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Depressed dialysis patients more likely to be hospitalized or die, researcher finds
September 15, 2008Dialysis patients diagnosed with depression are nearly twice as likely to be hospitalized or die within a year than those who are not depressed, a UT Southwestern Medical Center researcher has found.
In the study, available online and in the Sept. 15 issue of Kidney International, researchers monitored 98 dialysis patients for up to 14 months. More than a quarter of dialysis patients received a psychiatric diagnosis of some form of depression based on a Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM IV).
This is the first reported link between adverse clinical outcomes in dialysis patients and depression made through a formal psychiatric interview based on the DSM-IV standards. More than 80 percent of the depressed patients died or were hospitalized, compared with 43 percent of non-depressed patients. Cardiovascular events, which previously have been linked to depression, led to 20 percent of the hospitalizations.
"Twenty percent of patients who start dialysis will die by the end of the first year," said Dr. Susan Hedayati, assistant professor of internal medicine and the study's lead author. "What we don't know yet is, if their depression is treated, could it extend dialysis patients' survival and improve their quality of life."
Dr. Hedayati, a staff nephrologist at the Dallas Veterans Affairs Medical Center, said depression-like symptoms - such as loss of energy, poor appetite and sleep disturbances - are often observed in patients with chronic disease, so it is important to get a scientifically valid diagnosis for clinical depression.
Twenty-six million people in America have chronic kidney disease and more than 20 million are at increased risk, according to the National Kidney Foundation. End-stage renal disease occurs when the patients' kidneys have failed to the point where dialysis or a kidney transplant is needed. Dialysis filters toxic chemicals in the blood and helps control blood pressure. With hemodialysis, the kind investigated in this latest study, a filter functions as an artificial kidney to remove waste, extra chemicals and fluid from the body.
Coronary artery disease, congestive heart failure and diabetes are known co-morbidities for patients with end-stage renal disease. In this paper, with the addition of each co-morbidity, a dialysis patient was about 30 percent more likely to be hospitalized or die. If the patient had depression, however, the relationship was even stronger, with about a 100 percent increase in these dire outcomes, Dr. Hedayati said.
"Nephrologists don't have as much data showing that treating anemia or increasing the dose of dialysis will improve survival, and yet during our routine rounds with dialysis patients we intervene on those issues," Dr. Hedayati said. "Nephrologists don't usually ask patients about depression. Since depression is so prevalent and can negatively affect dialysis patients, we need to ask about it."
Depression is a treatable disease, so Dr. Hedayati hopes hospitalizations and deaths can be reduced with further research. Other large trials involving dialysis patients, including some that evaluated treatment of high cholesterol, using ACE-inhibitors or increasing the dose of dialysis, haven't been shown to make a significant difference in life expectancy or hospitalization, Dr. Hedayati said.
"Now that we know depression in dialysis patients is associated with adverse outcomes such as death and hospitalization, we need to take another step forward and figure out if treating it will make a difference in patient outcomes," Dr. Hedayati said.
Researchers from Duke University Medical Center, Veterans Affairs Medical Center in Durham, N.C., and George Washington University also participated in the study.
The study was supported by the Agency for Health Care, Research and Quality; the John A. Hartford Foundation; the Claude D. Pepper Older Americans Independence Center; and the VA.
Visit http://www.utsouthwestern.org/kidneys to learn more about clinical services in nephrology at UT Southwestern.
The University of Texas Southwestern Medical Center at Dallas
"Twenty percent of patients who start dialysis will die by the end of the first year," said Dr. Susan Hedayati, assistant professor of internal medicine and the study's lead author. "What we don't know yet is, if their depression is treated, could it extend dialysis patients' survival and improve their quality of life."
Dr. Hedayati, a staff nephrologist at the Dallas Veterans Affairs Medical Center, said depression-like symptoms - such as loss of energy, poor appetite and sleep disturbances - are often observed in patients with chronic disease, so it is important to get a scientifically valid diagnosis for clinical depression.
Twenty-six million people in America have chronic kidney disease and more than 20 million are at increased risk, according to the National Kidney Foundation. End-stage renal disease occurs when the patients' kidneys have failed to the point where dialysis or a kidney transplant is needed. Dialysis filters toxic chemicals in the blood and helps control blood pressure. With hemodialysis, the kind investigated in this latest study, a filter functions as an artificial kidney to remove waste, extra chemicals and fluid from the body.
