The negative impact of depressive symptoms on patient and technique survival in peritoneal dialysis: a prospective cohort study.

Abstract

The relationship between depression and long-term clinical outcomes in peritoneal dialysis is unclear. This study was to explore the effect of depressive symptoms on patient survival and technique survival in continuous ambulatory peritoneal dialysis (CAPD) patients. Patients who had received CAPD therapy for ≥ 3months were recruited from January to June, 2009, with follow-up until June, 2019. The Beck Depression Inventory-II (BDI-II) was used to evaluate depressive symptoms (BDI scores ≥ 14) at baseline. The primary outcome was all-cause mortality, and the secondary outcome was technique failure. Participants were 275 CAPD patients (mean age 49.6 ± 15.9years, male 54.2%). Of these, 86 (31.3%) experienced depressive symptoms. The depressive group had fewer males, longer PD duration at enrollment, higher calcium levels, and lower residual glomerular filtration rates (all P < 0.05) than the non-depressive group. Long-term patient survival (P = 0.037) and technique survival (P = 0.003) were significantly poorer in depressive group than in non-depressive group. After adjustment for confounders in multivariate Cox proportional hazard regression models, depressive symptoms remained independent predictors of mortality risk [hazard ratio (HR) 1.60, 95% confidence interval (CI) 1.03-2.48; P = 0.035] and technique failure (HR 1.92, 95% CI 1.07-3.47; P = 0.029). The prevalence of patients with depressive symptoms was 31.3% in this cohort. The patient survival rate and technique survival rate in depressive group were lower than in non-depressive group. Depressive symptoms were independent risk factors for long-term mortality and technique failure in CAPD patients.