Depression in patients with chronic renal disease: where are we going?

Impact of chronic kidney disease on illness perceptions, coping, self-efficacy, psychological distress and quality of life

Chronic kidney disease (CKD) negatively impacts psychological well-being and quality of life (QoL). Underpinned by the Common Sense Model (CSM), this study evaluated the potential mediating role of self-efficacy, coping styles and psychological distress on the relationship between illness perceptions and QoL in patients living with CKD. Participants were 147 people with stage 3-5 kidney disease. Measures included eGFR, illness perceptions, coping styles, psychological distress, self-efficacy and QoL. Correlational analyses were performed, followed by regression modelling. Poorer QoL was associated with greater distress, engagement in maladaptive coping, poorer illness perceptions and lower self-efficacy. Regression analysis revealed that illness perceptions predicted QoL, with psychological distress acting as a mediator. The proportion of variance explained was 63.8%. These findings suggest that psychological interventions are likely to enhance QoL in CKD, if they target the mediating psychological processes associated with illness perceptions and psychological distress.

Assessment of psychological distress in end stage renal disease: is it spirituality related?

Introduction

Patients undergoing hemodialysis (HD) are faced with bearing this burden and report poor mental health. Spirituality can be a key factor in managing these problems among HD patients.

Aim

This cross-sectional study aimed at exploring possible factors that are associated with psychological distress among HD patients and testing its relation to spirituality.

Methods

HD patients were recruited from six dialysis units in Greece. Psychological distress was assessed using the scale Symptom Check List 90-R and spirituality using the Facit Sp-12 questionnaire. In addition, a special design questionnaire regarding demographic, social, and clinical characteristic was administrated.

Results

According to the results, factors such age, gender, marital status and area of residence are associated with psychological distress, while dimensions of spirituality such Meaning in Life and Peace can have a positive influence on psychological distress.

Conclusion

This study highlights the vital role of spirituality, which can act as a mechanism for managing stressful situations. In particular, this study highlights the positive effect of the meaning and purpose of life, as well as the role of peace and harmony.

Suicide and chronic kidney disease: a case-control study

Background

The association of chronic kidney disease (CKD) and dialysis with suicide is not well established. The objectives of this study were to assess the association of suicide with CKD and dialysis and investigate whether differences exist between dialysis modalities or the durations of dialysis.

Methods

Data were obtained from the Taiwan National Health Insurance Research Database. A total of 51 642 patients who died from suicide between 2000 and 2012 and 206 568 living control patients matched by age, gender and residency area were examined. Known risk factors included sociodemographic characteristics, physical comorbidities and psychiatric disorders, which were controlled for as covariates in the analysis. The crude odds ratios (ORs) and adjusted ORs (aORs) for various risk factors were obtained using conditional logistic regression.

Results

After potential confounders were controlled for, CKD was significantly associated with an increased risk of suicide [aOR = 1.25, 95% confidence interval (CI) = 1.17-1.34]. End-stage renal disease patients on haemodialysis (HD) had an increased risk of suicide compared with controls (aOR = 3.35, 95% CI = 3.02-3.72). Moreover, patients who initially underwent dialysis within 0-3 months had a significantly increased risk of suicide (aOR = 20.26, 95% CI = 15.99-25.67).

Conclusions

CKD and HD are positively associated with suicide. Suicide is preventable; therefore, assessing mental and physical disorders is essential and recommended to all physicians, particularly those treating patients in the early phase of HD.

Exploring the relationship between illness perceptions and depression in patients with chronic kidney disease: A systematic literature review

BACKGROUND

The prevalence of depression is found to increase from early stages to later stages of chronic kidney disease. Research on illness perceptions in patients undergoing dialysis has confirmed that patients' beliefs are associated with important outcomes; one of the most significant being depression. However, the association between illness perceptions and depression in patients in pre-dialysis care remains unclear.

OBJECTIVE

The main objective of this systematic review was to explore the associative relationship between illness perceptions and depression in patients with CKD prior to the commencement of dialysis.

