Date Published: June 13, 2019
Publisher: Public Library of Science
Author(s): Ping-Hsun Wu, Ming-Yen Lin, Teng-Hui Huang, Yi-Ting Lin, Chi-Chih Hung, Yi-Chun Yeh, Hung-Tien Kuo, Yi-Wen Chiu, Shang-Jyh Hwang, Jer-Chia Tsai, Juan-Jesus Carrero, Wisit Cheungpasitporn.
Depression is common in dialysis patients, but the clinical impact of this condition is poorly defined.
Out of 57,703 patients starting dialysis during 2000–2007 recorded in the National Health Insurance Research Database of Taiwan, we identified 2,475 patients with a clinical diagnosis of depression, and compared them with 1:5 age- and sex-matched patients without a depression diagnosis (n = 12,375). Patients were followed up for hospitalisation due to severe infections, major adverse cardiovascular events (MACE) and death. Multivariable Cox regression and competing risk analyses (accounting for death when appropriate) were used to estimate risk associations.
Patients with depression had a higher frequency of comorbidities. During a mean follow-up of 3.2 years, 1,140 severe infections, 806 MACE, and 1,121 deaths were recorded. Compared to controls, patients with depression were at increased risk of death (adjusted hazard ratio 1.24; 95%CI 1.16–1.33). Patients with depression were also at higher risk of severe (1.14; 1.06–1.22) and fatal infections (death within 30 days, 1.22; 1.09–1.35), attributed mainly to sepsis (1.19; 1.08–1.31), septic shock (1.36; 1.13–1.62) and pneumonia (1.19; 1.07–1.33). Conversely, no association was observed between depression and the MACE risk (1.04; 0.94–1.15).
Dialysis patients with depression are associated with increased risk of infections and death.
Depression is increasingly common in modern society and projected to be the future major cause of disability worldwide . Depression considerably reduces the quality of life and frequently accompanies a number of chronic diseases , including chronic kidney disease (CKD). Indeed, between 20 to 30% of patients with severe CKD suffer from depression [3–6]. Even if lacking a formal diagnosis of depression, patients with CKD were often reported as having the heavy burden of depression symptoms  and depression is considered a priority research subject among patients on or nearing dialysis .
The distribution of socio-demographic characteristics, comorbid medical disorders, and medications used by patients with depression and controls are shown in Table 1. Compared to controls, patients with depression had a slightly lower socioeconomic status, and presented with a higher frequency of comorbidities. They also more frequently used antipsychotic agents, benzodiazepines, and hypnotics.
In this large nationwide cohort of incident dialysis patients, we show that clinically diagnosed depression was associated with the risk of infectious complications and death. Conversely, there was no apparent association between depression and MACE.