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Depression in end-stage renal disease hemodialysis patients

Nature Clinical Practice Nephrology volume 2, pages 678–687 (2006)Cite this article

Abstract

Depression has been identified as a complicating comorbid diagnosis in a variety of medical conditions, including end-stage renal disease (ESRD). Despite this, the psychological health of hemodialysis patients is understudied. The purpose of this paper is to review the research and issues involved in the assessment of depression and its sequelae in ESRD. Accurate estimation of the prevalence of depression in the ESRD population has been difficult due to the use of different definitions of depression and varied assessment techniques, the overlap of depressive symptomatology with symptoms of uremia, and the confounding effects of medications. We suggest that depressive affect is a more important construct to study than diagnosis of depression syndromes per se in patients with chronic kidney disease. The Beck Depression Inventory is a reasonable measure of depressive affect in the ESRD population, if a higher than usual cutoff score is used or if its somatic components are omitted. Several pathways link depression and ESRD, and are probably bidirectional. As such, treatment of depressive affect could impact medical as well as psychological outcomes. The need for treatment intervention trials is great. Limited evidence regarding the safety and efficacy of treatment of hemodialysis patients with selective serotonin reuptake inhibitors is available, and cognitive behavioral therapy holds promise as an intervention for depression in this complex medical population.

Key Points

  • Determining the prevalence of depression in the end-stage renal disease (ESRD) population is complicated by the use of different definitions and assessment techniques, overlap of depressive symptomatology with symptoms of uremia, and confounding effects of medications

  • The prevalence of major depressive disorders and all depressive disorders in hemodialysis patients is probably around 10% and 20–30%, respectively

  • Depression may affect medical outcomes in ESRD patients by influencing immunologic and stress responses, nutritional status, and compliance with dialysis and other treatments

  • An association between depression and mortality in ESRD patients has been difficult to demonstrate

  • Limited data support the use of selective serotonin reuptake inhibitors and cognitive behavioral therapy in hemodialysis patients with depression; the need for more robust treatment intervention trials is great

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Authors and Affiliations

  1. Department of Psychiatry, SUNY Downstate Medical Center, Brooklyn, NY, USA

    Daniel Cukor

  2. Department of Psychology, George Washington University, Washington, DC, USA

    Rolf A Peterson

  3. Division of Renal Diseases and Hypertension, Department of Medicine, George Washington University, Washington, DC, USA

    Scott D Cohen & Paul L Kimmel

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  1. Daniel Cukor
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  2. Rolf A Peterson
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  3. Scott D Cohen
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  4. Paul L Kimmel
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Correspondence to Paul L Kimmel.

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Competing interests

PL Kimmel had consulting relationships with Ortho Biotech and Sigma Tau through early 2006, and is a stockholder in Johnson & Johnson and Glaxo Holdings.

The other authors declared they have no competing interests.

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Cukor, D., Peterson, R., Cohen, S. et al. Depression in end-stage renal disease hemodialysis patients. Nat Rev Nephrol 2, 678–687 (2006). https://doi.org/10.1038/ncpneph0359

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