Abstract
Depression and anxiety are the most common psychiatric disorders in end-stage renal disease (ESRD) patients treated with hemodialysis (HD) and may correlate with lower quality of life and increased mortality. Depression treatment in HD patients is still a challenge both for nephrologists and psychiatrists. The possible treatment of depressive disorders can be pharmacological and non-pharmacological. In our article, we focus on the use of sertraline, the medication which seems to be relatively safe and efficient in the abovementioned population, taking under consideration several limitations regarding the use of other selective serotonin reuptake inhibitors (SSRIs). In our paper, we discuss different aspects of sertraline use, taking into consideration possible benefits and side effects of drug administration like impact on QTc (corrected QT interval) prolongation, intradialytic hypotension (IDH), chronic kidney disease-associated pruritus (CKD-aP), bleeding, sexual functions, inflammation, or fracture risk. Before administering the medication, one should consider benefits and possible side effects, which are particularly significant in the treatment of ESRD patients; this could help to optimize clinical outcomes. Sertraline seems to be safe in the HD population when provided in proper doses. However, we still need more studies in this field since the ones performed so far were usually based on small samples and lacked placebo control.
Highlights
Depression and anxiety are the most common psychiatric disorders in end-stage renal disease (ESRD) patients treated with hemodialysis (HD)
As initiation of dialysis is a large change in everyday functioning with a potential to induce or worsen psychiatric symptoms, screening for depression [9] and anxiety is suggested at the beginning of renal replacement treatment
We focus on the use of sertraline due to several limitations regarding the use of other selective serotonin reuptake inhibitors (SSRIs) in ESRD patients
Summary
Depression and anxiety are the most common psychiatric disorders in end-stage renal disease (ESRD) patients treated with hemodialysis (HD). Their prevalence is increasing in recent years [1], reaching the rate of 20–40% for depression [2,3] and 20–52% for anxiety [4], depending on the methodological approach. Despite the number of studies on this issue, major depressive disorder (MDD) in ESRD patients is still underdiagnosed, and its treatment is not optimal [6] [Table 1]. As initiation of dialysis is a large change in everyday functioning with a potential to induce or worsen psychiatric symptoms, screening for depression [9] and anxiety is suggested at the beginning of renal replacement treatment
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