Coronary artery disease, congestive heart failure and diabetes are known co-morbidities for patients with end-stage renal disease. In this paper, with the addition of each co-morbidity, a dialysis patient was about 30 percent more likely to be hospitalized or die. If the patient had depression, however, the relationship was even stronger, with about a 100 percent increase in these dire outcomes, Dr. Hedayati said.
"Nephrologists don't have as much data showing that treating anemia or increasing the dose of dialysis will improve survival, and yet during our routine rounds with dialysis patients we intervene on those issues," Dr. Hedayati said. "Nephrologists don't usually ask patients about depression. Since depression is so prevalent and can negatively affect dialysis patients, we need to ask about it."
Depression is a treatable disease, so Dr. Hedayati hopes hospitalizations and deaths can be reduced with further research. Other large trials involving dialysis patients, including some that evaluated treatment of high cholesterol, using ACE-inhibitors or increasing the dose of dialysis, haven't been shown to make a significant difference in life expectancy or hospitalization, Dr. Hedayati said.
"Now that we know depression in dialysis patients is associated with adverse outcomes such as death and hospitalization, we need to take another step forward and figure out if treating it will make a difference in patient outcomes," Dr. Hedayati said.
Researchers from Duke University Medical Center, Veterans Affairs Medical Center in Durham, N.C., and George Washington University also participated in the study.
The study was supported by the Agency for Health Care, Research and Quality; the John A. Hartford Foundation; the Claude D. Pepper Older Americans Independence Center; and the VA.
Visit http://www.utsouthwestern.org/kidneys to learn more about clinical services in nephrology at UT Southwestern.
The University of Texas Southwestern Medical Center at Dallas
Dialysis Current Events and Dialysis News RSSReduced kidney function, high levels of protein in urine associated with adverse outcomes
Patients with high levels of proteinuria (protein in urine) in addition to another marker of reduced kidney function had an associated increased risk of all-cause death, heart attack or progression to kidney failure, according to a study in the February 3 issue of JAMA.
Severe complications of diabetes higher in depressed patients
Depression raises risks of advanced and severe complications from diabetes, according to a prospective study of Group Health primary-care patients in western Washington. These complications include kidney failure or blindness, the result of small vessel damage, as well as major vessel problems leading to heart attack or stroke.
New therapeutic approach identified for kidney disease associated with lupus
Investigators have identified a new disease mechanism and therapeutic approach for a type of advanced kidney disease that is a common cause of complications in patients with lupus.
Research at UCSB points to potential treatment for kidney disease
Research performed at UC Santa Barbara points to the drug rapamycin as a potential treatment for kidney disease.
Oral sodium phosphate laxative inducing hyperphosphatemia relates with weight?
Colon cleansing is used widely for colonoscopic exploration and colonic and gynecological surgery. Oral sodium phosphate (OSP) solution is the osmotic laxative most commonly used for this purpose.
Excess protein in urine is indicator of heart disease risk in whites, but not blacks
The cardiovascular risk that is associated with proteinuria, or high levels of protein in the urine, a common test used by doctors as an indicator of increased risk for progressive kidney disease, heart attack and stroke, has race-dependent effects, according to a new study by researchers at Wake Forest University School of Medicine.
Abnormal blood calcium levels deadly for kidney disease patients
Abnormally high or low blood calcium levels are linked to an increased chance of premature death in non-dialysis kidney disease patients, according to a study appearing in an upcoming issue of the Clinical Journal of the American Society Nephrology (CJASN).
Anemia drug not helpful for kidney disease patients
An international study authored by a UT Southwestern Medical Center researcher has concluded that the anemia drug darbepoetin alfa works no better than a placebo in several other applications previously thought to be promising.
TGen analysis identifies biomarkers for diabetic kidney failure
Researchers using a DNA analysis tool developed by the Translational Genomics Research Institute (TGen) and UCLA have identified genetic markers that could help treat chronic kidney disease among diabetics.
Hospital re-admission high for dialysis patients treated in long-term care hospitals
A new study by University of Cincinnati (UC) nephrologists shows that most dialysis patients admitted to long-term care hospitals face readmission to acute care facilities, and those with acute kidney failure don't often recover full kidney function.
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