Chronic Disease

Clinician interviews are the best method to determine whether patients with kidney failure are also depressed

Kidney failure occurs when a person's kidneys can no longer filter blood to get rid of waste products, balance electrolyte levels, control blood pressure, or stimulate red blood cell production. Also called end-stage renal disease (ESRD), kidney failure can be treated only with dialysis or a kidney transplant. A new study finds that patients with ESRD who suffer from depression end up in the hospital or die more frequently than ESRD patients who are not depressed.

To determine if patients at a Veterans Health Affairs unit in Durham, North Carolina, were depressed, researchers had them complete questionnaires on depression and also had a clinician conduct interviews with the patients. The results of the clinician interview more accurately diagnosed depression and predicted whether patients would be hospitalized or die during the year following the study. Of the 96 patients with ESRD who received dialysis, 26 (27 percent) were depressed. During the 1-year followup period, 21 of those 26 patients (81 percent) either died or were hospitalized compared with 31 of the 72 patients (43 percent) who were not depressed.

In light of these results, the authors suggest that more research is needed on the effects of antidepressants for people who suffer from kidney failure. Patients with ESRD are usually excluded from participating in treatment trials for antidepressants, but they may have better health outcomes if they are able to use those drugs. This study was funded in part by the Agency for Healthcare Research and Quality (T32 HS00079).

See "Death or hospitalization of patients on chronic hemodialysis is associated with a physician-based diagnosis of depression," by S. Susan Hedayati, M.D., M.H.Sc., Hayden B. Bosworth, Ph.D., Libbie P. Briley, M.D., M.D., F.A.S.N., and others in the October 2008 Kidney International 74(7), pp. 930-936.

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