METHODS

The inclusion criteria for papers in this review were studies investigating illness perceptions and depression in patients diagnosed with CKD. Eligible studies were identified by searching the following electronic databases; Medline, CENTRAL, Embase, Psych INFO, Web of Science and Scopus. Data on the participants and the severity of kidney disease, illness perceptions and depression were extracted.

RESULTS

Sixty-four studies met the criteria for full text review and of these, only four studies met the inclusion criteria following data extraction and quality assessment. Consistent with the common sense model, disease severity was found to be significantly associated with illness perceptions, and both were found to be associated with depression CONCLUSIONS: The results from this review provide further evidence that the illness perceptions and disease severity play a crucial role in the adaption to CKD. This review highlights the lack of research in this area and concludes that more studies are needed to determine the nature and impact of illness perceptions in relation to depression in pre-dialysis CKD.

Goal-Striving Stress Is Associated with Chronic Kidney Disease Among Participants in the Jackson Heart Study

OBJECTIVE

Research that assesses the relationship between psychosocial factors and chronic kidney disease (CKD) among African Americans (AAs) is limited. Using the Jackson Heart Study (JHS) cohort data, we investigated the association of goal-striving stress (GSS)-the stress experienced from not reaching goals-with prevalent CKD among AAs.

DESIGN

This was a cross-sectional analysis of JHS exam 1 data that assessed the relationship between GSS and CKD.

SETTING AND PARTICIPANTS

We utilized a sample from the JHS (n = 4967), an AA sample of women and men, 35-84 years old from the Jackson, MS metro area.

MAIN OUTCOME MEASURES

The baseline relationship between GSS levels (low, moderate, and high) and CKD (eGFR < 60 mL/min/1.73m²) was evaluated using a logistic regression model to estimate odds ratios (OR) on a 95% confidence interval (CI). The final model was adjusted for sex, age, socioeconomic status, health behaviors, risk factors, and total stress.

RESULTS

After full adjustment, the odds of prevalent CKD increased by 52% (OR 1.52; 95% CI 1.04, 2.24) for those reporting high (versus low) GSS.

CONCLUSIONS

Deficiencies between goal aspiration and achievement were associated with prevalent CKD. Potential interventions might consider the impact GSS contributes to prevalent CKD.

The relationship between coping, emotion regulation, and quality of life of patients on dialysis

Previous studies have investigated constructs that facilitate adaptation to chronic disease and improve quality of life and constructs that lead to psychopathological complications. The purpose of this research is to investigate the impact of coping and emotional regulation on the quality of life of patients on dialysis. Three questionnaires were administered to 78 patients on dialysis: Coping Orientations to Problems Experienced, Short Form (36), and Cognitive Emotion Regulation Questionnaire. Regressions analyses indicated that age, Rumination, Positive Refocusing, Avoidance Strategies, Approach to the Problem, and Transcendent Orientation predicted Physical Health. With regard to Mental Health, the predictors were gender, Self-Blame, Acceptance, Rumination, Positive Reappraisal, Catastrophizing, Avoidance Strategies, and Transcendent Orientation. This study confirms the relationship between emotional regulation, coping, and quality of life. The results highlight the need for total care of the patients, including an assessment of both physical state and psychological functioning in order to promote total well-being.

The Relationship Between Depressive Symptoms and Self-Management Behaviors in Patients With T2DM and Stage 3 CKD

PURPOSE

This study aimed to assess the relationship of depressive symptoms with self-management by adults with type 2 diabetes mellitus and chronic kidney disease.

DESIGN AND METHODS

Using a descriptive correlational design, participants completed Beck's Depression Inventory (BDI-II) and Summary of Diabetes Self-Care Activities measure.

FINDINGS

Reported were energy loss, sleep change, and fatigue. Performed less were exercise, physical activity, eating vegetables, and blood checks. Significant correlations were BDI-II total score with feet checking, energy loss with feet checking and exercise, and sleep change with feet soaking.

PRACTICE IMPLICATIONS

Depressive symptoms were associated to self-management behaviors that require physical energy. Assess for advancing symptoms.

