity analysis showed comparable results. No significant differences in secondary outcomes were observed between groups.
Guided internet-based self-help problem solving therapy for hemodialysis patients with depressive symptoms does not seem to be effective in reducing these symptoms as compared to usual care. Future research should examine how to best design content and accessibility of an intervention for depressive symptoms in hemodialysis patients.
Dutch Trial Register: Trial NL6648 (NTR6834) (prospectively registered 13th November 2017).
Diagnosis and Management of Depression in Patients With Kidney Disease
2021, Seminars in Nephrology
Depression disproportionately affects patients with kidney disease, including those with nondialysis chronic kidney disease, end-stage kidney disease requiring dialysis, and kidney transplant recipients. Patients across the spectrum of kidney disease should be screened for depression every 6 to 12 months using self-report questionnaires, followed by an interview with a clinician to confirm the presence of sadness or anhedonia when depressive symptoms are identified. Pharmacologic treatment with selective serotonin reuptake inhibitors has not consistently shown benefit compared with placebo and may be associated with serious adverse outcomes including cardiovascular events, bleeding, and fractures. However, based on the availability of alternative therapies, a watchful trial with close monitoring for therapeutic and adverse effects is reasonable. Several clinical trials have suggested that cognitive behavioral therapy and physical activity improve depressive symptoms when compared with a control group. Given the low risk associated with these therapies, they should be recommended to patients who have access and are amenable to such interventions. Future trials are needed to study therapeutic options for depression in nondialysis chronic kidney disease, peritoneal dialysis, or kidney transplant recipients, as well as alternative pharmacologic therapy and combination therapies. Given improvement in depressive symptoms with placebo in existing trials, inclusion of a control group is paramount.
Depression symptoms and quality of life in patients receiving renal replacement therapy in Jordan: A cross-sectional study
2021, Annals of Medicine and Surgery
Citation Excerpt :
This may be explained by the fact that patients receiving RRT can experience depressive symptoms when they become less active in the group, but that as time passes, they may begin to adjust and adapt to their current clinical regimen, or that the decreased fluctuation in their biochemical parameters causes them to experience less depressive symptoms than when they first started receiving RRT. Other research, on the other hand, found that younger age, female gender, longer dialysis period, and comorbidities were the most important predictors of depression and depressive symptoms [28,29]. The lack of a correlation between depressive symptoms and age or gender in this study could suggest that RRT patients take each day as it comes.
Patients with chronic illnesses, such as those with chronic kidney disease (CKD) that are undergoing renal replacement therapy (RRT), face significant psychological changes. This descriptive cross-sectional research was carried out to investigate the factors that influence depressive symptoms and quality of life (QoL) in patients with end-stage renal disease. Data were collected from 70 participants undergoing RRT using a self-reported questionnaire that included sociodemographic information, depressive symptoms, disease status, and QoL. The Beck Depression Inventory-II (BDI-II) screening scale was used to measure depressive symptoms and the SF-36 (Medical Outcome Survey-Short Form 36) was used to assess QoL. Participants in the study rated their depressive symptoms as ‘minimum (44.3%), ‘mild’ (20%), ‘moderate’ (21.4%), and ‘severe (14.3%). Furthermore, a shorter duration of dialysis and comorbid conditions were significantly associated with the development of depressive symptoms. Patients on RRT for a longer period of time had lower physical activity scores than patients on dialysis for a shorter period of time. Male participants have a higher mental QoL than female participants, suggesting that the mental aspect of renal disease is less impaired than the physical aspect. The findings of this study are expected to increase awareness of RRT therapy targets and enhance patient outcomes.
Social determinants of racial and socioeconomic disparities in CKD and ESRD
2020, Psychosocial Aspects of Chronic Kidney Disease: Exploring the Impact of CKD, Dialysis, and Transplantation on Patients
Race and ethnicity imprecisely align with genetic differences based on ancestral origin. Rather, they reflect a complex and interacting mix of social, cultural, and biological factors. While genetic differences clearly contribute to some racial and ethnic disparities, including those in chronic kidney disease (CKD), these disparities are also fueled by the clustering of negative social determinants of health, or social risks, in minority and socially disadvantaged populations. These social risks have clear and strong associations with both CKD and end-stage renal disease (ESRD) and contribute to the substantial disparities that exist in CKD and ESRD across racial, ethnic, and socioeconomic lines. This chapter reviews the socially constructed nature of race and ethnicity, discusses the substantial disparities that exist in CKD and ESRD populations across race, ethnicity, and social class, and describes the role that social risks play in the development of CKD and ESRD and in their disparate impact on low-income and racial/ethnic minority populations.

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Originally published online as doi:10.1053/j.ajkd.2005.07.002 on September 2, 2005.

Supported in part by a fellowship grant from the Agency for Health Care, Research, and Quality (S.S.H.); grant no. DK02724-01A1 from The National Institutes of Health (L.A.S.); investigator initiative grant no. 20-034 from the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development (H.B.B.); and grant no. R01 HL070713 from the National Heart, Lung and Blood Institute (H.B.B.).

The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

View full text

Original InvestigationDialysis therapyPhysician-Diagnosed Depression as a Correlate of Hospitalizations in Patients Receiving Long-Term Hemodialysis

Section snippets

Participants and Explanatory Variables

Patients

Discussion

Kidney Int

Kidney Int

Ann Epidemiol

Kidney Int

Am J Kidney Dis

Kidney Int

USRDS 2003 Annual Report

USRDS 2001 Annual Report

Relationship of depression to increased risk of mortality and rehospitalization in patients with congestive heart failure

Arch Intern Med

Depression following myocardial infarctionImpact on 6-month survival

JAMA

Depression and 18-month prognosis after myocardial infarction

Circulation

Sertraline treatment of major depression in patients with acute MI or unstable angina

JAMA

Correlates of depression in chronic dialysis patientsMorbidity and mortality

Res Nurs Health

Depression, perception of illness and mortality in patients with end-stage renal disease

Int J Psychiatry Med

Use of psychiatric and medical health care by veterans with severe mental illness

Psychiatr Serv

Original Investigation
Dialysis therapy
Physician-Diagnosed Depression as a Correlate of Hospitalizations in Patients Receiving Long-Term Hemodialysis