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Pearce CJ, Hall N, Hudson JL, Farrington K, Tucker MJR, Wellsted D, Jones J, Sharma S, Norton S, Ormandy P, Palmer N, Quinnell A, Fitzgerald L, Griffiths S, Chilcot J. Approaches to the identification and management of depression in people living with chronic kidney disease: A scoping review of 860 papers. J Ren Care 2024; 50:4-14. [PMID: 36645375 DOI: 10.1111/jorc.12458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/09/2022] [Accepted: 12/30/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Depression is prevalent across the spectrum of Chronic Kidney Disease and associated with poorer outcomes. There is limited evidence regarding the most effective interventions and care pathways for depression in Chronic Kidney Disease. OBJECTIVES To investigate how depression is identified and managed in adults with Chronic Kidney Disease. DESIGN Scoping review. METHODS Systematic search of eight databases with pre-defined inclusion criteria. Data relevant to the identification and/or management of depression in adults with Chronic Kidney Disease were extracted. RESULTS Of 2147 articles identified, 860 were included. Depression was most identified using self-report screening tools (n = 716 studies, 85.3%), with versions of the Beck Depression Inventory (n = 283, 33.7%) being the most common. A total of 123 studies included data on the management of depression, with nonpharmacological interventions being more frequently studied (n = 55, 45%). Cognitive Behavioural Therapy (n = 15) was the most common nonpharmacological intervention, which was found to have a significant effect on depressive symptoms compared to controls (n = 10). However, how such approaches could be implemented as part of routine care was not clear. There was limited evidence for antidepressants use in people with Chronic Kidney Disease albeit in a limited number of studies. CONCLUSIONS Depression is commonly identified using validated screening tools albeit differences exist in reporting practices. Evidence regarding the management of depression is mixed and requires better-quality trials of both pharmacological and nonpharmacological approaches. Understanding which clinical care pathways are used and their evidence, may help facilitate the development of kidney care specific guidelines for the identification and management of depression.
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Affiliation(s)
- Christina J Pearce
- Department of Psychology, Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Natalie Hall
- School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, UK
| | - Joanna L Hudson
- Department of Psychology, Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ken Farrington
- School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, UK
- Renal Unit, Lister Hospital, Stevenage, UK
| | | | - David Wellsted
- School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, UK
| | - Julia Jones
- School of Health and Social Work, University of Hertfordshire, Hatfield, UK
| | - Shivani Sharma
- School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, UK
| | - Sam Norton
- Department of Psychology, Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Paula Ormandy
- School of Health and Society, University of Salford, Salford, UK
| | - Nick Palmer
- Independent PPI lead & Kidney Care UK, Alton, UK
| | | | - Lauren Fitzgerald
- School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, UK
| | - Sophie Griffiths
- Department of Psychology, Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Joseph Chilcot
- Department of Psychology, Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Jayakumar S, Jennings S, Halvorsrud K, Clesse C, Yaqoob MM, Carvalho LA, Bhui K. A systematic review and meta-analysis of the evidence on inflammation in depressive illness and symptoms in chronic and end-stage kidney disease. Psychol Med 2023; 53:5839-5851. [PMID: 36254747 DOI: 10.1017/s0033291722003099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Depression affects approximately 27% of adults with chronic kidney disease (CKD) and end-stage kidney failure (ESKF). Depression in this population is associated with impaired quality of life and increased mortality. The extent of inflammation and the impact on depression in CKD/ESKF is yet to be established. Through a systematic literature review and meta-analysis, we aim to understand the relationship between depression and inflammation in CKD/ESKF patients. METHODS We searched nine electronic databases for published studies until January 2022. Titles and abstracts were screened against inclusion and exclusion criteria. Data extraction and study quality assessment was carried out independently by two reviewers. A meta-analysis was carried out where appropriate; otherwise a narrative review of studies was completed. RESULTS Sixty studies met our inclusion criteria and entered the review (9481 patients included in meta-analysis). Meta-analysis of cross-sectional associations revealed significantly higher levels of pro-inflammatory biomarkers; C-reactive protein; Interleukin 6 (IL-6) and tumour necrosis factor-alpha in patients with depressive symptoms (DS) compared to patients without DS. Significantly lower levels of anti-inflammatory cytokine IL-10 were found in patients with DS compared to patients without DS. Considerable heterogeneity was detected in the analysis for most inflammatory markers. CONCLUSION We found evidence for an association of higher levels of pro-inflammatory and lower anti-inflammatory cytokines and DS in patients with CKD/ESKF. Clinical trials are needed to investigate whether anti-inflammatory therapies will be effective in the prevention and treatment of DS in these patients with multiple comorbidities.
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Affiliation(s)
- Simone Jayakumar
- Center for Psychiatry and Mental Health, Wolfson Institute of Population Health, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
- Department of Clinical Pharmacology, William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Stacey Jennings
- Center for Psychiatry and Mental Health, Wolfson Institute of Population Health, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | | | - Christophe Clesse
- Center for Psychiatry and Mental Health, Wolfson Institute of Population Health, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
- Department of Clinical Pharmacology, William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Muhammad Magdi Yaqoob
- Translational Medicine and Therapeutics, William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Livia A Carvalho
- Department of Clinical Pharmacology, William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Kamaldeep Bhui
- Center for Psychiatry and Mental Health, Wolfson Institute of Population Health, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
- Department of Psychiatry and Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- East London NHS Foundation Trust and Oxford Health NHS Foundation Trust, London, UK
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Haghighat N, Mohammadshahi M, Shayanpour S, Haghighizadeh MH, Rahmdel S, Rajaei M. The Effect of Synbiotic and Probiotic Supplementation on Mental Health Parameters in Patients Undergoing Hemodialysis: A Double-blind, Randomized, Placebo-controlled Trial. Indian J Nephrol 2021; 31:149-156. [PMID: 34267437 PMCID: PMC8240938 DOI: 10.4103/ijn.ijn_341_19] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/29/2019] [Accepted: 03/07/2020] [Indexed: 12/27/2022] Open
Abstract
Introduction The purpose of this double-blind clinical trial, was to examine the effect of supplementation with the synbiotic and probiotic on the mental health, quality of life, and anemia in HD patients. Methods Seventy-five HD patients were randomly assigned to receive the synbiotic (n = 23) as 15 g of prebiotics, 5 g of probiotic powder containing Lactobacillus acidophilus, Bifidobacterium bifidum, Bifidobacterium lactis, and Bifidobacterium longum (2.7 × 107 CFU/g each); probiotics (n = 23) as 5 g probiotics similar to the synbiotic group with 15 g of maltodextrin as placebo; and placebo (n = 19) as 20 g of maltodextrin. Serum hemoglobin (Hb) and albumin (Alb) were measured. Beck depression and anxiety index (BDI/BAI) was used to assess symptoms of depression and anxiety. The health-related quality of life (HRQoL) was assessed using the questionnaire SF-36. Results From baseline to 12 weeks, synbiotic and probiotic supplementation resulted in a significant decrease in BDI and BAI score in comparison to the placebo (P < 0.05). Between and intergroup comparison showed no significant changes between the groups in terms of HRQoL. However, the serum Hb level increased significantly in the synbiotic and probiotic group compared to the placebo group (P < 0.001). Conclusion Overall, 12 weeks of synbiotic and probiotic supplementation resulted in an improvement in mental health and anemia compared with the placebo, whereas they failed to enhance the quality of life in HD patients.