Cognitive Changes in Chronic Kidney Disease and After Transplantation

Cognitive impairment is very common in chronic kidney disease (CKD) and is strongly associated with increased mortality. This review article will discuss the pathophysiology of cognitive impairment in CKD, as well as the effect of dialysis and transplantation on cognitive function. In CKD, uremic toxins, hyperparathyroidism and Klotho deficiency lead to chronic inflammation, endothelial dysfunction and vascular calcifications. This results in an increased burden of cerebrovascular disease in CKD patients, who consistently have more white matter hyperintensities, microbleeds, microinfarctions and cerebral atrophy on magnetic resonance imaging scans. Hemodialysis, although beneficial in terms of uremic toxin clearance, also contributes to cognitive decline by causing rapid fluid and osmotic shifts. Decreasing the dialysate temperature and increasing total dialysis time limits these shifts and helps maintain cognitive function in hemodialysis patients. For many patients, kidney transplantation is the preferred treatment modality, because it reverses the underlying mechanisms causing cognitive impairment in CKD. These positive effects have to be balanced against the possible neurotoxicity of infections and immunosuppressive medications, especially glucocorticosteroids and calcineurin inhibitors. A limited number of studies have addressed the overall effect of transplantation on cognitive function. These have mostly found an improvement after transplantation, but have a limited applicability to daily practice because they have only included relatively young patients.

Quality of life related to health chronic kidney disease: Predictive importance of mood and somatic symptoms

OBJECTIVE

To compare the predictive capacity of self-reported somatic symptoms and mood (depression and anxiety) on health-related quality of life (HRQOL) in patients with chronic renal disease.

METHOD

Data were obtained from 52 patients undergoing haemodialysis. Measures included a) the SF-36 health survey, b) the somatic symptoms scale revised (ESS-R) and c) the hospital anxiety and depression scale (HADS). Multiple regression was the main method of statistical analysis.

RESULTS

Patients exhibited HRQOL levels below normative values, with anxiety and depression prevalence at 36.5% and 27%, respectively. Mood was the strongest predictor of physical (β=-.624) and mental (β=-.709) HRQOL. Somatic symptoms were also associated with physical HRQOL, but their predictive value was weaker (β=-.270).

CONCLUSIONS

These results indicate that mood is a superior predictor of the physical and mental components of HRQOL in patients compared with the number and severity of physical symptoms. The data underline the importance of assessing negative emotional states (depression and anxiety) in kidney patients as a basis for intervention, which may facilitate reduction of the impact of chronic renal disease on HRQOL.

DEPRESSÃO E INSUFICIÊNCIA RENAL CRÔNICA: UMA ANÁLISE PSICOSSOCIOLÓGICA

Este estudo objetivou apreender as representações sociais (RS) elaboradas por pacientes nefrológicos em tratamento da hemodiálise e por seus familiares acerca da depressão e da insuficiência renal crônica (IRC). A amostra foi não probabilística, com 52 participantes, dos quais 26 eram pacientes, submetidos a um questionário sociodemográfico, à Escala Hospitalar de Ansiedade e Depressão, (subescala de depressão) e a uma entrevista semiestruturada. Os dados foram coletados em três hospitais e processados pelo SPSS 19.0 e pelo Alceste, sendo analisados por meio da estatística descritiva e análise lexical. Verificou-se que a RS da depressão foi ancorada nos elementos psico/cognitivo, físico/orgânico e psicossocial, objetivada principalmente na tristeza e no isolamento. A IRC foi representada com base nas adversidades psicossociais vivenciadas pelos grupos de pertença investigados. Observou-se que esta doença foi ancorada no suporte familiar e espiritual, nas restrições hídricas e alimentares, sendo associada ao desconhecimento da hemodiálise.

Depression and quality of life in relation to decreased glomerular filtration rate among adults with hypertension in rural northeast China

BACKGROUND/AIMS

We aim to investigate the extent to which depression and quality of life might be associated with decreased glomerular filtration rate (GFR) in a large hypertensive population in rural Northeast China.

