Clinical Nephrology – Epidemiology – Clinical Trials
Kidney International (2002) 62, 199–207; doi:10.1046/j.1523-1755.2002.00411.x
Depression as a predictor of mortality and hospitalization among hemodialysis patients in the United States and Europe
Antonio Alberto Lopes, Jennifer Bragg, Eric Young, David Goodkin, Donna Mapes, Christian Combe, Luis Piera, Philip Held, Brenda Gillespie and Friedrich K Port for the Dialysis Outcomes and Practice Patterns Study (DOPPS)
Department of Medicine, Federal University of Bahia, Brazil; University Renal Research and Education Association (URREA), and Kidney Epidemiology and Cost Center (KECC), University of Michigan, and Division of Nephrology, University of Michigan and VAMC, Ann Arbor, Michigan, USA; Amgen, Inc., Thousand Oaks, California, USA; Service de Néphrologie B, Center Hospitalier Universitaire de Bordeaux, Bordeaux, France; Hospital General Vall D'Hebron, Barcelona, Spain; and Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
Correspondence: Antonio A. Lopes, M.D., Ph.D., University Renal Research and Education Association, 315 W. Huron, Suite 260, Ann Arbor, Michigan 48103, USA. E-mail: aaslopes@ufba.br or urrea@urrea.org
Received 23 October 2001; Revised 18 January 2002; Accepted 12 February 2002.
Abstract
Depression as a predictor of mortality and hospitalization among hemodialysis patients in the United States and Europe.
Background
Depression is not uncommon among patients with end-stage renal disease (ESRD) being treated by hemodialysis. 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). The 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 dumps that nothing could cheer you up" and (2) "downhearted and blue." A response of "a good bit,""most," or "all" of the time were classified as depressed.
Results
The prevalence of depression was nearly 20%. The 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). These associations were not significantly different between US and European patients.
Conclusions
Self-reported depression by two simple questions was associated with increased risks of mortality and hospitalization for hemodialysis patients. Future research needs to assess whether early identification and treatment of depression may help to improve quality of life and survival in hemodialysis patients.
Keywords:
depression, end-stage renal disease (ESRD), hemodialysis, hospitalization, mortality
