#5293 THE IMPACT OF SEVERE DEPRESSION ON THE SURVIVAL OF OLDER PATIENTS WITH END-STAGE KIDNEY DISEASE

Abstract

Abstract Background and Aims Incidence of depression increases in patients with end-stage kidney disease (ESKD). We evaluated the association between depression and mortality among older patients with ESKD, which has not been studied previously. Method This nationwide prospective cohort study included 487 patients with ESKD aged > 65 years, who were categorized into minimal, mild-to-moderate, and severe depression groups based on their Beck Depression Inventory-II (BDI-II) scores. BDI-II scores were separated into three symptom domains: affective, cognitive, and somatic depressive symptoms. The association between the depression groups and survival were analyzed using multivariate Cox proportional hazard regression models. Predisposing factors for high BDI-II scores were evaluated using logistic regression analysis. The associations among the three depressive-symptom domains and survival were also analyzed. Results The severe depression group showed a higher modified Charlson comorbidity index value and lower serum albumin, phosphate, and uric acid levels than the other depression groups. The Kaplan–Meier curve revealed a significantly lower survival in the severe depression group than in the minimal and mild-to-moderate depression groups (P = 0.011). Multivariate Cox regression analysis confirmed that severe depression was an independent risk factor for mortality in the study cohort [hazard ratio (HR), 1.39; 95% confidence interval (CI), 1.01–1.91; P = 0.041). BDI-II scores were associated with modified Charlson comorbidity index (P = 0.009) and serum albumin level (P = 0.004) in multivariate linear regression. Among the three depressive symptoms, higher somatic symptom scores were associated with increased mortality (HR, 2.45; 95% CI, 1.25–4.79; P = 0.009). Conclusion Among older patients with ESKD, severe depression increases mortality compared with minimal or mild-to-moderate depression. And patients with concomitant somatic symptoms require careful management of their comorbidities and nutritional status.