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Affiliation(s)
- Neda Haghighat
- Laparoscopy Research Center, School of Medicine, Shiraz University of Medical Sciences, Ahvaz, Iran
| | - Majid Mohammadshahi
- Nutrition and Metabolic Diseases Research Center and Department of Nutrition, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Shokouh Shayanpour
- Department of Nephrology, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Hossein Haghighizadeh
- Department of Biostatistics and Epidemiology, Faculty of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Samaneh Rahmdel
- Department of Food Hygiene and Quality Control, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Majdadin Rajaei
- Department of Radiation Oncology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Gregg LP, Hedayati SS. Pharmacologic and psychological interventions for depression treatment in patients with kidney disease. Curr Opin Nephrol Hypertens 2020; 29:457-464. [PMID: 32701597 PMCID: PMC7735461 DOI: 10.1097/mnh.0000000000000629] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW It remains controversial whether existing therapies, including pharmacologic and psychological interventions, are effective for treatment of depression in patients with chronic kidney disease (CKD) and end-stage kidney disease. RECENT FINDINGS Most studies of depression treatment were underpowered or uncontrolled. The CKD Antidepressant Sertraline Trial showed no benefit of a serotonin-selective reuptake inhibitor (SSRI), sertraline, over double-blind matched placebo for the treatment of depressive symptoms in patients with nondialysis CKD. A Trial of Sertraline vs. Cognitive Behavioral Therapy (CBT) for End-stage Renal Disease Patients with Depression showed improvement in depressive symptoms from baseline in both groups and a marginal benefit of sertraline over CBT that was of unclear clinical significance, given the lack of an active control group. SSRIs are associated with poor tolerability in clinical trials and serious adverse outcomes in large retrospective studies. SUMMARY Although the data do not support unlimited use of SSRIs in patients with CKD or end-stage kidney disease, it is reasonable to initiate a cautious trial of sertraline while closely monitoring for depressive symptom improvement and adverse effects. CBT is a low-risk, possibly effective intervention to treat major depressive disorder in patients with kidney disease who have access to such treatments.
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Affiliation(s)
- L. Parker Gregg
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX
- Renal Section, Medical Service, VA North Texas Health Care System, Dallas, TX
| | - S. Susan Hedayati
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX
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Zhang Y, Wang H, Yan C, Wang L, Cheung EFC, Chan RC. Working memory training can improve anhedonia in college students with subsyndromal depressive symptoms. Psych J 2019; 8:401-410. [DOI: 10.1002/pchj.271] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 12/04/2018] [Accepted: 12/05/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Yi‐Jing Zhang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of PsychologyChinese Academy of Sciences Beijing China
- Department of PsychologyUniversity of Chinese Academy of Sciences Beijing China
| | - Hao‐Yu Wang
- School of Psychological and Cognitive SciencesPeking University Beijing China
| | - Chao Yan
- School of Psychology and Cognitive ScienceEast China Normal University Shanghai China
- Key Laboratory of Brain Functional Genomics, Ministry of Education, Shanghai Key Laboratory of Brain Functional Genomics (MOE & STCSM)East China Normal University Shanghai China
| | - Ling‐Ling Wang
- School of Psychology and Cognitive ScienceEast China Normal University Shanghai China
| | | | - Raymond C.K. Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of PsychologyChinese Academy of Sciences Beijing China
- Department of PsychologyUniversity of Chinese Academy of Sciences Beijing China
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Vadiei N, Bhattacharjee S. Patterns and predictors of depression treatment among adults with chronic kidney disease and depression in ambulatory care settings in the United States. Int Urol Nephrol 2018; 51:303-309. [PMID: 30515735 DOI: 10.1007/s11255-018-2034-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 11/19/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE One in five adults with chronic kidney disease (CKD) in the United States (US) suffers from depression. Comorbid depression in adults with CKD is associated with higher morbidity and mortality. This study used US national survey data to examine patterns and predictors of depression treatment among adults with non-dialysis-dependent CKD in the US. METHODS A retrospective, cross-sectional study was conducted using 2014-2015 National Ambulatory Medical Care Survey (NAMCS) data. The final study sample consisted of visits by 9.02 million adults (unweighted n = 262; age ≥ 18 years) with CKD and depression in the US. Depression treatment was defined as antidepressant use with or without psychotherapy. To identify predictors of depression treatment, multivariable logistic regression analysis was conducted adjusting for predisposing, enabling, and need factors. RESULTS Approximately half of adults with CKD and depression received depression treatment. Primary care was the main setting of treatment, and the most commonly prescribed antidepressant class was selective serotonin reuptake inhibitors. Adults being seen for treatment of a chronic problem were 3.2 times more likely to receive depression treatment (OR 3.20; 95% CI 1.38-7.21). In addition, there was a 9% higher likelihood of receiving depression treatment for each unit increase in total number of medications (OR 1.09; 95% CI 1.01-1.19). Finally, adults receiving care in the South were 63% less likely to receive depression treatment (OR 0.37; 95% CI 0.15-0.89). CONCLUSIONS Depression treatment was recorded in approximately half of US ambulatory care visits involving adults with CKD and depression from 2014 to 2015. Further research is warranted to determine how to appropriately manage treatment of depression in adults with CKD.
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Affiliation(s)
- Nina Vadiei
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, 1295 North Martin Avenue, Tucson, AZ, 85721, USA.
| | - Sandipan Bhattacharjee
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, 1295 North Martin Avenue, Tucson, AZ, 85721, USA
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Chilcot J, Hudson JL. Is successful treatment of depression in dialysis patients an achievable goal? Semin Dial 2018; 32:210-214. [PMID: 30418698 DOI: 10.1111/sdi.12755] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Depression is undisputedly common among individuals with End-Stage Kidney Failure and associated with adverse outcomes. It is well recognized that effective treatments for depression are needed within routine dialysis care. But, are we any closer to successfully treating depression in dialysis patients? We consider this question here with respect to two common treatments, antidepressant medication and cognitive behavioural therapy (CBT). Currently, there are limited data from randomized placebo-controlled trials regarding the acceptability and efficacy of antidepressants. CBT trials appear to show more consistent treatment effects, albeit the feasibility of routine delivery remains unknown. No studies in dialysis patients has evaluated the combined effects of CBT with antidepressants. There is a need to consider pragmatic depression treatment trials in dialysis patients in order to increase study recruitment in order to have more reliable data from which to evaluate the evidence base. Furthermore, we need to understand why treatments work, and for whom do they work? Lastly, addressing issues surrounding treatment acceptability and implementation as part of regular care remain as key challenges that require attention if we are to improve the mental health of individuals on dialysis.