METHODS

A total of 5566 hypertensive participants aged 35 years and older were screened with a stratified cluster multistage sampling scheme in rural areas of Liaoning Province during 2012-2013. Decreased GFR was defined as estimated GFR <60 ml/min/1.73 m2.

RESULTS

The overall prevalence of decreased GFR was 3.2%. In the multivariable regression model, participants with moderate or greater depression had a greater risk for having a decreased GFR (OR: 1.739, 95%CI: 1.004 to 3.014) after full adjustment. Every -point increase of all the domains in WHOQOL-BREF, except for physical and environment domains, was significantly related to a lower risk for decreased GFR adjusting for age, gender and race. However, after fully adjustment, only social relations remained significant (OR: 0.899, 95%CI: 0.820 to 0.985). Increasing in total scores of WHOQOL-BREF was a protective factor against decreased GFR after fully adjustment.

CONCLUSION

We found that moderate or greater depression and lower quality of life were associated with higher risks for developing decreased GFR.

Exploring the relationships between health status, illness perceptions, coping strategies and psychological morbidity in a chronic kidney disease cohort

BACKGROUND

Using the common sense model of illness adjustment, this study aimed to explore the impact of chronic kidney disease (CKD) on individual illness perceptions, coping styles and psychological well-being.

METHODS

Eighty individuals (50 men and 30 women) with an average age of 62.66 years (standard deviation, 11.98) were included in the study. All participants were under the care of the Renal Unit of a metropolitan tertiary referral hospital. Twenty-nine patients (36%) had CKD stage 3b-4, and 51 (64%) had CKD stage 5 (or end stage kidney disease [ESKD]). Disease severity was evaluated using the health perceptions questionnaire, coping styles assessed with the Carver brief COPE scale, illness perceptions explored with the brief illness perceptions questionnaire and anxiety and depression measured using the hospital anxiety and depression scale.

RESULTS

The hospital anxiety and depression scale assessment revealed 13 patients (16.3%) with moderate or severe anxiety and 6 (7.5%) with moderate depression. Consistent with the common sense model, disease activity had a significant direct influence on illness perceptions, while, in turn, illness perceptions had a significant direct influence on depression and anxiety. Adaptive and maladaptive coping were found to mediate the relationship between illness perceptions, and anxiety and depression.

CONCLUSIONS

The results provide evidence that it is the perception of an illness rather than the actual symptoms themselves that best account for adaption to CKD. These findings suggest that intervention strategies aimed at increasing psychological well-being need to focus on changing illness perceptions rather than improving symptoms of CKD or coping mechanisms.

Prevalence of Depressive Symptoms among Hemodialysis and Peritoneal Dialysis Patients

INTRODUCTION

End stage renal disease (ESRD) affects patient's physical and psychological health. Depression is the most common psychiatric illness among patients with ESRD. This study aimed to identify the prevalence of depressive symptoms among patients undergoing peritoneal (PD) and hemodialysis (HD), also to correlate these symptoms with the demographic data.

METHODS

this is a cross-sectional study that includes 133 PD patients and 133 HD patients attending the King Fahad Dialysis Center at King Saud Medical Complex (KSMC), Riyadh, Saudi Arabia. Socio-demographic data were documented. Depression was evaluated by using the zung self- rating depression scale (Zung SDS).

RESULTS

using the Zung SDS; the prevalence of depression was significantly higher among PD patients (98.5%) in compare with HD patients (83.5%).

CONCLUSION

the study reveals that there is a high prevalence of depressive symptoms among PD and HD patients. This will lead us to think of adding a system for screening, diagnosis and treatment of depression for all dialysis patients to improve their life.

