Depression in dialysis patients with end-stage kidney disease: investigating the role of psychosocial stressors, co-occurring medical conditions and demographic influences.

BACKGROUND

Depression is common in end-stage kidney disease (ESKD) and is associated with poorer outcomes and higher mortality. However, treatment guidance is inconsistently applied.

AIMS: To investigate screening measures, somatic symptoms, comorbidities and psychosocial and cultural influences on depression diagnosis in ESKD patients.

METHOD: We recruited 300 people with ESKD receiving maintenance hospital haemodialysis in a deprived ethnically diverse area. We assessed depression using validated screening tools (Hamilton Depression Rating Scale and Patient Health Questionnaire 2) and a definitive ICD-10 diagnosis using a structured interview (Clinical Interview Schedule-Revised). We considered the role of adverse life events, co-occurring medical conditions, as well as age, sex and ethnicity, using descriptive statistics and multiple logistic regression.

RESULTS

An ICD-10 diagnosis of moderate or severe depression was made in 8% of the sample, taking care to exclude potentially confounding symptoms associated with chronic kidney disease and depression. Applying validated thresholds on commonly used screening tools yielded substantially higher prevalence estimates. An ICD-10 diagnosis of moderate and severe depression associated with loss events: death of a spouse, child or parent (odds ratio 3.62, 95% CI: 1.09-12, p = 0.04), financial strain (odds ratio 3.51, 95% CI: 1.04-11.87, p = 0.04), type 2 diabetes (odds ratio 5.32, 95% CI: 1.34-20.76, p = 0.02) and education, whereby university graduates were less likely to have depression than school-only attendees (odds ratio 0.18, 95% CI: 0.03-1.02, p = 0.05). Ethnicity and sex were not significantly associated with moderate or severe depression.

CONCLUSIONS

We found a lower prevalence of moderate to severe depression than commonly reported. Future research should consider careful diagnostic assessment, financial strain, loss events and physical co-occurring medical conditions such as diabetes.