Drug treatment ineffective in reducing mortality risk of patients with CKD, depression
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Key takeaways:
- Patients with chronic kidney disease diagnosed with depression face adverse health risks.
- Antidepressants did not reduce the risks that patients faced during the study.
Patients with chronic kidney disease who received medication to treat their depression did not see a reduction in adverse health risks for hospitalizations and mortality, a recently published study shows.
“The extent to which depression affects the progression of chronic kidney disease (CKD) and leads to adverse clinical outcomes remains inadequately understood,” Rosalba Hernandez, PhD, of the College of Nursing, University of Illinois, and colleagues wrote.
The authors wrote that depressive symptoms (DS) “are common in adults with non-dialysis-dependent [CKD] with an estimated prevalence in the range of 15% to [greater than] 50%.
“Despite this high prevalence, limited available data suggest that only a small fraction of patients with CKD are screened for depression,” the authors wrote, “and even fewer receive depression treatment.”
Researchers reviewed records of 4,839 adults with CKD who participated in the multicenter Chronic Renal Insufficiency Cohort Study (CRIC) and used the Beck Depression Inventory to quantify DS. “Antidepressant use was identified from medication bottles and prescription lists,” the authors wrote.
Data from the CRIC study showed 27.4% of adults with CKD had elevated DS at baseline, but only 31% of them were prescribed antidepressant medication.
Upon examination, “elevated DS at baseline were associated with significantly greater risk for an incident cardiovascular disease event, hospitalization and all-cause mortality, but not CKD progression, adjusted for antidepressants,” the authors wrote.
When reviewing the medical records comparing participants without elevated DS and not using antidepressants, patients on antidepressants showed higher risks for hospitalization and all-cause mortality. “Elevated DS posed a significant risk to non-dialysis CKD patients, and antidepressants did not mitigate this risk,” the authors wrote.
The study had some limitations, the authors wrote, including “the inability to make inferences regarding causality among depressive symptoms, antidepressant medication use and adverse outcomes. Moreover, despite robust adjustment for other important factors, we cannot exclude the possibility for residual confounding.”
The CRIC study also did not include information on nonpharmacological approaches to depression treatment, “so we are unable to account for its potential role. Although we were able to identify the presence of antidepressants, we cannot confirm their indication and extent of treatment compliance,” the authors added.
“Our results underscore the substantial negative impact of depression on adults with CKD,” the authors concluded. “Given the lack of apparent benefit of antidepressants in adults with depression and non-dialysis CKD, these results inform the need not only to further investigate the role of antidepressants in this population but also to further evaluate alternative treatment options, especially nonpharmacologic treatments.”
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