Depression in Patients with End-Stage Renal Disease Treated with Dialysis

Abstract

The World Health Organization has highlighted depression as the second most common and economically costly chronic disease that will affect nonmedically ill people globally over the next decades (1). Depression in patients with another medical or psychiatric illness, or “compound depression,” is typically of greater intensity and more difficult to treat than depression occurring in patients without other underlying disorders (2–6). Depression has been identified as the most common psychiatric illness in patients with end-stage renal disease (ESRD), but its prevalence has varied widely in different studies, in different populations, using different assessment tools (2,3,7). Among the difficulties in evaluating the data has been the wide variety of assessment tools used to quantify depressive affect and for establishing the diagnosis of depression in patients with and without medical illness. Depression is characterized by both cognitive and somatic features. The somatic characteristics of depression have an uncanny similarity to the symptoms of uremia, such as anorexia, sleep disturbances, fatigue, gastrointestinal disorders, aspects of volume overload, and pain (3,7–9). These similarities make the determination of the role of an association between depression and mortality potentially problematic (3,8,9). Depression might mediate differential outcome in patients with chronic medical illnesses through effects on the underlying disease, compliance, nutrition, immune status, through marital and family dynamics, or through differential access to care (3,8,9). The association between depression and outcome in ESRD patients treated with dialysis has also been controversial. We showed that depression was associated with hospitalization in a substantial proportion of patients participating in the US ESRD Medicare program in 1993 (10). While early studies seemed to demonstrate a clear relationship between depression and mortality in patients treated with hemodialysis, more contemporary studies were unable …