Anemia, uremic symptoms, poor dialysis may trigger depression in patients with ESKD
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Key takeaways:
- Numerous conditions can lead to depression in patients with advanced chronic kidney disease.
- Patients should be given the option of either drug therapy or “talk therapy” for treating their depression.
AUSTIN, Texas — Patients on dialysis face a host of issues that may lead to long-term depression and jeopardize their chances of getting a transplant, a speaker said here.
Those conditions can include anemia, dialysis inadequacy and uremic symptoms for patients with advanced chronic kidney disease before initiating dialysis, Susan Hedayati, MD, MHSc, who gave the Shaul G. Massry Distinguished Lecture at the National Kidney Foundation Spring Clinical Meetings, said.
Comorbidities that can influence depression include sleep apnea, thyroid disease, poor nutrition and a lack of physical activity, she said.
Drug therapy to treat depression can have some adverse events, Hedayati said; patients with advanced CKD and end-stage kidney disease on antidepressants have been “systematically excluded from large, multicenter, randomized clinical trials of depression treatment due to concerns for safety and adverse events,” Hedayati, the associate vice chair for research in the department of internal medicine, director for clinical and translational research in nephrology and co-director of the O’Brien Kidney Clinical and Translational Core at the University of Texas Southwestern Medical Center, said. “This is because a lot of antidepressant medications are associated with potential adverse events in a setting of CKD and a reduced GFR.”
One class of antidepressants that commonly cause adverse events for patients with CKD, Hedayati said, are serotonin reuptake inhibitors. “This class of drugs is notorious for causing GI upset – nausea and vomiting – in the general population, let alone patients with uremia who are already enduring those symptoms,” she said.
Group therapy
Some patients with advanced CKD or with ESKD can benefit from group cognitive behavioral therapy (CBT) for their depression, Hedayati said. Among 85 patients in a study that involved CBT for 12 weekly sessions for 3 months, results showed patients had more improvement in Beck Depression Inventory (BDI) scores after receiving CBT compared with controls. “At 9 months, the decrease in depressive symptoms was higher compared to controls,” Hedayati said, although patients in both groups showed some improvement in BDI scores.
Another study using therapy administered by social workers while patients received dialysis treatment showed improvement during CBT. “There was also a significant treatment effect in improving intradialytic weight gain during CBT. But once CBT ended, that treatment effect did not last,” she said.
Hedayati said it is not always clear whether patients diagnosed with depression would prefer drug therapy or options like group therapy for treatment. In a survey of patient preferences done by Rajnish Mehrotra, MD, MS, at the University of Washington Seattle, Hedayati said patient views were split on the two options. “The reasons for that were, patients were like, ‘You know, I already spend so much time on dialysis or going to different clinics for my other comorbid conditions; I don’t want to spend anymore time talking to other health care providers about anything,’” Hedayati said. “And the people that picked talk therapy said they did not want another medication to add to a concomitant medications [list] they were already on for treatment.
“Until more data become available [on the best therapy], both options should be presented to the patient,” Hedayati said.
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