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Affiliation(s)
- Joseph Chilcot
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Joanna L Hudson
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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9
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Abstract
Chronic kidney disease (CKD) is highly prevalent in the United States and throughout the world,(1) with approximately 13% of adults affected.(2) In addition, according to recent estimates, almost half of patients with CKD stages 3 to 5 are 70 years of age and older.(2) In the United States, the number of prevalent end-stage renal disease cases continues to increase in patients older than age 65. In light of the demographic characteristics of patients with CKD and ESRD, there has been considerable focus on associations between CKD and cardiovascular outcomes.(3) Until recently, less attention had been paid to other consequences of CKD in general and among older individuals with CKD in particular, but there is now solid evidence linking CKD with impairments of physical function, cognitive function, and emotional function and quality of life. This review summarizes available literature on these topics, focusing specifically on physical functioning and frailty, cognitive function, emotional health, including depression and anxiety, and health-related quality of life.
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Hedayati SS, Gregg LP, Carmody T, Jain N, Toups M, Rush AJ, Toto RD, Trivedi MH. Effect of Sertraline on Depressive Symptoms in Patients With Chronic Kidney Disease Without Dialysis Dependence: The CAST Randomized Clinical Trial. JAMA 2017; 318:1876-1890. [PMID: 29101402 PMCID: PMC5710375 DOI: 10.1001/jama.2017.17131] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
IMPORTANCE Major depressive disorder (MDD) is prevalent among patients with chronic kidney disease (CKD) and is associated with morbidity and mortality. The efficacy and adverse events of selective serotonin reuptake inhibitors in these patients are unknown. OBJECTIVE To determine whether treatment with sertraline improves depressive symptoms in patients with CKD and MDD. DESIGN, SETTING, AND PARTICIPANTS The Chronic Kidney Disease Antidepressant Sertraline Trial (CAST) was a randomized, double-blind, placebo-controlled trial involving 201 patients with stage 3, 4, or 5 non-dialysis-dependent CKD, who were enrolled at 3 US medical centers. The Mini Neuropsychiatric Interview was used to establish MDD. The first participant was randomized in March 2010 and the last clinic visit occurred in November 2016. INTERVENTIONS After a 1-week placebo run-in, participants were randomized to sertraline (n = 102) for 12 weeks at an initial dose of 50 mg/d (escalated to a maximum dose of 200 mg/d based on tolerability and response) or matching placebo (n = 99). MAIN OUTCOMES AND MEASURES The primary outcome was improvement in depressive symptom severity from baseline to 12 weeks determined by the 16-item Quick Inventory of Depression Symptomatology-Clinician Rated (QIDS-C16) (score range, 0-27; minimal clinically important difference, 2 points). Secondary outcomes included improvement in quality of life (Kidney Disease Quality of Life Survey-Short Form; score range, 0-100; higher scores indicate more favorable quality of life) and adverse events. RESULTS There were 201 patients (mean [SD] age, 58.2 [13.2] years; 27% female) randomized. The primary analysis included 193 patients who had at least 1 outcome assessment after randomization. The mean (SD) baseline QIDS-C16 score was 14.0 (2.4) in the sertraline group (n = 97) and 14.1 (2.4) in the placebo group (n = 96). The median participation time was 12.0 weeks and the median achieved dose was 150 mg/d, which was not significantly different between the groups. The QIDS-C16 score changed by -4.1 in the sertraline group and by -4.2 in the placebo group (between-group difference, 0.1 [95% CI, -1.1 to 1.3]; P = .82). There was no significant between-group difference in change in patient-reported overall health on the Kidney Disease Quality of Life Survey (median score, 0 in the sertraline group vs 0 in the placebo group; between-group difference, 0 [95% CI, -10.0 to 0]; P = .61). Nausea or vomiting occurred more frequently in the sertraline vs placebo group (22.7% vs 10.4%, respectively; between-group difference, 12.3% [95% CI, 1.9% to 22.6%], P = .03), as well as diarrhea (13.4% vs 3.1%; between-group difference, 10.3% [95% CI, 2.7% to 17.9%], P = .02). CONCLUSIONS AND RELEVANCE Among patients with non-dialysis-dependent CKD and MDD, treatment with sertraline compared with placebo for 12 weeks did not significantly improve depressive symptoms. These findings do not support the use of sertraline to treat MDD in patients with non-dialysis-dependent CKD. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00946998.
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Affiliation(s)
- S. Susan Hedayati
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas
- Division of Nephrology, Department of Medicine, Veterans Affairs North Texas Health Care System, Dallas
| | - L. Parker Gregg
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas
- Division of Nephrology, Department of Medicine, Veterans Affairs North Texas Health Care System, Dallas
| | - Thomas Carmody
- Division of Biostatistics, Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas
| | - Nishank Jain
- Division of Nephrology, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock
- Central Arkansas Veterans Affairs Health Care System, Little Rock
| | - Marisa Toups
- Department of Psychiatry, Dell Medical School, University of Texas, Austin
| | - A. John Rush
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University, Durham, North Carolina
| | - Robert D. Toto
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Madhukar H. Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas
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Mohammadi-Kalaveh S, Toulabi T, Hasanvand S, Gholami M, Ghasemi F. The Impact of Multidisciplinary Rehabilitation on Depressive Symptoms in Hemodialysis Patients. West J Nurs Res 2017; 40:738-752. [PMID: 28322670 DOI: 10.1177/0193945916685091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Depressive symptom is the most frequent psychological problem reported among chronic kidney disease (CKD) patients being treated by hemodialysis. This article evaluates the effectiveness of multidisciplinary rehabilitation on depressive symptoms in hemodialysis patients and clarifies the role of nurses. This quasi-experimental study was done on 30 patients in the hemodialysis center (educational hospital) in 2013. Eight rehabilitation plans were conducted by nurses. Beck Depression Inventory (BDI) was used before and after intervention. Our data were analyzed using descriptive and inferential statistics. Result of this study shows that there was a significant difference between mean depressive symptom score before (36.4 ± 10.9) and after (10.5 ± 3.1) rehabilitation ( p < .001). It is recommended that rehabilitation program be implemented in all hemodialysis centers with the participation of specialists in different fields.
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Affiliation(s)
| | - Tahereh Toulabi
- 1 Lorestan University of Medical Sciences, Khorramabad, Iran
| | | | | | - Fatemeh Ghasemi
- 1 Lorestan University of Medical Sciences, Khorramabad, Iran
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12
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King-Wing Ma T, Kam-Tao Li P. Depression in dialysis patients. Nephrology (Carlton) 2017; 21:639-46. [PMID: 26860073 DOI: 10.1111/nep.12742] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 12/23/2015] [Accepted: 02/05/2016] [Indexed: 11/30/2022]
Abstract
Depression is the most common psychiatric illness in patients with end-stage renal disease (ESRD). The reported prevalence of depression in dialysis population varied from 22.8% (interview-based diagnosis) to 39.3% (self- or clinician-administered rating scales). Such differences were attributed to the overlapping symptoms of uraemia and depression. Systemic review and meta-analysis of observational studies showed that depression was a significant predictor of mortality in dialysis population. The optimal screening tool for depression in dialysis patients remains uncertain. The Beck Depression Inventory (BDI), Patient Health Questionnaire (PHQ) and Center for Epidemiologic Studies Depression Scale (CESD) have been validated for screening purposes. Patients who scored ≥14 using BDI should be referred to a psychiatrist for early evaluation. Structured Clinical Interview for DSM disorders (SCID) remains the gold standard for diagnosis. Non-pharmacological treatment options include cognitive behavioural therapy and exercise training programs. Although frequent haemodialysis may have beneficial effects on patients' physical and mental well-being, it cannot and should not be viewed as a treatment of depression. Selective serotonin reuptake inhibitors (SSRIs) are generally effective and safe in ESRD patients, but most studies were small, non-randomized and uncontrolled. The European Renal Best Practice (ERBP) guideline suggests a trial of SSRI for 8 to 12 weeks in dialysis patients who have moderate-major depression. The treatment effect should be re-evaluated after 12 weeks to avoid prolonging ineffective medication. This review will discuss the current understanding in the diagnosis and management of depression in dialysis patients.
