TY - JOUR
T1 - The association between depression and chronic kidney disease and mortality among patients hospitalized with congestive heart failure
AU - Hedayati, S. Susan
AU - Jiang, Wei
AU - O'Connor, Christopher M.
AU - Kuchibhatla, Maragatha
AU - Krishnan, K. Ranga
AU - Cuffe, Michael S.
AU - Blazing, Michael A.
AU - Szczech, Lynda A.
N1 - Funding Information:
Supported in part by a fellowship grant from the Agency for Health Care, Research and Quality (S.S.H.); and grant no. DK02724-01A1 from The National Institutes of Health (L.A.S.). M.A.B. receives honoraria from Merck and Pfizer.
PY - 2004/8
Y1 - 2004/8
N2 - Background: The point prevalence of depression and its relationship to poor outcomes among patients with chronic kidney disease (CKD) has not been fully characterized. Methods: We performed a secondary analysis of a prospective cohort of 374 patients admitted with congestive heart failure between March 1, 1997 and June 30, 1998, to investigate the point prevalence of depression among patients with CKD and its association with mortality. The Beck Depression Inventory (BDI) was administered to all patients. Those who scored 10 or higher were administered the National Institute of Mental Health Diagnostic Interview Schedule (DIS). Logistic regression was used to examine the association between severe CKD, corresponding to a creatinine clearance less than 30 mL/min/72 kg (<0.50 mL/s/72 kg), depression, and mortality at 1 year. Results: Point prevalences of depressive symptoms by BDI and major depression by DIS were 54.8% and 21.6% if severe CKD was present and 32.8% and 13.0% if severe CKD was absent, respectively. After controlling for important clinical factors, severe CKD was associated with depressive symptoms by BDI (odds ratio, 2.89; 95% confidence interval, 1.39 to 5.99). Both depression by DIS and severe CKD were significant predictors of mortality. The increased mortality risk associated with depression did not decline with decreasing kidney function. Conclusion: Depression was more prevalent among patients with than without severe CKD and had at least as strong an association with mortality as compared with depression in patients with no or less severe CKD. The point prevalence of depression decreased when the DIS interview was used, perhaps related to the presence of somatic measures on the BDI reflecting uremia. Studies assessing the efficacy of antidepressants among patients with CKD are needed to determine whether, in addition to treating depression, pharmacotherapy impacts mortality.
AB - Background: The point prevalence of depression and its relationship to poor outcomes among patients with chronic kidney disease (CKD) has not been fully characterized. Methods: We performed a secondary analysis of a prospective cohort of 374 patients admitted with congestive heart failure between March 1, 1997 and June 30, 1998, to investigate the point prevalence of depression among patients with CKD and its association with mortality. The Beck Depression Inventory (BDI) was administered to all patients. Those who scored 10 or higher were administered the National Institute of Mental Health Diagnostic Interview Schedule (DIS). Logistic regression was used to examine the association between severe CKD, corresponding to a creatinine clearance less than 30 mL/min/72 kg (<0.50 mL/s/72 kg), depression, and mortality at 1 year. Results: Point prevalences of depressive symptoms by BDI and major depression by DIS were 54.8% and 21.6% if severe CKD was present and 32.8% and 13.0% if severe CKD was absent, respectively. After controlling for important clinical factors, severe CKD was associated with depressive symptoms by BDI (odds ratio, 2.89; 95% confidence interval, 1.39 to 5.99). Both depression by DIS and severe CKD were significant predictors of mortality. The increased mortality risk associated with depression did not decline with decreasing kidney function. Conclusion: Depression was more prevalent among patients with than without severe CKD and had at least as strong an association with mortality as compared with depression in patients with no or less severe CKD. The point prevalence of depression decreased when the DIS interview was used, perhaps related to the presence of somatic measures on the BDI reflecting uremia. Studies assessing the efficacy of antidepressants among patients with CKD are needed to determine whether, in addition to treating depression, pharmacotherapy impacts mortality.
KW - Beck Depression Inventory (BDI)
KW - Depression
KW - National Institute of Mental Health Diagnostic Interview Schedule (DIS)
KW - chronic kidney disease (CKD)
KW - congestive heart failure (CHF)
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U2 - 10.1053/j.ajkd.2004.04.025
DO - 10.1053/j.ajkd.2004.04.025
M3 - Article
C2 - 15264178
AN - SCOPUS:3242739578
SN - 0272-6386
VL - 44
SP - 207
EP - 215
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 2
ER -