Stress and the kidney

The prevalence of CKD has increased considerably over the past 2 decades. The rising rates of CKD have been attributed to known comorbidities such as diabetes, hypertension, and obesity; however, recent research has begun to explore the degree to which social, economic, and psychological factors have implications for the prevalence and progression of CKD, especially among high-risk populations such as African Americans. It has been suggested that stress can have implications for CKD, but this area of research has been largely unexplored. One contributing factor associated with the paucity of research on CKD is that many of the social, psychological, and environmental stressors cannot be recreated or simulated in a laboratory setting. Social science has established that stress can have implications for health, and we believe that stress is an important determinant of the development and progression of CKD. We draw heavily from the social scientific and social epidemiologic literature to present an intersectional conceptual frame specifying how stress can have implications for kidney disease, its progression, and its complications through multiple stressors and pathways.

Insuficiência renal crônica: representações sociais de pacientes com e sem depressão

Este estudo objetivou apreender as representações sociais acerca da insuficiência renal crônica (IRC) elaboradas por pacientes com e sem depressão no contexto da hemodiálise. Participaram do estudo 26 pacientes nefrológicos, com idades entre 22 e 73 anos (M=44,19; DP=11,83), que responderam a uma entrevista semiestruturada e à Escala Hospitalar de Ansiedade e Depressão (HADS). Os resultados evidenciaram que 20% apresentaram sintomas depressivos. Os pacientes com a síndrome depressiva apontaram, em suas representações acerca da IRC, o impacto do diagnóstico em suas vidas, que foi permeado por sentimentos de medo da morte e recusa em iniciar o tratamento. Os pacientes sem a depressão destacaram elementos associados ao significado positivo do tratamento e ao apoio recebido pela família. Os resultados apontam para a importância de uma abordagem interdisciplinar que enfoque o suporte psicossociológico e nutricional no tratamento da doença renal.

Prevalence of depression symptoms and serum levels of interleukin-6 in hemodialysis patients

AIM

In hemodialysis patients, depression appears as the most common psychopathological condition. States of advanced chronic kidney disease and dialysis are associated with a state of chronic inflammation. Depression has been linked to activation of the immune system characterized by high levels of pro-inflammatory cytokines. In this study, we investigated the possible correlations between depression, and interleukin-6 (IL-6) in hemodialysis patients.

METHODS

Seventy-five hemodialysis patients were enrolled in a cross-sectional study from September to November 2011 in Pelotas, Rio Grande do Sul. Demographic data were obtained from a questionnaire and the Beck Depression Inventory (BDI) was used to determine the presence or absence of depression symptoms. Biochemical parameters, dialysisdosage delivery, and IL-6 serum levels were measured.

RESULTS

Prevalence of depression among hemodialysis patients was 48% (BDI ≥ 14). In biochemical assessments, depressed patients showed a decrease in urea (P = 0.01) and increase of IL-6 (P = 0.04) levels. The correlation analysis between BDI scores and the biochemical variables showed that BDI was negatively correlated with urea (P = 0.03) and potassium (P = 0.04), but not with IL-6 levels.

CONCLUSION

Hemodialysis patients with depression showed higher levels of IL-6 but the severity of depressive symptoms was not correlated with levels of this cytokine.

Psychosocial intervention improves depression, quality of life, and fluid adherence in hemodialysis

Patients with ESRD have high rates of depression, which is associated with diminished quality of life and survival. We determined whether individual cognitive behavioral therapy (CBT) reduces depression in hemodialysis patients with elevated depressive affect in a randomized crossover trial. Of 65 participants enrolled from two dialysis centers in New York, 59 completed the study and were assigned to the treatment-first group (n=33) or the wait-list control group (n=26). In the intervention phase, CBT was administered chairside during dialysis treatments for 3 months; participants were assessed 3 and 6 months after randomization. Compared with the wait-list group, the treatment-first group achieved significantly larger reductions in Beck Depression Inventory II (self-reported, P=0.03) and Hamilton Depression Rating Scale (clinician-reported, P<0.001) scores after intervention. Mean scores for the treatment-first group did not change significantly at the 3-month follow-up. Among participants with depression diagnosed at baseline, 89% in the treatment-first group were not depressed at the end of treatment compared with 38% in the wait-list group (Fisher's exact test, P=0.01). Furthermore, the treatment-first group experienced greater improvements in quality of life, assessed with the Kidney Disease Quality of Life Short Form (P=0.04), and interdialytic weight gain (P=0.002) than the wait-list group, although no effect on compliance was evident at follow-up. In summary, CBT led to significant improvements in depression, quality of life, and prescription compliance in this trial, and studies should be undertaken to assess the long-term effects of CBT on morbidity and mortality in patients with ESRD.

