Depression in dialysis patients

• Published in: Nephrology (Carlton, Vic.) Vic.), 2016-08, Vol.21 (8), p.639-646
• Main Authors: Ma, Terry King‐Wing, Li, Philip Kam‐Tao
• Format: Article
• Language: English
• Subjects: Antidepressive Agents - therapeutic use; Cognitive ability; Cognitive Therapy; depression; Depression - diagnosis; Depression - epidemiology; Depression - psychology; Depression - therapy; Diagnosis; Dialysis; Epidemiology; Hemodialysis; Humans; Kidney Failure, Chronic - diagnosis; Kidney Failure, Chronic - epidemiology; Kidney Failure, Chronic - psychology; Kidney Failure, Chronic - therapy; Medicare; Mental depression; Patients; Physical training; Predictive Value of Tests; Psychiatric Status Rating Scales; Renal Dialysis - adverse effects; Risk Factors; Serotonin uptake inhibitors; Severity of Illness Index; Surveys and Questionnaires; Treatment Outcome
• ISSN: 1320-5358; 1440-1797
• DOI: 10.1111/nep.12742

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. Summary at a Glance This review examines some current features of the diagnosis and management of depression in dialysis patients. The overlapping symptoms of kidney failure managed with dialysis and depression and their interpretation are highlighted. The evidence and rationale for treatment are discussed.