Association between major depressive episodes in patients with chronic kidney disease and initiation of dialysis, hospitalization, or death

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Abstract

Context: Patients with chronic kidney disease (CKD) experience increased rates of hospitalization and death. Depressive disorders are associated with morbidity and mortality. Whether depression contributes to poor outcomes in patients with CKD not receiving dialysis is unknown. Objective: To determine whether the presence of a current major depressive episode (MDE) is associated with poorer outcomes in patients with CKD. Design, Setting, and Patients: Prospective cohort study of 267 consecutively recruited outpatients with CKD (stages 2-5 and who were not receiving dialysis) at a VA medical center between May 2005 and November 2006 and followed up for 1 year. An MDE was diagnosed by blinded personnel using the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria. Main Outcome Measures: The primary outcome was event-free survival defined as the composite of death, dialysis initiation, or hospitalization. Secondary outcomes included each of these events assessed separately. Results: Among 267 patients, 56 had a current MDE (21%) and 211 did not (79%). There were 127 composite events, 116 hospitalizations, 38 dialysis initiations, and 18 deaths. Events occurred more often in patients with an MDE compared with those without an MDE (61% vs 44%, respectively, P=.03). Four patients with missing dates of hospitalization were excluded from survival analyses. The mean (SD) time to the composite event was 206.5 (19.8) days (95% CI, 167.7-245.3 days) for those with an MDE compared with 273.3 (8.5) days (95% CI, 256.6-290.0 days) for those without an MDE (P=.003). The adjusted hazard ratio (HR) for the composite event for patients with an MDE was 1.86 (95% CI, 1.23-2.84). An MDE at baseline independently predicted progression to dialysis (HR, 3.51; 95% CI, 1.77-6.97) and hospitalization (HR, 1.90; 95% CI, 1.23-2.95). Conclusion: The presence of an MDE was associated with an increased risk of poor outcomes in CKD patients who were not receiving dialysis, independent of comorbidities and kidney disease severity.

Original languageEnglish (US)
Pages (from-to)1946-1953
Number of pages8
JournalJAMA - Journal of the American Medical Association
Volume303
Issue number19
DOIs
StatePublished - May 19 2010

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Chronic Renal Insufficiency
Dialysis
Hospitalization
Mortality
Kidney Diseases
Survival Analysis
Depressive Disorder
Diagnostic and Statistical Manual of Mental Disorders
Disease-Free Survival
Comorbidity
Cohort Studies
Outpatients
Outcome Assessment (Health Care)
Prospective Studies
Depression
Morbidity

ASJC Scopus subject areas

  • Medicine(all)

Cite this

@article{c55768efb9e2413b9f6bca5a78ff55ed,
title = "Association between major depressive episodes in patients with chronic kidney disease and initiation of dialysis, hospitalization, or death",
abstract = "Context: Patients with chronic kidney disease (CKD) experience increased rates of hospitalization and death. Depressive disorders are associated with morbidity and mortality. Whether depression contributes to poor outcomes in patients with CKD not receiving dialysis is unknown. Objective: To determine whether the presence of a current major depressive episode (MDE) is associated with poorer outcomes in patients with CKD. Design, Setting, and Patients: Prospective cohort study of 267 consecutively recruited outpatients with CKD (stages 2-5 and who were not receiving dialysis) at a VA medical center between May 2005 and November 2006 and followed up for 1 year. An MDE was diagnosed by blinded personnel using the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria. Main Outcome Measures: The primary outcome was event-free survival defined as the composite of death, dialysis initiation, or hospitalization. Secondary outcomes included each of these events assessed separately. Results: Among 267 patients, 56 had a current MDE (21{\%}) and 211 did not (79{\%}). There were 127 composite events, 116 hospitalizations, 38 dialysis initiations, and 18 deaths. Events occurred more often in patients with an MDE compared with those without an MDE (61{\%} vs 44{\%}, respectively, P=.03). Four patients with missing dates of hospitalization were excluded from survival analyses. The mean (SD) time to the composite event was 206.5 (19.8) days (95{\%} CI, 167.7-245.3 days) for those with an MDE compared with 273.3 (8.5) days (95{\%} CI, 256.6-290.0 days) for those without an MDE (P=.003). The adjusted hazard ratio (HR) for the composite event for patients with an MDE was 1.86 (95{\%} CI, 1.23-2.84). An MDE at baseline independently predicted progression to dialysis (HR, 3.51; 95{\%} CI, 1.77-6.97) and hospitalization (HR, 1.90; 95{\%} CI, 1.23-2.95). Conclusion: The presence of an MDE was associated with an increased risk of poor outcomes in CKD patients who were not receiving dialysis, independent of comorbidities and kidney disease severity.",
author = "Hedayati, {S. Susan} and Minhajuddin, {Abu T.} and Masoud Afshar and Toto, {Robert D.} and Trivedi, {Madhukar H.} and Rush, {A. John}",
year = "2010",
month = "5",
day = "19",
doi = "10.1001/jama.2010.619",
language = "English (US)",
volume = "303",
pages = "1946--1953",
journal = "JAMA - Journal of the American Medical Association",
issn = "0098-7484",
publisher = "American Medical Association",
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TY - JOUR

