Depressive symptoms reported within the first 90 days of hemodialysis (HD) initiation were associated with a higher risk of mortality and dialysis withdrawal over the coming year, according to a study published online ahead of print by Nephrology Dialysis Transplantation.
A one-point increase in depression score was linked to an adjusted hazard ratio of 1.08 for mortality and 1.19 for dialysis withdrawal, reported the researchers, who were led by Eduardo Lacson Jr., MD, of Fresenius Medical Care North America.
“[T]he early period immediately after initiating dialysis has been identified as one of the highest risk for death and hospitalization,” Dr. Lacson and colleagues wrote. “Our findings support the notion that depressive symptoms may contribute, at least in part, to the burden of illness in these incident HD patients.”
The study evaluated responses to two Medical Outcomes Study Short Form-36 questions associated with depressive symptoms: “Have you felt so down in the dumps nothing could cheer you up?” and “Have you felt downhearted and blue?”.
In the study cohort of 6,415 patients admitted to Fresenius facilities between Jan. 1, 2006, and Dec. 31, 2006, there were 784 deaths (12.2%) and 285 dialysis withdrawals (4.4%) during the yearlong follow-up period.
Frequent depressive symptoms were reported in 14.1% of patients for the down-in-the-dumps question, 16.1% for the downhearted-and-blue question, and 20.8% for either question. Patients with frequent depressive symptoms reported slightly lower physical component score and much lower mental component score, were younger, and had lower serum albumin and creatinine.
The combined category for the two questions had an unadjusted mortality hazard ratio of 1.24, case-mix adjusted hazard ratio of 1.36, and case-mix plus laboratory adjusted hazard ratio of 1.32. The hazard ratios for withdrawal from dialysis were 1.37, 1.56, and 1.62, respectively.
However, with the inclusion of mental component score in the models, the depressive symptoms variable lost statistical significance.
“Whether further evaluation for and treatment of depression during this early vulnerable period may improve symptoms, increase survival, and decrease premature withdrawal from dialysis requires confirmation in prospective clinical trials,” Dr. Lacson and colleagues wrote.