Depression Symptoms in Haemodialysis Patients Predict All-Cause Mortality but Not Kidney Transplantation: A Cause-Specif
- PDF / 526,453 Bytes
- 8 Pages / 595.276 x 790.866 pts Page_size
- 8 Downloads / 215 Views
ORIGINAL ARTICLE
Depression Symptoms in Haemodialysis Patients Predict All-Cause Mortality but Not Kidney Transplantation: A Cause-Specific Outcome Analysis Joseph Chilcot, PhD 1 & Ayman Guirguis, MRCPsych 2,3,4 & Karin Friedli, PhD 5 & Michael Almond, DM FRCP 6 & Clara Day, PhD FRCP 7 & Maria Da Silva-Gane, MSc 2,5 & Andrew Davenport, MD FRCP 8 & Naomi A. Fineberg, MRCPsych 3,4 & Benjamin Spencer, MRCPsych 9,10 & David Wellsted, PhD 3 & Ken Farrington, MD FRCP 2,4
# The Author(s) 2017. This article is an open access publication
Abstract Background Depression is common in haemodialysis (HD) patients and associated with poor outcomes. Purpose To evaluate whether depression symptoms predict survival and transplantation in a large sample of haemodialysis patients using cause-specific survival models. Methods Survival data was collected between April 2013 and November 2015, as part of the screening phase of a multicentre randomised placebo-controlled trial of sertraline in HD patients. Depression was measured using the Beck Depression Inventory-II (BDI-II) and the Patient Health Questionnaire-9 (PHQ-9). Demographic and clinical data were collected via a self-report questionnaire and medical records. Competing risk survival analysis involved causespecific and subdistribution hazard survival models. All models were adjusted for appropriate covariates including comorbidity and C-reactive protein (CRP) in a subanalysis.
Results Of 707 cases available for analysis, there were 148 deaths. The mean survival time was 787.5 days. Cumulative survival at 12 months was 88.5%. During the study follow-up period, there were 92 transplants. The cumulative transplant event rate at 12 months was 7.8%. In separate adjusted models, depression symptoms predicted mortality (BDI-II HR = 1.03 95% CI 1.01, 1.04; PHQ-9 HR = 1.04 95% CI 1.01, 1.06). With respect to screening cut-off scores, a PHQ9 ≥ 10 was associated with mortality (HR = 1.51 95% CI 1.01, 2.19) but not a BDI-II ≥ 16. Depression symptoms were not associated with time to transplantation in either cause-specific or subdistribution model. Conclusions Consistent with past findings in HD patients, depression symptoms predicted survival but were not associated with kidney transplantation. Suitable treatments for depression need further evaluation, and their impact upon quality of life and clinical outcomes determined.
* Joseph Chilcot [email protected]
5
Centre for Lifespan and Chronic Illness Research, Department of Psychology, School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield AL10 9AB, UK
6
Southend University Hospital NHS Foundation Trust, Prittlewell Chase, Westcliff-On-Sea, Essex SSO ORY, UK
7
Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham B15 2WB, UK
8
UCL Centre for Nephrology, Royal Free Hospital NHS Foundation Trust, Rowland Hill Street, London NW3 2PF, UK
9
Department of Psychological Medicine, Institute of Psychiatry, Psychology and Ne
Data Loading...