T1 - Association between major depressive episodes in patients with chronic kidney disease and initiation of dialysis, hospitalization, or death

AU - Hedayati, S. Susan

AU - Minhajuddin, Abu T.

AU - Afshar, Masoud

AU - Toto, Robert D.

AU - Trivedi, Madhukar H.

AU - Rush, A. John

PY - 2010/5/19

Y1 - 2010/5/19

N2 - Context: Patients with chronic kidney disease (CKD) experience increased rates of hospitalization and death. Depressive disorders are associated with morbidity and mortality. Whether depression contributes to poor outcomes in patients with CKD not receiving dialysis is unknown. Objective: To determine whether the presence of a current major depressive episode (MDE) is associated with poorer outcomes in patients with CKD. Design, Setting, and Patients: Prospective cohort study of 267 consecutively recruited outpatients with CKD (stages 2-5 and who were not receiving dialysis) at a VA medical center between May 2005 and November 2006 and followed up for 1 year. An MDE was diagnosed by blinded personnel using the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria. Main Outcome Measures: The primary outcome was event-free survival defined as the composite of death, dialysis initiation, or hospitalization. Secondary outcomes included each of these events assessed separately. Results: Among 267 patients, 56 had a current MDE (21%) and 211 did not (79%). There were 127 composite events, 116 hospitalizations, 38 dialysis initiations, and 18 deaths. Events occurred more often in patients with an MDE compared with those without an MDE (61% vs 44%, respectively, P=.03). Four patients with missing dates of hospitalization were excluded from survival analyses. The mean (SD) time to the composite event was 206.5 (19.8) days (95% CI, 167.7-245.3 days) for those with an MDE compared with 273.3 (8.5) days (95% CI, 256.6-290.0 days) for those without an MDE (P=.003). The adjusted hazard ratio (HR) for the composite event for patients with an MDE was 1.86 (95% CI, 1.23-2.84). An MDE at baseline independently predicted progression to dialysis (HR, 3.51; 95% CI, 1.77-6.97) and hospitalization (HR, 1.90; 95% CI, 1.23-2.95). Conclusion: The presence of an MDE was associated with an increased risk of poor outcomes in CKD patients who were not receiving dialysis, independent of comorbidities and kidney disease severity.

AB - Context: Patients with chronic kidney disease (CKD) experience increased rates of hospitalization and death. Depressive disorders are associated with morbidity and mortality. Whether depression contributes to poor outcomes in patients with CKD not receiving dialysis is unknown. Objective: To determine whether the presence of a current major depressive episode (MDE) is associated with poorer outcomes in patients with CKD. Design, Setting, and Patients: Prospective cohort study of 267 consecutively recruited outpatients with CKD (stages 2-5 and who were not receiving dialysis) at a VA medical center between May 2005 and November 2006 and followed up for 1 year. An MDE was diagnosed by blinded personnel using the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria. Main Outcome Measures: The primary outcome was event-free survival defined as the composite of death, dialysis initiation, or hospitalization. Secondary outcomes included each of these events assessed separately. Results: Among 267 patients, 56 had a current MDE (21%) and 211 did not (79%). There were 127 composite events, 116 hospitalizations, 38 dialysis initiations, and 18 deaths. Events occurred more often in patients with an MDE compared with those without an MDE (61% vs 44%, respectively, P=.03). Four patients with missing dates of hospitalization were excluded from survival analyses. The mean (SD) time to the composite event was 206.5 (19.8) days (95% CI, 167.7-245.3 days) for those with an MDE compared with 273.3 (8.5) days (95% CI, 256.6-290.0 days) for those without an MDE (P=.003). The adjusted hazard ratio (HR) for the composite event for patients with an MDE was 1.86 (95% CI, 1.23-2.84). An MDE at baseline independently predicted progression to dialysis (HR, 3.51; 95% CI, 1.77-6.97) and hospitalization (HR, 1.90; 95% CI, 1.23-2.95). Conclusion: The presence of an MDE was associated with an increased risk of poor outcomes in CKD patients who were not receiving dialysis, independent of comorbidities and kidney disease severity.

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