LAS VEGAS – Depression in patients with chronic kidney disease is common, underrecognized, and undertreated, Dr. Daniel E. Weiner asserted at a meeting sponsored by the National Kidney Foundation.
Moreover, a recent meta-analysis by University of Toronto researchers demonstrated that the presence of depressive symptoms in patients on long-term dialysis was independently associated with a 51% increase in mortality, noted Dr. Weiner, a nephrologist at Tufts University, Boston.
Dr. Daniel E. Weiner
The meta-analysis included 12 observational studies in which formal depression scales were utilized in more than 21,000 dialysis patients. Even after adjusting for potential publication bias, the presence of depressive symptoms was associated with a 45% increased risk of mortality (Am. J. Kidney Dis. 2014;63:623-35).
The prevalence of depression is elevated among patients across the spectrum of chronic kidney disease (CKD) severity. This was highlighted in a study in which 272 consecutive non–dialysis dependent patients with stage 2-5 CKD underwent screening for depression using the structured Mini International Neuropsychiatric Interview. One in five met criteria for an ongoing major depressive episode. The prevalence of depression didn’t vary significantly by CKD stage (Am. J. Kidney Dis. 2009;54:424-32).
Depression is even more common among patients on dialysis for end-stage renal disease, with prevalence rates of up to 42% reported, Dr. Weiner continued.
He urged physicians to routinely screen for depression in patients with CKD. Studies indicate that’s not widely being done at present, probably in part because the evidence for therapeutic benefit is spotty because the large randomized controlled trials of antidepressant medications have generally excluded patients with advanced CKD.
Dr. Weiner, however, argued that routine screening in patients with CKD is warranted given that the yield is markedly higher than in the general population, depression is associated with increased mortality in dialysis-dependent patients, and it is a treatable disorder. There is evidence from small studies that the selective serotonin reuptake inhibitors (SSRIs) are safe in patients with CKD. Cognitive-behavioral therapy and exercise-based treatment regimens also are backed by supporting evidence.
Dr. Weiner reported having no financial conflicts regarding his presentation.