Depression as a predictor of mortality and hospitalization among hemodialysis patients in the United States and Europe

Abstract

Background. Depression is not uncornrnon among patients with end-stage renal disease (ESRD) being treated by hernodialysis. We investigated whether risk of mortality and rate of hospitalization may be predicted from physician-diagnosed depression and patients’ self-reports of depressive symptoms. Methods. Data were analyzed from the Dialysis Outcomes and Practice Patterns Study (DOPPS) for randomly selected ESRD patients being treated by hemodialysis in the United States (142 facilities, 2855 patients) and five European countries (101 facilities, 2401 patients). lhe diagnosis of depression during the past year was abstracted from the medical records. In addition, the patients were asked to indicate how much of their time over the previous four weeks they had felt (1) “so down in the durnps that nothing could cheer you up” and (2) “downhearted and blue. A response of “a good bit[ “most[ or “ali” of the time were ciassified as depressed. Results. lhe prevalence of depression was nearly 20%. lhe relative risks of mortality and hospitalization among depressed (vs. non-depressed), adjusted for time on dialysis, age, race, socioeconomic status, comorbid indicators and country were, respectively: 1.23 and 1.11 for physician-diagnosed depression, 1.48 and 1.15 for the “so down in the dumps” question, and 1.35 and 1.11 for the “downhearted and blue” question (P < 0.05 for all six relative risks). lhese associations were not significantiy different between US and European patients. Conclusions. Self-reported depression by two simple questions was associated with increased risks of rnortality and hospitalization for hemodialysis patients. Future research needs to assess whether eariy identification and treatment of depression may help to improve quality of life and survival in hemodialysis patients.