Depression Often Undertreated in Kidney Disease Patients on Chronic Dialysis

Depression Often Undertreated in Kidney Disease Patients on Chronic Dialysis

Patients on chronic hemodialysis due to kidney failure often suffer from depression but they frequently show no interest in modifying or starting anti-depressant therapy, and specialists are often unwilling to prescribe anti-depressants, a study found.

The study, titled “Acceptance of Anti-Depressant Treatment by Patients on Hemodialysis and their Renal Providers,” was published in the Clinical Journal of the American Society of Nephrology (CJASN).

Patients requiring chronic hemodialysis due to kidney failure, a possible consequence of chronic kidney disease (CKD), often show signs of depression, suggesting this might be an unaddressed issue among these patients.

To investigate how patients and their doctors accept anti-depressant therapy, Steven Weisbord, MD, MSc, and Julio Pena-Polanco, MD, put together a team and asked 101 patients on chronic hemodialysis in a clinical trial to complete a questionnaire asking about symptoms of depression every month for one year.

Based on their answers, 39 of the 101 patients met the criteria for depression. These patients had signs of depression on 147 of 373 monthly assessments. In 102 of these 147 assignments, patients were on anti-depressants. And, in 51 out of 70 monthly assessments, patients were found to be unwilling to accept the recommendations to intensify treatment.

Acute events, chronic illness, or dialysis were the main reasons reported for these patients’ depression. In 11 of 18 cases in which patients did accept recommendations, it was the specialists who were unwilling to prescribe anti-depressants.

“The Centers for Medicare and Medicaid Services’ Quality Improvement Program for end-stage renal disease recently mandated that all dialysis facilities report individual patient screening and treatment plans for depression; however, there is a paucity of evidence documenting the effectiveness of anti-depressant treatment in this patient population and it remains unknown whether patients on dialysis want treatment for depression,” Weisbord said in a press release.

The findings of this study were analyzed by Maree Hackett, PhD, and Meg Jardine, PhD, in an accompanying editorial titled, “We Need to Talk about Depression and Dialysis: But What Questions Should We Ask and Does Anyone Know the Answers?

Hackett and Jardine noted that maybe this elevated number of patients suffering from depression is due to the association between risk factors for depression and kidney failure, as well as changes in socialization and the psychological state caused by the chronic disease.

“Depression in people receiving dialysis treatment is associated with lower quality of life, increased hospitalizations and, in all likelihood, shortened survival,” the authors said. “The importance of the inner experience may get lost … in a setting of intensive medical intervention, inter-current comorbidities, and high rates of unwelcome events.”

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