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Affiliation(s)
- Terry King-Wing Ma
- Division of Nephrology, Carol and Richard Yu PD Research Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong
| | - Philip Kam-Tao Li
- Division of Nephrology, Carol and Richard Yu PD Research Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong
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Shirazian S, Grant CD, Aina O, Mattana J, Khorassani F, Ricardo AC. Depression in Chronic Kidney Disease and End-Stage Renal Disease: Similarities and Differences in Diagnosis, Epidemiology, and Management. Kidney Int Rep 2016; 2:94-107. [PMID: 29318209 PMCID: PMC5720531 DOI: 10.1016/j.ekir.2016.09.005] [Citation(s) in RCA: 134] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 09/12/2016] [Accepted: 09/13/2016] [Indexed: 12/14/2022] Open
Abstract
Depression is highly prevalent and is associated with poor quality of life and increased mortality among adults with chronic kidney disease (CKD), including those with end-stage renal disease (ESRD). However, there are several important differences in the diagnosis, epidemiology, and management of depression between patients with non-dialysis-dependent CKD and ESRD. Understanding these differences may lead to a better understanding of depression in these 2 distinct populations. First, diagnosing depression using self-reported questionnaires may be less accurate in patients with ESRD compared with CKD. Second, although the prevalence of interview-based depression is approximately 20% in both groups, the risk factors for depression may vary. Third, potential mechanisms of depression might also differ in CKD versus ESRD. Finally, considerations regarding the type and dose of antidepressant medications vary between CKD and ESRD. Future studies should further examine the mechanisms of depression in both groups, and test interventions to prevent and treat depression in these populations.
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Affiliation(s)
- Shayan Shirazian
- Division of Nephrology, Department of Medicine, Winthrop University Hospital, Mineola, New York, USA
| | - Candace D Grant
- Division of Nephrology, Department of Medicine, Winthrop University Hospital, Mineola, New York, USA
| | - Olufemi Aina
- Division of Nephrology, Department of Medicine, Winthrop University Hospital, Mineola, New York, USA
| | - Joseph Mattana
- Division of Nephrology, Department of Medicine, Winthrop University Hospital, Mineola, New York, USA
| | - Farah Khorassani
- Department of Clinical Health Professions, St. John's University College of Pharmacy and Health Sciences, Queens, New York, USA.,Department of Pharmacy, The Zucker Hillside Hospital, Queens, New York, USA
| | - Ana C Ricardo
- Division of Nephrology, Department of Medicine, University of Illinois, Chicago, Illinois, USA
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Chen SS, Unruh M, Williams M. In Quality We Trust; but Quality of Life or Quality of Care? Semin Dial 2016; 29:103-10. [PMID: 26860436 DOI: 10.1111/sdi.12470] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The ESRD program provides medical care to a diverse and medically complex patient population. The care for the ESRD patient population has become increasingly benchmarked with process of care measures. These measures include dialysis adequacy, anemia, nutrition, and vascular access outcomes. These process-related dialysis measures may not improve the care of the individual patient as care relates to the individual's goals and values. There is also evidence that these process measures may not be causally related to quality of life, hospitalization, and survival. The adoption of patient-reported outcomes may shift the balance toward more patient-centered care. However, the extent to which mandated measures of health-related quality of life and patient satisfaction result in improved outcomes remains unclear.
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Affiliation(s)
- Shan Shan Chen
- Nephrology Division, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Mark Unruh
- Nephrology Division, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico.,Renal Section, Medicine Service, Department of Medicine, Raymond G. Murphy VA Medical Center, School of Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Mark Williams
- Nephrology Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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15
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Weisbord SD. Patient-Centered Dialysis Care: Depression, Pain, and Quality of Life. Semin Dial 2016; 29:158-64. [DOI: 10.1111/sdi.12464] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Steven D. Weisbord
- Renal Section; Medicine Service Line and the Center for Health Equity Research and Promotion; VA Pittsburgh Healthcare System; Pittsburgh Pennsylvania
- Renal-Electrolyte Division; Department of Medicine; University of Pittsburgh School of Medicine; Pittsburgh Pennsylvania
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16
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Hedayati SS, Daniel DM, Cohen S, Comstock B, Cukor D, Diaz-Linhart Y, Dember LM, Dubovsky A, Greene T, Grote N, Heagerty P, Katon W, Kimmel PL, Kutner N, Linke L, Quinn D, Rue T, Trivedi MH, Unruh M, Weisbord S, Young BA, Mehrotra R. Rationale and design of A Trial of Sertraline vs. Cognitive Behavioral Therapy for End-stage Renal Disease Patients with Depression (ASCEND). Contemp Clin Trials 2015; 47:1-11. [PMID: 26621218 DOI: 10.1016/j.cct.2015.11.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 11/21/2015] [Accepted: 11/23/2015] [Indexed: 11/18/2022]
Abstract
Major Depressive Disorder (MDD) is highly prevalent in patients with End Stage Renal Disease (ESRD) treated with maintenance hemodialysis (HD). Despite the high prevalence and robust data demonstrating an independent association between depression and poor clinical and patient-reported outcomes, MDD is under-treated when identified in such patients. This may in part be due to the paucity of evidence confirming the safety and efficacy of treatments for depression in this population. It is also unclear whether HD patients are interested in receiving treatment for depression. ASCEND (Clinical Trials Identifier Number NCT02358343), A Trial of Sertraline vs. Cognitive Behavioral Therapy (CBT) for End-stage Renal Disease Patients with Depression, was designed as a multi-center, 12-week, open-label, randomized, controlled trial of prevalent HD patients with comorbid MDD or dysthymia. It will compare (1) a single Engagement Interview vs. a control visit for the probability of initiating treatment for comorbid depression in up to 400 patients; and (2) individual chair-side CBT vs. flexible-dose treatment with a selective serotonin reuptake inhibitor, sertraline, for improvement of depressive symptoms in 180 of the up to 400 patients. The evolution of depressive symptoms will also be examined in a prospective longitudinal cohort of 90 HD patients who choose not to be treated for depression. We discuss the rationale and design of ASCEND, the first large-scale randomized controlled trial evaluating efficacy of non-pharmacologic vs. pharmacologic treatment of depression in HD patients for patient-centered outcomes.