Depressed mood and poor quality of life in male patients with chronic renal failure undergoing hemodialysis

OBJECTIVE

To assess mood and quality of life in male hemodialysis patients, and to correlate mood swings with the different domains of the quality of life questionnaire.

METHOD

Forty-seven male patients undergoing regular hemodialysis for more than six months were included in the study. The Hamilton Rating Scale for Depression and the Kidney Disease Quality of Life Questionnaire, in a version translated into and adapted to Portuguese, were used.

RESULTS

The patients' age was 39.4±8.9 years (median±SD). Depression was observed in 32 (68.1%) patients according to the Hamilton Rating Scale for Depression. A significant negative correlation was found between the results from the Hamilton Rating Scale for Depression and the following parameters of the specific dimensions of the Kidney Disease Quality of Life Questionnaire: list of symptoms and problems (rs=-0.399; p=0.005), quality of social interaction (rs=-0.433; p=0.002), and quality of sleep (rs=-0.585; p<0.001). Among the generic domains, mood showed a significant negative correlation with general health (rs=-0.475; p<0.001), emotional well-being (rs=-0.354; p=0.015), social functioning and energy/fatigue (rs=-0.518; p<0.001). The other parameters of the Kidney Disease Quality of Life Questionnaire did not show significant correlations with the Hamilton Rating Scale for Depression.

CONCLUSION

Mood showed a negative correlation with the various scores of quality of life assessed by the Kidney Disease Quality of Life Questionnaire, suggesting a possible influence of mood on the quality of life of chronic renal patients undergoing hemodialysis.

Psychosocial risk and protective factors for depression in the dialysis population: a systematic review and meta-regression analysis

OBJECTIVE

Research into the association between psychosocial factors and depression in End-Stage Renal Disease (ESRD) has expanded considerably in recent years identifying a range of factors that may act as important risk and protective factors of depression for this population. The present study provides the first systematic review and meta-analysis of this body of research.

METHODS

Published studies reporting associations between any psychosocial factor and depression were identified and retrieved from Medline, Embase, and PsycINFO, by applying optimised search strategies. Mean effect sizes were calculated for the associations across five psychosocial constructs (social support, personality attributes, cognitive appraisal, coping process, stress/stressor). Multiple hierarchical meta-regression analysis was applied to examine the moderating effects of methodological and substantive factors on the strength of the observed associations.

RESULTS

57 studies covering 58 independent samples with 5956 participants were identified, resulting in 246 effect sizes of the association between a range of psychosocial factors and depression. The overall mean effect size (Pearsons correlation coefficient) of the association between psychosocial factor and depression was 0.36. The effect sizes between the five psychosocial constructs and depression ranged from medium (0.27) to large levels (0.46) with personality attributes (0.46) and cognitive appraisal (0.46) having the largest effect sizes. In the meta-regression analyses, identified demographic (gender, age, location of study) and treatment (type of dialysis) characteristics moderated the strength of the associations with depression.

CONCLUSION

The current analysis documents a moderate to large association between the presence of psychosocial risk factors and depression in ESRD.

Event-related distress in kidney disease patients

BACKGROUND

Non-dialysis-dependent chronic kidney disease (CKD) and dialysis-dependent Stage 5 CKD (CKD5) are associated with a significant physical and psychosocial burden. Little is known, however, about the impact of stressful life events on CKD and CKD5 patients. This study aimed to determine the prevalence of stressful life events in CKD and CKD5 patients and identify the factors correlated with high levels of event-related distress.

