The prevalence and treatment of depression among patients starting dialysis

Background: Depression is common in patients with end-stage renal disease (ESRD) and is associated with increased mortality, but little is known about depression in patients just after they start dialysis therapy. We sought to assess the prevalence of depressive symptoms in patients with ESRD starting dialysis therapy, identify patient characteristics associated with depression, and determine whether patients with serious depressive symptoms were receiving treatment. Methods: We implemented a multicenter prospective cohort study at 14 dialysis centers in Connecticut. Patients with ESRD who were 18 years and older were interviewed within 10 days of initiating dialysis therapy between November 2000 and July 2001. The Beck Depression Inventory (BDI) was used to assess depressive symptoms. Chi-square tests were used to evaluate associations between several patient characteristics and depression, and multivariable logistic regression models were used to determine odds ratios (ORs) for depression, with adjustment for baseline variables. Results: Among 123 patients, 44% (54 of 123 patients) had scores above the validated cutoff value in the BDI for depression. In logistic regression analysis, depression was statistically significantly associated with Caucasian race (OR, 3.4; P = 0.02), lower self-rated quality of life (OR, 2.2; P = 0.003), and no previous acquaintances on dialysis therapy (OR, 10.2; P = 0.03). Only 16% (9 of 54 patients) of depressed patients were being treated at enrollment; 13% (5 of 38 patients) of those with mild symptoms and 25% (4 of 16 patients) with more severe symptoms were being treated. Conclusion: Our results show that depressive symptoms are very common at the start of dialysis therapy, and specific characteristics are associated with a greater burden of depressive symptoms. Despite a high prevalence, treatment rates are low, even among patients with moderate to severe symptoms of depression.