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Affiliation(s)
- S Susan Hedayati
- Renal Section, VA North Texas Health Care System, United States; Division of Nephrology, University of Texas Southwestern Medical Center, United States.
| | - Divya M Daniel
- Kidney Research Institute, University of Washington, United States
| | - Scott Cohen
- Division of Nephrology, George Washington University, United States
| | - Bryan Comstock
- School of Public Health, University of Washington, United States
| | - Daniel Cukor
- Department of Psychiatry, SUNY Downstate Medical Center, United States
| | | | - Laura M Dember
- Division of Nephrology, University of Pennsylvania, United States
| | - Amelia Dubovsky
- Department of Psychiatry, University of Washington, United States
| | | | - Nancy Grote
- School of Social Work, University of Washington, United States
| | - Patrick Heagerty
- School of Public Health, University of Washington, United States
| | - Wayne Katon
- Department of Psychiatry, University of Washington, United States
| | - Paul L Kimmel
- National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, United States
| | | | - Lori Linke
- Kidney Research Institute, University of Washington, United States
| | - Davin Quinn
- Department of Psychiatry, University of New Mexico, United States
| | - Tessa Rue
- School of Public Health, University of Washington, United States
| | - Madhukar H Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center, United States
| | - Mark Unruh
- Division of Nephrology, University of New Mexico, United States
| | - Steven Weisbord
- Division of Nephrology, VA Pittsburgh Healthcare System and University of Pittsburgh School of Medicine, United States
| | - Bessie A Young
- Kidney Research Institute, University of Washington, United States
| | - Rajnish Mehrotra
- Kidney Research Institute, University of Washington, United States
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Friedli K, Almond M, Day C, Chilcot J, Gane MDS, Davenport A, Guirguis A, Fineberg N, Spencer B, Wellsted D, Farrington K. A study of sertraline in dialysis (ASSertID): a protocol for a pilot randomised controlled trial of drug treatment for depression in patients undergoing haemodialysis. BMC Nephrol 2015; 16:172. [PMID: 26503099 PMCID: PMC4621949 DOI: 10.1186/s12882-015-0170-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 10/14/2015] [Indexed: 11/17/2022] Open
Abstract
Background The prevalence of depression in people receiving haemodialysis is high with estimates varying between 20 and 40 %. There is little research on the effectiveness of antidepressants in dialysis patients with the few clinical trials suffering significant methodological issues. We plan to carry out a study to evaluate the feasibility of conducting a randomised controlled trial in patients on haemodialysis who have diagnosed Major Depressive Disorder. Methods/Design The study has two phases, a screening phase and the randomised controlled trial. Patients will be screened initially with the Beck Depression Inventory to estimate the number of patients who score 16 or above. These patients will be invited to an interview with a psychiatrist who will invite those with a diagnosis of Major Depressive Disorder to take part in the trial. Consenting patients will be randomised to either Sertraline or placebo. Patients will be followed-up for 6 months. Demographic and clinical data will be collected at screening interview, baseline interview and 2 weeks, and every month (up to 6 months) after baseline. The primary outcome is to evaluate the feasibility of conducting a randomised, double blind, placebo pilot trial in haemodialysis patients with depression. Secondary outcomes include estimation of the variability in the outcome measures for the treatment and placebo arms, which will allow for a future adequately powered definitive trial. Analysis will primarily be descriptive, including the number of patients eligible for the trial, drug exposure of Sertraline in haemodialysis patients and the patient experience of participating in this trial. Discussion There is an urgent need for this research in the dialysis population because of the dearth of good quality and adequately powered studies. Research with renal patients is particularly difficult as they often have complex medical needs. This research will therefore not only assess the outcome of anti-depressants in haemodialysis patients with depression but also the process of running a randomised controlled trial in this population. Hence, the outputs of this feasibility study will be used to inform the design and methodology of a definitive study, adequately powered to determine the efficacy of anti-depressants in patient on haemodialysis with depression. Trial registration ISRCTN registry ISRCTN06146268 and EudraCT reference: 2012-000547-27.
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Affiliation(s)
- Karin Friedli
- Centre for Lifespan and Chronic Illness Research, Department of Psychology, School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, AL10 9AB, UK.
| | - Michael Almond
- Southend University Hospital NHS Foundation Trust, Prittlewell Chase, Westcliff - On - Sea, Essex, SSO ORY, UK. .,Postgraduate Medical School, University of Hertfordshire, College Lane Campus, Hatfield, AL10 9AB, UK.
| | - Clara Day
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Queen Elizabeth Medical Centre, Birmingham, B15 2TH, UK.
| | - Joseph Chilcot
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 5th floor Bermondsey Wing, Guy's Campus, London Bridge, London, SE1 9RT, UK.
| | - Maria da Silva Gane
- Centre for Lifespan and Chronic Illness Research, Department of Psychology, School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, AL10 9AB, UK. .,Renal Unit, Lister Hospital, East & North Herts NHS Trust, Coreys Mill Lane, Stevenage, SG1 4AB, UK.
| | - Andrew Davenport
- University College London Centre for Nephrology, Royal Free Hampstead NHS Trust, Rowland Hill Street, London, NW3 2PF, UK.
| | - Ayman Guirguis
- Renal Unit, Lister Hospital, East & North Herts NHS Trust, Coreys Mill Lane, Stevenage, SG1 4AB, UK. .,Hertfordshire Partnership University NHS Foundation Trust, Rosanne House, Welwyn Garden City, AL8 6HG, UK. .,Postgraduate Medical School, University of Hertfordshire, College Lane Campus, Hatfield, AL10 9AB, UK.
| | - Naomi Fineberg
- Hertfordshire Partnership University NHS Foundation Trust, Rosanne House, Welwyn Garden City, AL8 6HG, UK. .,Postgraduate Medical School, University of Hertfordshire, College Lane Campus, Hatfield, AL10 9AB, UK.
| | - Benjamin Spencer
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Weston Education Centre, 10 Cutcombe Street, London, SE5 9RJ, UK. .,South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, SE5 8AZ, UK.
| | - David Wellsted
- Centre for Lifespan and Chronic Illness Research, Department of Psychology, School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, AL10 9AB, UK.
| | - Ken Farrington
- Renal Unit, Lister Hospital, East & North Herts NHS Trust, Coreys Mill Lane, Stevenage, SG1 4AB, UK. .,Postgraduate Medical School, University of Hertfordshire, College Lane Campus, Hatfield, AL10 9AB, UK.
