TY - JOUR
T1 - Association between depression and death in people with CKD
T2 - A meta-analysis of cohort studies
AU - Palmer, Suetonia C.
AU - Vecchio, Mariacristina
AU - Craig, Jonathan C.
AU - Tonelli, Marcello
AU - Johnson, David W.
AU - Nicolucci, Antonio
AU - Pellegrini, Fabio
AU - Saglimbene, Valeria
AU - Logroscino, Giancarlo
AU - Hedayati, S. Susan
AU - Strippoli, Giovanni F M
N1 - Funding Information:
We acknowledge the specialist support from the Cochrane Renal Group. Ruth Mitchell, specialist information manager, designed and ran the electronic database searches. Narelle Willis, coordinating editor, provided administrative support. We also thank Michela Sciancalepore for administrative support.
PY - 2013/9
Y1 - 2013/9
N2 - Background: Depression occurs relatively commonly in people with chronic kidney disease (CKD), but it is uncertain whether depression is a risk factor for premature death in this population. Interventions to reduce mortality in CKD consistently have been ineffective and new strategies are needed. Study Design: Systematic review and meta-analysis of cohort studies. Setting & Population: Adults with CKD. Selection Criteria for Studies: Cohort studies identified in Ovid MEDLINE through week 3 December 2012 without language restriction. Predictor: Depression status as determined by physician diagnosis, clinical coding, or self-reported scales. Selection Criteria for Studies: All-cause and cardiovascular mortality. Outcomes were summarized as relative risks (RRs) with 95% CIs using random-effects meta-analysis. Results: 22 studies (83,381 participants) comprising 12,063 cases of depression (mean prevalence, 27.4%; 95% CI, 20.0%-36.3%) with a follow-up of 3 months to 6.5 years were included. Methodological quality generally was good or fair. Depression consistently increased the risk of death from any cause (RR, 1.59; 95% CI, 1.35-1.87), but had less certain effects on cardiovascular mortality (RR, 1.88; 95% CI, 0.84-4.19). Associations for mortality were similar regardless of the diagnostic method used for depression, but were weaker in analyses controlled for preexisting cardiovascular disease (RR, 1.36; 95% CI, 1.23-1.50). Limitations: Meta-analyses adjusting for antidepressant medication use were not possible, and data for kidney transplant recipients and individuals with earlier stages of CKD not treated with dialysis were limited. Conclusions: Depression is associated with a substantially increased risk of death in people with CKD. Effective treatment for depression in people with CKD may reduce mortality.
AB - Background: Depression occurs relatively commonly in people with chronic kidney disease (CKD), but it is uncertain whether depression is a risk factor for premature death in this population. Interventions to reduce mortality in CKD consistently have been ineffective and new strategies are needed. Study Design: Systematic review and meta-analysis of cohort studies. Setting & Population: Adults with CKD. Selection Criteria for Studies: Cohort studies identified in Ovid MEDLINE through week 3 December 2012 without language restriction. Predictor: Depression status as determined by physician diagnosis, clinical coding, or self-reported scales. Selection Criteria for Studies: All-cause and cardiovascular mortality. Outcomes were summarized as relative risks (RRs) with 95% CIs using random-effects meta-analysis. Results: 22 studies (83,381 participants) comprising 12,063 cases of depression (mean prevalence, 27.4%; 95% CI, 20.0%-36.3%) with a follow-up of 3 months to 6.5 years were included. Methodological quality generally was good or fair. Depression consistently increased the risk of death from any cause (RR, 1.59; 95% CI, 1.35-1.87), but had less certain effects on cardiovascular mortality (RR, 1.88; 95% CI, 0.84-4.19). Associations for mortality were similar regardless of the diagnostic method used for depression, but were weaker in analyses controlled for preexisting cardiovascular disease (RR, 1.36; 95% CI, 1.23-1.50). Limitations: Meta-analyses adjusting for antidepressant medication use were not possible, and data for kidney transplant recipients and individuals with earlier stages of CKD not treated with dialysis were limited. Conclusions: Depression is associated with a substantially increased risk of death in people with CKD. Effective treatment for depression in people with CKD may reduce mortality.
KW - Depression
KW - dialysis
KW - mortality
KW - outcomes
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U2 - 10.1053/j.ajkd.2013.02.369
DO - 10.1053/j.ajkd.2013.02.369
M3 - Article
C2 - 23623139
AN - SCOPUS:84883253381
SN - 0272-6386
VL - 62
SP - 493
EP - 505
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 3
ER -