Depressive affect in incident hemodialysis patients

McDougall, Kathryn; Larkin, John; Wingard, Rebecca L.; Jiao, Yanmei; Rosen, Sophia; Ma, Lin; Usvyat, Len; Maddux, Franklin W.

doi:10.1093/ckj/sfx054

Cited by 7 publications

(3 citation statements)

References 31 publications

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“…Depression has been consistently associated with increased mortality risk among patients receiving dialysis [3], but whether depression is associated with cardiovascular/infection events in these patients has not been well explored. Previous studies show inconsistencies in the association of depression with adverse outcomes [5, 16–20], often hampered by small sample sizes, outcome ascertainment bias, inadequate adjustment for confounding variables and short-term follow-up.…”

Section: Introductionmentioning

confidence: 99%

Depression amongst patients commencing maintenance dialysis is associated with increased risk of death and severe infections: A nationwide cohort study

Lin

Huang

et al. 2019

PLoS ONE

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Background Depression is common in dialysis patients, but the clinical impact of this condition is poorly defined. Methods Out of 57,703 patients starting dialysis during 2000–2007 recorded in the National Health Insurance Research Database of Taiwan, we identified 2,475 patients with a clinical diagnosis of depression, and compared them with 1:5 age- and sex-matched patients without a depression diagnosis (n = 12,375). Patients were followed up for hospitalisation due to severe infections, major adverse cardiovascular events (MACE) and death. Multivariable Cox regression and competing risk analyses (accounting for death when appropriate) were used to estimate risk associations. Results Patients with depression had a higher frequency of comorbidities. During a mean follow-up of 3.2 years, 1,140 severe infections, 806 MACE, and 1,121 deaths were recorded. Compared to controls, patients with depression were at increased risk of death (adjusted hazard ratio 1.24; 95%CI 1.16–1.33). Patients with depression were also at higher risk of severe (1.14; 1.06–1.22) and fatal infections (death within 30 days, 1.22; 1.09–1.35), attributed mainly to sepsis (1.19; 1.08–1.31), septic shock (1.36; 1.13–1.62) and pneumonia (1.19; 1.07–1.33). Conversely, no association was observed between depression and the MACE risk (1.04; 0.94–1.15). Conclusion Dialysis patients with depression are associated with increased risk of infections and death.

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Section: Introductionmentioning

confidence: 99%

Depression amongst patients commencing maintenance dialysis is associated with increased risk of death and severe infections: A nationwide cohort study

Lin

Huang

et al. 2019

PLoS ONE

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“…In addition to the KDQOL we also employed the PHQ-2 which is a self-administered questionnaire that is specifically made for assessing depression severity (17), but has been validated for hemodialysis patients (18).…”

Section: Methodsmentioning

confidence: 99%

Mental Effects of Excess Parathyroid Hormone in Hemodialysis Patients: A Possible Role for Parathyroid 2 Hormone Receptor?

Diskin

2019

Ther Apher Dial

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Depression as measured by the kidney disease quality of life (KDQOL) form is known to be an independent risk factor for mortality dialysis patients. Excess parathyroid hormone (PTH) has long been associated with neuropsychiatric disturbances. Those psychiatric complications are currently attributed to hypercalcemia with very little evidence; however, with the discovery of the parathyroid hormone 2 receptor (PTH2R) in the brain which can be activated by PTH, PTH2R might indicate a direct effect of PTH. As secondary and tertiary hyperparathyroidism is common in dialysis patients where the serum calcium is low or normal, we chose to investigate a possible relationship between PTH levels and depression in dialysis patients. This was a matched pair observational study with 10 patients with intact PTH values above 1000 pg/mL who were matched with 10 patients who had PTH values less than 400 pg/mL for the presence of diabetes, years on dialysis, duration of dialysis time, Kt/V, hemoglobin, and 25 OH vitamin D levels, as well as intravenous iron and erythropoietin administration. The Kidney Disease Quality of Life questionnaire (KDQOL-36) scores and patient Health Questionnaire scores were analyzed during that time. All variables underwent tests for normality and matched pair t-test. All subscales of the KDQOL-36 were worse in the high PTH group with the effect on daily life reaching P = 0.01 and the burden of disease and symptoms both reaching P = 0.02. PTH and PTH2R may be appropriate targets for investigations to improve the quality of life in hemodialysis patients.

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“…Ravaghi et al [ 3 ] found that the prevalence of depression among MHD patients in Iran was estimated to be 62%, and a South Korean study reported that moderate to severe depression is common in MHD patients and is associated with health-related quality of life [ 4 ]. Depression increases the rate of hospital admissions, the duration of hospitalization, and the risk of death in patients undergoing MHD [ 5 – 7 ].…”

Section: Introductionmentioning

confidence: 99%

High neutrophil-to-lymphocyte ratio is a significant predictor of depressive symptoms in maintenance hemodialysis patients: a cross-sectional study

Feng

et al. 2022

BMC Psychiatry

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Background Depression is one of the most important psychiatric disorders in chronic kidney disease patients who undergo maintenance hemodialysis (MHD). Previous studies have shown that low-grade inflammation is involved in the progression of depressive symptoms. The neutrophil-to-lymphocyte ratio (NLR) is an inflammatory marker that is inexpensive and easy to measure. However, the association between NLR and depression symptoms in MHD patients has not been examined. Methods In this single-center, cross-sectional study, we included 160 patients undergoing MHD. The Patient Health Questionnaire-9 (PHQ-9) was used to assess depressive symptoms. NLR was calculated as the ratio of neutrophils to lymphocytes. Multinomial logistic regression and multivariate linear regression analyses were used to examine the association between NLR and depressive symptoms in MHD patients. Results Depressive symptoms were detected in 36.7% of the 160 MHD patients. Multinomial logistic regression showed that NLR was a significant predictor of mild (odds ratio [OR]: 1.383, 95% confidence interval [CI]: 1.015–1.884, p = 0.04) and moderate/moderately severe depressive symptoms (OR: 1.441, 95% CI: 1.017–2.042, p = 0.04) in MHD patients, adjusted for age, sex, Kt/V, dialysis duration, history of kidney transplantation, history of hypertension, and Charlson comorbidity index score. In addition, multivariate linear regression analysis showed that NLR was an independent influencing factor for PHQ-9 score in MHD patients, after adjusting for confounding factors. Conclusions These findings suggest that NLR can be used as a biomarker for predicting depressive symptoms in MHD patients.

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Depressive affect in incident hemodialysis patients

Cited by 7 publications

References 31 publications

Depression amongst patients commencing maintenance dialysis is associated with increased risk of death and severe infections: A nationwide cohort study

Depression amongst patients commencing maintenance dialysis is associated with increased risk of death and severe infections: A nationwide cohort study

Mental Effects of Excess Parathyroid Hormone in Hemodialysis Patients: A Possible Role for Parathyroid 2 Hormone Receptor?

High neutrophil-to-lymphocyte ratio is a significant predictor of depressive symptoms in maintenance hemodialysis patients: a cross-sectional study

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