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18
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Eyler RF, Unruh ML, Quinn DK, Mary Vilay A. Psychotherapeutic Agents in End-Stage Renal Disease. Semin Dial 2015; 28:417-26. [DOI: 10.1111/sdi.12370] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Rachel F. Eyler
- School of Pharmacy; University of Connecticut; Storrs Connecticut
| | - Mark L. Unruh
- School of Medicine; University of New Mexico; Albuquerque New Mexico
| | - Davin K. Quinn
- School of Medicine; University of New Mexico; Albuquerque New Mexico
| | - Aloun Mary Vilay
- College of Pharmacy; University of New Mexico; Albuquerque New Mexico
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19
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Effects of omega-3 fatty acids on depression and quality of life in maintenance hemodialysis patients. Am J Ther 2015; 21:275-87. [PMID: 24987942 DOI: 10.1097/mjt.0000000000000078] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Depression and health-related quality of life (HRQoL) are closely interrelated among hemodialysis (HD) patients and associated with negative impacts on patients' clinical outcomes. Considering previous reports on clinical benefits of omega-3 fatty acids in major depression and HRQoL in other patient populations, this study examined effects of omega-3 fatty acids on depression and HRQoL in chronic HD patients. In this randomized placebo-controlled trial, 40 adult patients with a Beck Depression Inventory (BDI) score of ≥16 and HD vintage of at least 3 months were randomized to ingest 6 soft-gel capsules of either omega-3 fatty acids (180 mg eicosapentaenoic acid and 120 mg docosahexaenoic acid in each capsule) or corresponding placebo, daily for 4 months. At baseline and after 4 months, 2 questionnaires of BDI and the Medical Outcome Study 36-Item Short-Form Health Survey were completed by each patient. Although baseline BDI score was comparable between the 2 groups, it was significantly lower in the omega-3 group compared with the placebo group at the end of the study (P = 0.008). Except for mental health, social functioning, and general health, other domains of HRQoL showed significant improvement in the omega-3 group compared with the placebo group at month 4 of the study (P < 0.05 for all). Regression analysis revealed that ameliorated BDI score by omega-3 treatment had considerable role in the improvement of overall HRQoL score, physical and mental component dimensions, and score of physical functioning, role-physical, and bodily pain. Supplemental use of omega-3 fatty acids in HD patients with depressive symptoms seems to be efficacious in improving depressive symptoms and HRQoL.
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20
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Paudel K, Namagondlu G, Samad N, McKitty K, Fan SL. Lack of motivation: a new modifiable risk factor for peritonitis in patients undergoing peritoneal dialysis? J Ren Care 2014; 41:33-42. [PMID: 25410720 DOI: 10.1111/jorc.12101] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Can we identify modifiable risk factors for peritonitis in patients undergoing peritoneal dialysis (PD)? We aimed to determine whether housing standard, PD exchange technique or patient motivation might be modifiable risks for peritonitis. We also explored the relationship between lack of motivation and depression. METHODS Nurse home visits assessed PD exchange technique, environment and patient motivation. Motivation scores were correlated separately with an Apathy Evaluation Score and a depression score using PHQ-9 questionnaires. RESULTS Home hygiene, exchange technique and motivation were above average in 53%, 56% and 60%, respectively in 104 patients undergoing PD. After 15 months, 25.9% patients developed peritonitis but nurses' ratings of homes and exchange techniques were not predictive. Low patient motivation was predictive. Patients rated to have above or below median motivation had significantly different Apathy Scores (p = 0.0002). Unmotivated depressed patients were significantly more likely to develop peritonitis compared to motivated depressed patients. CONCLUSION Lack of motivation predicted peritonitis particularly if associated with depression. Further studies are required focusing on specific motivation scoring schemes and the psychosocial support that might lead to better outcomes.
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Affiliation(s)
- Klara Paudel
- Department of Renal Medicine and Transplantation, Barts Health NHS Trust, London, UK
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21
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Belayev LY, Mor MK, Sevick MA, Shields AM, Rollman BL, Palevsky PM, Arnold RM, Fine MJ, Weisbord SD. Longitudinal associations of depressive symptoms and pain with quality of life in patients receiving chronic hemodialysis. Hemodial Int 2014; 19:216-24. [PMID: 25403142 DOI: 10.1111/hdi.12247] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Depressive symptoms and pain are common in patients on chronic hemodialysis (HD), yet their associations with quality of life (QOL) are not fully understood. We sought to characterize the longitudinal associations of these symptoms with QOL. As part of a trial comparing two symptom management strategies in patients receiving chronic HD, we assessed depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9), and pain using the Short Form McGill Pain Questionnaire (SF-MPQ) monthly over 24 months. We assessed health-related QOL (HR-QOL) quarterly using the Short Form 12 (SF-12) and global QOL (G-QOL) using a single-item survey. We used random effects linear regression to analyze the independent associations of depressive symptoms and pain, scaled based on 5-point increments in symptom scores, with HR-QOL and G-QOL. Overall, 286 patients completed 1417 PHQ-9 and SF-MPQ symptom assessments, 1361 SF-12 assessments, and 1416 G-QOL assessments. Depressive symptoms were independently and inversely associated with SF-12 physical HR-QOL scores (β = -1.09; 95% confidence interval [CI]: -1.69, -0.50, P < 0.001); SF-12 mental HR-QOL scores (β = -4.52; 95% CI: -5.15, -3.89, P < 0.001); and G-QOL scores (β = -0.64; 95%CI: -0.79, -0.49, P < 0.001). Pain was independently and inversely associated with SF-12 physical HR-QOL scores (β = -0.99; 95% CI: -1.30, -0.68, P < 0.001) and G-QOL scores (β = -0.12; 95%CI: -0.20, -0.05, P = 0.002); but not with SF-12 mental HR-QOL scores (β = -0.16; 95%CI: -0.050, 0.17, P = 0.34). In patients receiving chronic HD, depressive symptoms and to a lesser extent pain, are independently associated with reduced HR-QOL and G-QOL. Interventions to alleviate these symptoms could potentially improve patients' HR-QOL and G-QOL.
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Affiliation(s)
- Linda Y Belayev
- Division of Renal-Electrolyte, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA
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Mehrotra R, Perazella MA, Choi MJ. American Society of Nephrology Quiz and Questionnaire 2013: RRT. Clin J Am Soc Nephrol 2014; 9:1497-503. [PMID: 24875191 DOI: 10.2215/cjn.12711213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The Nephrology Quiz and Questionnaire (NQ&Q) remains an extremely popular session for attendees of the Annual Meeting of the American Society of Nephrology. As in past years, the conference hall of the 2013 meeting was overflowing with interested audience members. Topics covered by expert discussants included electrolyte and acid-base disorders, glomerular disease, ESRD/dialysis, and transplantation. Complex cases representing each of these categories, along with single best answer questions, were prepared by a panel of experts. Before the meeting, program directors of United States nephrology training programs answered questions through an Internet-based questionnaire. A new addition to the NQ&Q was participation in the questionnaire by nephrology fellows. To review the process, members of the audience test their knowledge and judgment on a series of case-oriented questions prepared and discussed by experts. Their answers are compared in real time using audience response devices with the answers of nephrology fellows and training program directors. The correct and incorrect answers are then briefly discussed after the audience responses and the results of the questionnaire are displayed. This article recapitulates the session and reproduces its educational value for CJASN readers. Enjoy the clinical cases and expert discussions.
