The association of depressive symptoms with survival in a Dutch cohort of patients with end-stage renal disease

• Published in: Nephrology, dialysis, transplantation dialysis, transplantation, 2010-01, Vol.25 (1), p.231-236
• Main Authors: Riezebos, Robert K., Nauta, Klaas-Jan, Honig, Adriaan, Dekker, Friedo W., Siegert, Carl E. H.
• Format: Article
• Language: English
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cohort Studies; depression; Depression - epidemiology; Emergency and intensive care: renal failure. Dialysis management; end-stage renal disease; Endpoint Determination; Female; Follow-Up Studies; HADS; Health Surveys; Humans; Intensive care medicine; Kidney Failure, Chronic - mortality; Kidney Failure, Chronic - psychology; Kidney Failure, Chronic - therapy; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Netherlands - epidemiology; Peritoneal Dialysis; Prevalence; Prospective Studies; Renal Dialysis; Renal failure; renal replacement therapy; survival; Survival Rate
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfp383

Aim. To evaluate the prevalence and the influence on survival of depressive symptoms in a European cohort of end-stage renal disease (ESRD) patients on renal replacement therapy (RRT). Methods. In a prospective fashion, symptoms of depression were evaluated in ESRD patients on RRT using the depression subscore of the Hospital Anxiety and Depression Scale (HADS). Fatal and non-fatal clinical events were determined during a 1-year follow-up. Results. Of 101 patients with ESRD, 42% showed manifest depressive symptoms, defined as a HADS-D score ≥7. No association was found between depressive symptoms and severity of somatic disease. During follow-up, all-cause mortality was significantly higher in patients with depressive symptoms above threshold (n = 42, mortality: 26%) compared to patients with depressive symptoms below threshold (n = 59, mortality 8%), (crude HR 3.3, CI 1.2–9.6, P = 0.02). The excess in mortality was mainly caused by a higher incidence of septicaemia (0 versus 12%, P = 0.01). After adjustment for clinical parameters, this association between depressive symptoms and mortality became even stronger. There was no significant difference observed in the incidence of cardiovascular events. Conclusions. Patients with ESRD treated with dialysis show a high level of depressive symptoms that is independently associated with poor survival. Future research should address appropriate therapeutic regimens.