Depression Diagnoses After Living Kidney Donation

Abstract

Background Limited data exist on correlates of psychological outcomes after kidney donation. Methods We used a database integrating OPTN registrations for 4,650 living kidney donors in 1987–2007 with administrative data of a U.S. private health insurer (2000–2007 claims) to identify depression diagnoses among prior living donors. The burden and demographic correlates of depression after enrollment in the insurance plan were estimated by Cox’s regression. Graft failure and death of the donor’s recipient were examined as time-varying exposures. Results After start of insurance benefits, the cumulative frequency of depression diagnosis was 4.2% at one-year and 11.5% at five years, and was less common than among age-and-gender matched general insurance beneficiaries (rate ratio 0.70, 95% CI 0.60–0.81). Demographic and clinical correlates of increased likelihood of depression diagnoses among the prior donors included female gender, white race and some perioperative complications. After adjustment for donor demographic factors, recipient death (aHR 2.23, 95% CI 1.11–4.48) and death-censored graft failure (aHR 3.30, 95% CI 1.49–7.34) were associated with two-to-three times the relative risk of subsequent depression diagnosis among non-spousal unrelated donors. There were trends towards increased depression diagnoses after recipient death and graft failure among spousal donors, but no evidence of associations of these recipient events with the likelihood of depression diagnosis among related donors. Conclusions Recipient death and graft loss predict increased depression risk among unrelated living donors in this privately-insured sample. Informed consent and post-donation care should consider the potential impact of recipient outcomes on the psychological health of the donor.

Emotional Well-Being of Living Kidney Donors: Findings From the RELIVE Study

“…Unlike our findings, Lentine et al, utilizing donor billing data to identify antidepressant use as an indicator of depressive symptomatology (6), reported higher rates of depression in US white donors. Qualitative research and retrospective studies note an association between recipient outcomes and adverse emotional outcomes from donation (12).…”

The Outcomes of Living Kidney Donation from Medically Complex Donors: Implications for the Donor and the Recipient

“…Additional studies corroborate overall favorable long-term outcomes for kidney donors [6, 17–20], suggesting that donation does not introduce substantial kidney-specific morbidity such as ESRD, hypertension, proteinuria, or anemia [20, 21], depression [22] or malignancy [23]. With the evolution in surgical techniques for donor nephrectomy [24], perioperative outcomes are excellent [6, 20, 25–29] and continue to improve, despite increasing donor comorbidity [29].…”

Gender differences in use of prescription narcotic medications among living kidney donors

“…As previously stated, women have been shown to experience higher risks of chronic medical and co-morbid mood disorders which may increase risks of chronic pain, more severe pain, and more disability due to pain (29,30,32,49). Using similar methodology, we previously reported that female donors were more than twice as likely as male donors to be diagnosed with depression after donation (aHR 2.41; 95% CI 1.89–3.06) (37). In the current study, psychiatric conditions, such as depression or anxiety, were among the top 20 most common primary diagnoses in the 7 days preceding narcotic prescription fills among female donors and non-donors, and also among male donors, although these conditions comprised <2% of the primary diagnoses preceding narcotic medication use.…”

“…For example, we previously found that post-donation depression, defined by a clinical diagnosis or use of an anti-depressant medication, was more than twice as likely among female donors compared to male donors (adjusted hazard ratio, aHR, 2.41), white donors compared to non-white donors (aHR 2.07), and those who experienced peri-operative complications compared to those who did not (aHR 2.46) (37). …”