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Affiliation(s)
- Rajnish Mehrotra
- Division of Nephrology, Kidney Research Institute and Harborview Medical Center, University of Washington, Seattle, Washington;
| | - Mark A Perazella
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; and
| | - Michael J Choi
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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The effect of omega-3 fatty acids on depressive symptoms and inflammatory markers in maintenance hemodialysis patients: a randomized, placebo-controlled clinical trial. Eur J Clin Pharmacol 2014; 70:655-65. [PMID: 24643636 DOI: 10.1007/s00228-014-1666-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 02/28/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE This study was designed to investigate the effects of omega-3 fatty acids on depression and chronic inflammation in hemodialysis patients. METHOD Fifty-four maintenance hemodialysis patients were randomized to ingest two omega-3 (each containing 180 mg eicosapentaenoic acid and 120 mg docosahexaenoic acid) or placebo capsules, three times daily for 4 months. MAIN OUTCOME MEASURES Beck Depression Inventory (BDI) score and serum levels of C-reactive protein (CRP), interleukin (IL)-6, IL-10, tumor necrosis factor (TNF)-α, ferritin, intact parathyroid hormone (iPTH), and ratios of IL-10 to IL-6 and IL-10 to TNF-α were measured at baseline and at the end of the study. RESULTS Omega-3 supplement lowered BDI score significantly after 4 months of intervention. Among pro- and anti-inflammatory mediators, only serum ferritin level and IL-10 to IL-6 ratio showed significant changes in favor of omega-3 supplement during the study. In linear regression model adjusted for baseline values, omega-3 treatment was a significant predictor of reduced serum CRP, ferritin, and iPTH levels, and increased IL-10 to IL-6 ratio. No significant association was found between the anti-inflammatory and anti-depressant effects of omega-3 supplement. CONCLUSIONS Supplemental use of omega-3 fatty acids decreases depressive symptoms in hemodialysis patients apart from their anti-inflammatory effects.
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Teles F, Azevedo VFDD, Miranda CTD, Miranda MPDM, Teixeira MDC, Elias RM. Depression in hemodialysis patients: the role of dialysis shift. Clinics (Sao Paulo) 2014; 69:198-202. [PMID: 24626947 PMCID: PMC3935125 DOI: 10.6061/clinics/2014(03)10] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 08/23/2013] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Depression is the most important neuropsychiatric complication in chronic kidney disease because it reduces quality of life and increases mortality. Evidence demonstrating the association between dialysis shift and depression is lacking; thus, obtaining such evidence was the main objective of this study. METHOD This cross-sectional study included patients attending a hemodialysis program. Depression was diagnosed using Beck's Depression Inventory. Excessive daytime sleepiness was evaluated using the Epworth Sleepiness Scale. RESULTS A total of 96 patients were enrolled (55 males, age 48±14 years). Depression and excessive daytime sleepiness were observed in 42.7% and 49% of the patients, respectively. When comparing variables among the three dialysis shifts, there were no differences in age, dialysis vintage, employment status, excessive daytime sleepiness, hemoglobin, phosphorus levels, or albumin levels. Patients in the morning shift were more likely to live in rural areas (p<0.0001), although patients in rural areas did not have a higher prevalence of depression (p = 0.30). Patients with depression were more likely to be dialyzed during the morning shift (p = 0.008). Independent risk factors for depression were age (p<0.03), lower levels of hemoglobin (p<0.01) and phosphorus (p<0.01), and dialysis during the morning shift (p = 0.0009). The hospitalization risk of depressive patients was 4.5 times higher than that of nondepressive patients (p<0.008). CONCLUSION These data suggest that depression is associated with dialysis shift, higher levels of phosphorus, and lower levels of hemoglobin. The results highlight the need for randomized trials to determine whether this association occurs by chance or whether circadian rhythm disorders may play a role.
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Affiliation(s)
- Flavio Teles
- School of Medicine, State University of Health Sciences of Alagoas, Renal Division, MaceióAL, Brazil, State University of Health Sciences of Alagoas, School of Medicine, Renal Division, Maceió/AL, Brazil
| | - Vega Figueiredo Dourado de Azevedo
- School of Medicine, State University of Health Sciences of Alagoas, Renal Division, MaceióAL, Brazil, State University of Health Sciences of Alagoas, School of Medicine, Renal Division, Maceió/AL, Brazil
| | - Claudio Torres de Miranda
- Federal University of Alagoas, School of Medicine, MaceióAL, Brazil, Federal University of Alagoas School of Medicine, Maceió/AL, Brazil
| | - Milma Pires de Melo Miranda
- Federal University of Alagoas, School of Medicine, MaceióAL, Brazil, Federal University of Alagoas School of Medicine, Maceió/AL, Brazil
| | - Maria do Carmo Teixeira
- School of Medicine, State University of Health Sciences of Alagoas, Renal Division, MaceióAL, Brazil, State University of Health Sciences of Alagoas, School of Medicine, Renal Division, Maceió/AL, Brazil
| | - Rosilene M Elias
- School of Medicine, University of Sao Paulo, Renal Division, São PauloSP, Brazil, University of Sao Paulo School of Medicine, Renal Division, São Paulo/SP, Brazil
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Sertraline decreases serum level of interleukin-6 (IL-6) in hemodialysis patients with depression: Results of a randomized double-blind, placebo-controlled clinical trial. Int Immunopharmacol 2013; 17:917-23. [DOI: 10.1016/j.intimp.2013.09.020] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 08/21/2013] [Accepted: 09/05/2013] [Indexed: 11/23/2022]
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O’Neil A. The Relationship Between Coronary Heart Disease (CHD) and Major Depressive Disorder (MDD): Key Mechanisms and the Role of Quality of Life. EUROPES JOURNAL OF PSYCHOLOGY 2013. [DOI: 10.5964/ejop.v9i1.466] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Unruh ML, Larive B, Chertow GM, Eggers PW, Garg AX, Gassman J, Tarallo M, Finkelstein FO, Kimmel PL. Effects of 6-times-weekly versus 3-times-weekly hemodialysis on depressive symptoms and self-reported mental health: Frequent Hemodialysis Network (FHN) Trials. Am J Kidney Dis 2013; 61:748-58. [PMID: 23332990 DOI: 10.1053/j.ajkd.2012.11.047] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 11/14/2012] [Indexed: 11/11/2022]
Abstract
BACKGROUND Patients undergoing maintenance hemodialysis frequently exhibit poor mental health. We studied the effects of frequent in-center and nocturnal hemodialysis on depressive symptoms and self-reported mental health. STUDY DESIGN 1-year randomized controlled clinical trials. SETTING & PARTICIPANTS Hemodialysis centers in the United States and Canada. 332 patients were randomly assigned to frequent (6-times-weekly) compared with conventional (3-times-weekly) hemodialysis in the Frequent Hemodialysis Network (FHN) Daily (n = 245) and Nocturnal (n = 87) Trials. INTERVENTION The Daily Trial was a trial of frequent (6-times-weekly) compared with conventional (3-times-weekly) in-center hemodialysis. The Nocturnal Trial assigned patients to either frequent nocturnal (6-times-weekly) hemodialysis or conventional (3-times-weekly) hemodialysis. OUTCOMES Self-reported depressive symptoms and mental health. MEASUREMENTS Beck Depression Inventory and the mental health composite score and emotional subscale of the RAND 36-Item Health Survey at baseline and 4 and 12 months. The mental health composite score is derived by summarizing these domains of the RAND 36-Item Health Survey: emotional, role emotional, energy/fatigue, and social functioning scales. RESULTS In the Daily Trial, participants randomly assigned to frequent compared with conventional in-center hemodialysis showed no significant change over 12 months in adjusted mean Beck Depression Inventory score (-1.9 ± 0.7 vs -0.6 ± 0.7; P = 0.2), but experienced clinically significant improvements in adjusted mean mental health composite (3.7 ± 0.9 vs 0.2 ± 1.0; P = 0.007) and emotional subscale (5.2 ± 1.6 vs -0.3 ± 1.7; P = 0.01) scores. In the Nocturnal Trial, there were no significant changes in the same metrics in participants randomly assigned to nocturnal compared with conventional hemodialysis. LIMITATIONS Trial interventions were not blinded. CONCLUSIONS Frequent in-center hemodialysis, as compared with conventional in-center hemodialysis, improved self-reported general mental health. Changes in self-reported depressive symptoms were not statistically significant. We were unable to conclude whether nocturnal hemodialysis yielded similar effects.
