Physician-diagnosed depression as a correlate of hospitalizations in patients receiving long-term hemodialysis

S. Susan Hedayati, Steven C. Grambow, Lynda A. Szczech, Karen M. Stechuchak, Andrew S. Allen, Hayden B. Bosworth

Research output: Contribution to journalArticle

90 Scopus citations

Abstract

•Background: Hospital admissions consume a large proportion of costs for the end-stage renal disease (ESRD) program in the United States. We investigated whether a physician diagnosis of depression increases the risk for hospitalization or death in patients with ESRD receiving long-term hemodialysis (HD), independent of medical comorbidities. Methods: Centralized Veterans Affairs (VA) databases were used to identify a population-based prevalence cohort of 1,588 male patients with ESRD receiving long-term HD in VA facilities between September 1, 2000, and September 30, 2000. International Classification of Diseases, Ninth Revision, codes were used to identify comorbidities and depression diagnosis. Negative binomial regression models were used to examine the association between depression diagnosis and number of hospitalizations and cumulative hospital days in a 2-year observation period. Logistic regression models were used to investigate the association between depression diagnosis and hospitalization, death, and death or hospitalization. Results: The prevalence of physician-diagnosed depression was 14.7%. Patients with a depression diagnosis were more likely to be white and have more comorbidities. Depression diagnosis was associated with increased hospital days (rate ratio for adjusted model, 1.31; 95% confidence interval, 1.04 to 1.66) and increased number of hospitalizations (rate ratio for adjusted model, 1.30; 95% confidence interval, 1.11 to 1.52). Depression diagnosis was not statistically associated with death or the composite of death or hospitalization in adjusted models. Conclusion: Physician-diagnosed depression was associated significantly with both increased hospitalization rate and length of stay in patients with ESRD receiving outpatient HD in VA facilities, independent of demographics and comorbidities. Prospective studies should be conducted to assess whether treatment of depression will decrease hospitalization in these patients.

Original languageEnglish (US)
Pages (from-to)642-649
Number of pages8
JournalAmerican Journal of Kidney Diseases
Volume46
Issue number4
DOIs
StatePublished - Oct 1 2005

Keywords

  • Depression
  • End-stage renal disease (ESRD)
  • Hemodialysis (HD)
  • Hospitalizations
  • Mortality

ASJC Scopus subject areas

  • Nephrology

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