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Dialysis and depression

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Death or hospitalization of patients on chronic hemodialysis is associated with a physician-based diagnosis of depression

From: Kidney International (2008) 74, 930–936

Another study that appears well designed showing that dialysis patients have increased health complications or death if they have depression. This study used the gold standard diagnostic evaluation tool - the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, which was performed by a physician. The overall rate of hospitalization or death was about twice as high in those individuals diagnosed with depression compared to those without the diagnosis, even after corrections were made for confounding factors such as age, race, sex, years on dialysis, and number of comorbidities.

Previous studies have shown similar outcomes but people were screened for depression with self-report rating scales as opposed to a physician evaluation. Depression is very common in individuals receiving dialysis, as are symptoms similar to depression (fatigue, lack of appetite, and sleep disturbances). Clearly there is an increased risk of hospitalization (which comprised most of the increased episodes as opposed to death) in individuals who meet full diagnostic criteria for depression.

Additional studies need to be conducted to better understand this association and see if treatment of depression can reverse the trend.