METHODS

This cross-sectional study's sample consisted of 181 patients (91 with non-dialysis-dependent CKD Stages 4 and 5, 90 with CKD5) who filled out the Impact of Event Scale (IES), which measures subjective distress related to stressful life events. Other measures included scores from the Medical Outcomes Study Short Form-36, Patient Health Questionnaire-9 (PHQ-9) and Dialysis Symptom Index (DSI).

RESULTS

One hundred and three subjects reported stressors on the IES. Almost half the stressors (49.5%) related to personal health; the rest fell into other categories. There were significant differences between the no stressor, low event-related distress and high event-related distress groups in age (P < 0.001), PHQ-9 score (P < 0.001) and DSI score (P = 0.002). After adjustment, PHQ-9 score was associated with high event-related distress [odds ratio (OR) 1.20, 95% confidence interval (CI) 1.10-1.32], as was DSI score (OR 1.04, 95% CI 1.02-1.07) in a separate model.

CONCLUSIONS

Event-related distress is common in CKD and CKD5 patients. High event-related distress is associated with worse depressive symptoms and greater somatic and emotional symptom burden, even with adjustments for age and gender. The renal practitioner may need to address patients' event-related distress in order to provide optimal care.

Assessment of depressive symptoms during post-transplant follow-up care performed via telehealth

Telehealth provides a successful medium for the treatment of depression and other mental health illnesses. Often, inadequate treatment for this condition is found in patients with chronic co-morbid conditions such as those presented by the transplant recipient, a population at risk for depression. One concern of healthcare providers is the inability to adequately screen for symptoms of depression. This secondary analysis describes depression screening of 138 transplant recipients receiving follow-up care via telehealth (TH) and standard care (SC) as part of a larger National Institute of Nursing Research-funded randomized clinical trial. Of subjects who consented, 70 (51%) were randomized to the TH portion of the study. Depressive symptoms were measured by the Center for Epidemiologic Studies-Depression (CES-D) survey at study entry and at 6 and 12 months postconsent into the study. Univariate and subgroup analyses using SAS found no differences between the TH (n = 70) and SC (n = 68) group for demographic and social characteristics. No differences in CES-D scores were found between TH and SC groups. The concern in adding distance in the care of this medically fragile population was not substantiated in this study.

Cognitive-behavioral group therapy is an effective treatment for major depression in hemodialysis patients

Depression is an important target of psychological assessment in patients with end-stage renal disease because it predicts their morbidity, mortality, and quality of life. We assessed the effectiveness of cognitive-behavioral therapy in chronic hemodialysis patients diagnosed with major depression by the Mini International Neuropsychiatric Interview (MINI). In a randomized trial conducted in Brazil, an intervention group of 41 patients was given 12 weekly sessions of cognitive-behavioral group therapy led by a trained psychologist over 3 months while a control group of 44 patients received the usual treatment offered in the dialysis unit. In both groups, the Beck Depression Inventory, the MINI, and the Kidney Disease and Quality of Life-Short Form questionnaires were administered at baseline, after 3 months of intervention or usual treatment, and after 9 months of follow-up. The intervention group had significant improvements, compared to the control group, in the average scores of the Beck Depression Inventory overall scale, MINI scores, and in quality-of-life dimensions that included the burden of renal disease, sleep, quality of social interaction, overall health, and the mental component summary. We conclude that cognitive-behavioral group therapy is an effective treatment of depression in chronic hemodialysis patients.

Social environmental stressors, psychological factors, and kidney disease

Kidney disease is one of the most striking examples of health disparities in American public health. Disparities in the prevalence and progression of kidney disease are generally thought to be a function of group differences in the prevalence of kidney disease risk factors such as diabetes, hypertension, and obesity. However, the presence of these comorbidities does not completely explain the elevated rate of progression from chronic kidney disease (CKD) to end-stage renal disease among high-risk populations such as African Americans. We believe that the social environment is an important element in the pathway from CKD risk factors to CKD and end-stage renal disease. This review of the literature draws heavily from social science and social epidemiology to present a conceptual frame specifying how social, economic, and psychosocial factors interact to affect the risks for and the progression of kidney disease.