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Affiliation(s)
- Mark L Unruh
- Division of Nephrology, University of New Mexico School of Medicine, Albuquerque, NM 87131, USA.
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28
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Hedayati SS. Improving symptoms of pain, erectile dysfunction, and depression in patients on dialysis. Clin J Am Soc Nephrol 2013; 8:5-7. [PMID: 23296377 DOI: 10.2215/cjn.11811112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Cilan H, Sipahioglu MH, Oguzhan N, Unal A, Turan T, Koc AN, Tokgoz B, Utas C, Oymak O. Association between depression, nutritional status, and inflammatory markers in peritoneal dialysis patients. Ren Fail 2012; 35:17-22. [PMID: 23150953 DOI: 10.3109/0886022x.2012.741643] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To investigate the relationship between depression, nutritional status, and inflammatory markers in patients on peritoneal dialysis (PD). PATIENTS AND METHODS This prospective study included 40 PD patients and 20 healthy people. The severity of depressive symptoms was assessed using the Beck depression inventory, the Hamilton depression rating scale, and the Hamilton anxiety rating scale. The depressive patients received antidepressant drug for 8 weeks. Blood samples were taken before and after antidepressant treatment for the high-sensitive C-reactive protein (hs-CRP), interleukin (IL)-1, IL-6, and tumor necrosis factor-α (TNF-α) levels. RESULTS Ten (25%) of the 40 PD patients had depression. No significant difference was determined between depressive patients and nondepressive patients. The mean erythrocyte sedimentation rate was higher in depressive patients. There was no significant difference for other inflammation parameters, including hs-CRP, TNF-α, IL-1, and IL-6, between depressive patients and nondepressive patients. In the depressive patients, we did not observe any significant change in nutritional parameters after antidepressant treatment. When we evaluated inflammation parameters of the depressive patients before and after antidepressant treatment, only IL-1 and IL-6 levels were significantly increased after antidepressant treatment. CONCLUSION The depressive disorder in PD patients is a common psychopathology and has no significant effects on nutritional status and inflammation.
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Affiliation(s)
- Havva Cilan
- Department of Nephrology, Erciyes University Medical Faculty, Kayseri, Turkey.
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Nagler EV, Webster AC, Vanholder R, Zoccali C. Antidepressants for depression in stage 3–5 chronic kidney disease: a systematic review of pharmacokinetics, efficacy and safety with recommendations by European Renal Best Practice (ERBP)*. Nephrol Dial Transplant 2012; 27:3736-45. [DOI: 10.1093/ndt/gfs295] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Park HC, Lee H, Lee JP, Kim DK, Oh KH, Joo KW, Lim CS, Kim YS, Ahn C, Oh YK. Lower residual renal function is a risk factor for depression and impaired health-related quality of life in Korean peritoneal dialysis patients. J Korean Med Sci 2012; 27:64-71. [PMID: 22219616 PMCID: PMC3247777 DOI: 10.3346/jkms.2012.27.1.64] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Accepted: 10/31/2011] [Indexed: 11/20/2022] Open
Abstract
We retrospectively evaluated demographic and biochemical parameters associated with depression and health-related quality of life (HRQOL) in maintenance peritoneal dialysis (PD) patients. This study included 105 patients maintaining PD at Seoul National University Hospital. Data were collected from electronic medical record. Korean Beck's Depression Inventory and Korean version of Kidney Disease Quality of Life short form, version 1.3 were used to evaluate depression and HRQOL, respectively. Moderate to severe depression was found in 24.8% of patients. Patients with lower normalized protein equivalent of nitrogen appearance (nPNA) (< 1.2 g/kg/day), lower weekly renal Kt/V(urea) (< 0.2), and lower serum albumin level (≤ 4.0 g/dL) were associated with depression (P < 0.05). Among them, lower weekly renal Kt/V(urea) was the only independent risk factor associated with depression (OR = 3.1, P = 0.007). Depressed patients showed significantly lower scores in every dimension of HRQOL (P < 0.001). Lower weekly renal Kt/V(urea) (β = 0.24, P = 0.005) and lower nPNA (β = 0.15, P = 0.03) were the independent risk factors associated with lower kidney dialysis component summary, whereas lower plasma hemoglobin level was the consistent risk factor for lower physical component summary (β = 0.22, P = 0.03) and mental component summary (β = 0.22, P = 0.01). Depression is a prevalent psychological problem in PD population. Residual renal function is the most important factor associated with depression and impaired HRQOL in PD patients.
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Affiliation(s)
- Hayne Cho Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hajeong Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Chun Soo Lim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Curie Ahn
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yun Kyu Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
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Hedayati SS, Yalamanchili V, Finkelstein FO. A practical approach to the treatment of depression in patients with chronic kidney disease and end-stage renal disease. Kidney Int 2011; 81:247-55. [PMID: 22012131 DOI: 10.1038/ki.2011.358] [Citation(s) in RCA: 168] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Depression is a common, under-recognized, and under-treated problem that is independently associated with increased morbidity and mortality in CKD patients. However, only a minority of CKD patients with depression are treated with antidepressant medications or nonpharmacologic therapy. Reasons for low treatment rates include a lack of properly controlled trials that support or refute efficacy and safety of various treatment regimens in CKD patients. The aim of this manuscript is to provide a comprehensive review of studies exploring depression treatment options in CKD. Observational studies as well as small trials suggest that certain serotonin-selective reuptake inhibitors may be safe to use in patients with advanced CKD and ESRD. These studies were limited by small sample sizes, lack of placebo control, and lack of formal assessment for depression diagnosis. Nonpharmacologic treatments were explored in selected ESRD samples. The most promising data were reported for frequent hemodialysis and cognitive behavioral therapy. Alternative proposed therapies include exercise training regimens, treatment of anxiety, and music therapy. Given the association of depression with cardiovascular events and mortality, and the excessive rates of cardiovascular death in CKD, it becomes imperative to not only investigate whether treatment of depression is efficacious, but also whether it would result in a reduction in morbidity and mortality in this patient population.
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Affiliation(s)
- S Susan Hedayati
- Renal Section, Medical Service, Veterans Affairs North Texas Health Care System, Dallas, Texas, USA.
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