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  • Title: The association of depressive symptoms with survival in a Dutch cohort of patients with end-stage renal disease.
    Author: Riezebos RK, Nauta KJ, Honig A, Dekker FW, Siegert CE.
    Journal: Nephrol Dial Transplant; 2010 Jan; 25(1):231-6. PubMed ID: 19654227.
    Abstract:
    AIM: To evaluate the prevalence and the influence on survival of depressive symptoms in a European cohort of end-stage renal disease (ESRD) patients on renal replacement therapy (RRT). METHODS: In a prospective fashion, symptoms of depression were evaluated in ESRD patients on RRT using the depression subscore of the Hospital Anxiety and Depression Scale (HADS). Fatal and non-fatal clinical events were determined during a 1-year follow-up. RESULTS: Of 101 patients with ESRD, 42% showed manifest depressive symptoms, defined as a HADS-D score > or =7. No association was found between depressive symptoms and severity of somatic disease. During follow-up, all-cause mortality was significantly higher in patients with depressive symptoms above threshold (n = 42, mortality: 26%) compared to patients with depressive symptoms below threshold (n = 59, mortality 8%), (crude HR 3.3, CI 1.2-9.6, P = 0.02). The excess in mortality was mainly caused by a higher incidence of septicaemia (0 versus 12%, P = 0.01). After adjustment for clinical parameters, this association between depressive symptoms and mortality became even stronger. There was no significant difference observed in the incidence of cardiovascular events. CONCLUSIONS: Patients with ESRD treated with dialysis show a high level of depressive symptoms that is independently associated with poor survival. Future research should address appropriate therapeutic regimens.
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