New initiative will bring treatment of depression into dialysis units
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Key takeaways:
- This project will offer treatment inside dialysis units with therapy and antidepressants.
- The approach could help overcome the inaccessibility of depression treatment for patients on dialysis.
A new initiative seeks to offer treatment for depression inside the dialysis clinic for patients with both conditions. The program will launch in February of 2024 across four states.
Funded by a $2 million award from the Patient-Centered Outcomes Research Institute, the initiative will bring talk therapy and antidepressants into dozens of dialysis units, and then have clinicians take notes on how the process benefits patients.
After 3 years, the goal is to come away with “lessons to be learned for the entire dialysis industry,” Rajnish Mehrotra, MD, MS, the leader of the project and head of the nephrology division at the University of Washington, told Healio.
“What we are trying to do is to implement an approach for detecting and treating depression in dialysis units that is actionable, that is scalable to make treatment available, that is effective to large populations of patients,” Mehrotra said.
ASCEND study
During the initiative, patients in dialysis units will be screened for depression and offered either cognitive behavioral therapy (CBT) — delivered in-unit via telehealth — or a prescription for the antidepressant sertraline. A 2019 study led by Mehrotra, called ASCEND, found both treatments were equally effective for patients receiving in-center dialysis.
That multicenter study of 184 patients on dialysis found that both treatments reduced depression symptoms after 12 weeks. Dialysis attendance was similar between patients on either treatment, though patients on sertraline scored better on quality of life (QoL) surveys.
The two different treatments allow patients some choice in how they address their symptoms, Mehrotra said. Participating in a virtual session of CBT while visiting a dialysis unit will come with some privacy compromises, but for some patients, that may be preferable to adding another pill to their already extensive regimens.
“That is a personal decision for an individual to make, and we’ll learn a lot of lessons along the way in terms of the choices people make, for us then to propose a scalable model,” he said.
Satellite Healthcare manages all 87 dialysis units being used in the initiative and has provided “support from the highest level,” Mehrotra said. Dialysis unit workers will receive training in depression treatment as part of the initiative, which will also deploy a “depression module” in Satellite’s electronic health records to track depression management “in real-time,” according to the project summary.
Bringing treatments directly to the patients could solve what Mehrotra described as a bottleneck that can prevent the sometimes debilitating symptoms of depression from being addressed.
Patients going into a dialysis unit multiple times a week may be reluctant to also visit a therapist, and those visits may not be covered by insurance, Mehrotra said, adding that “many nephrologists feel uncomfortable” prescribing antidepressants, wary of stepping beyond their scope of practice.
“Even if [depression] is detected, oftentimes it’s like, ‘Oh, too bad. Let me find someone who can help you,’” Mehrotra said. “And more often than not, that treatment’s not available.”
Potential growth
Mehrotra expects the initiative to possibly reach as many as 15,000 patients in 3 years. Surveys and interviews of patients, social workers and clinicians will assess the acceptability of treatment and effectiveness of training. Measures of success will include the following:
- percentage of eligible patients screened, diagnosed and treated;
- percentage of dialysis units that screen more than 90% of eligible patients and treat more than 75% of positive-screened patients; and
- percentage of treated patients with more than 50% improvement in depressive symptoms, QoL scores and increased adherence to dialysis treatments.
Patients on dialysis have indicated that depression is “a high priority area for them to get relief from” during prioritization exercises, Mehrotra said. Depression has “far-reaching consequences” on patients’ health and well-being and makes it harder to take many pills, obey dietary restrictions and show up for one dialysis appointment after another, he said.
“Putting it all together: [There is a] high symptom burden, patients want relief, depression is treatable. It’s just that treatments are inaccessible,” Mehrotra said. “It makes sense for us to take this next step.” – by Justin Cooper
References:
Implementing treatments for depression for patients undergoing long-term dialysis. https://www.pcori.org/research-results/2023/implementing-treatments-depression-patients-undergoing-long-term-dialysis. Published July 18, 2023. Accessed July 28, 2023.
Ma TK, et al. Nephrology. 2016;doi:10.1111/nep.12742.
Mehrotra R, et al. Ann Int. Med. https://www.pcori.org/research-results/2014/comparing-two-treatments-depression-among-patients-kidney-failure-receiving-hemodialysis-ascend-study. Published Jan. 20, 2023. Accessed July 28, 2023
For more information:
Rajnish Mehrotra, MD, MS, can be reached at rmehrotra@nephrology.washington.edu.
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