Approaches to the identification and management of depression in people living with chronic kidney disease: A scoping review of 860 papers

Abstract

Background: Depression is prevalent across the spectrum of Chronic Kidney Disease and associated with poorer outcomes. There is limited evidence regarding the most effective interventions and care pathways for depression in Chronic Kidney Disease.Objectives: To investigate how depression is identified and managed in adults with Chronic Kidney Disease.Design: Scoping review.Methods: Systematic search of eight databases with pre-defined inclusion criteria.Data relevant to the identification and/or management of depression in adults with Chronic Kidney Disease were extracted.Results: Of 2147 articles identified, 860 were included. Depression was most identified using self-report screening tools (n = 716 studies, 85.3%), with versions of the Beck Depression Inventory (n = 283, 33.7%) being the most common. A total of 123 studies included data on the management of depression, with nonpharmacological interventions being more frequently studied (n = 55, 45%). Cognitive Behavioural Therapy (n = 15) was the most common nonpharmacological intervention, which was found to have a significant effect on depressive symptoms compared to controls (n = 10). However, how such approaches could be implemented as part of routine care was not clear. There was limited evidence for antidepressants use in people with Chronic Kidney Disease albeit in a limited number of studies.

Organisational behaviour

“…This extends to communication with GPs, who appear to manage the prescription and monitoring of antidepressants according to centres. Since evidence for antidepressants in people with CKD is inconclusive and adverse events are common, continued monitoring is vital (Chilcot & Farrington, 2019;Friedli et al, 2017;Hedayati et al, 2017;Pearce et al, 2023). Integrated psychosocial pathways should therefore incorporate GPs, navigating care to kidney psychosocial teams and general hospital liaison psychiatry (Coyne & Fretwell, 2022).…”

“…Although not specific to the complexities and needs of people with CKD, these general guidelines advise that the choice of intervention should be influenced by, among other things, the likelihood of adherence to treatment and any potential adverse effects. This may be particularly relevant when considering antidepressant use in those with CKD (Guirguis et al, 2020) especially given the paucity of evidence relating to the management of depression in this population and the increased propensity for adverse drug reactions (Chilcot & Hudson, 2019;Natale et al, 2019;Pearce et al, 2023). Currently, little is known about how these NICE guidelines are adhered to as part of UK kidney care.…”

Depression among Patients with an Implanted Left Ventricular Assist Device: Uncovering Pathophysiological Mechanisms and Implications for Patient Care

“…Moreover, precipitating factors, such as chronic somatic illness, emotional stressors, or a family member's illness or death, may occasionally precede the onset of depression. Importantly, many chronic medical diseases have been suggested as possible causes leading to the development of depression, including cardiovascular disorders [25,26], metabolic ailments (e.g., diabetes mellitus and obesity) [27,28], chronic kidney disease [29], (post-) stroke events [30,31], and other neurological illnesses [32,33], among others.…”