Patterns and predictors of depression treatment among adults with chronic kidney disease and depression in ambulatory care settings in the United States
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One in five adults with chronic kidney disease (CKD) in the United States (US) suffers from depression. Comorbid depression in adults with CKD is associated with higher morbidity and mortality. This study used US national survey data to examine patterns and predictors of depression treatment among adults with non-dialysis-dependent CKD in the US.
A retrospective, cross-sectional study was conducted using 2014–2015 National Ambulatory Medical Care Survey (NAMCS) data. The final study sample consisted of visits by 9.02 million adults (unweighted n = 262; age ≥ 18 years) with CKD and depression in the US. Depression treatment was defined as antidepressant use with or without psychotherapy. To identify predictors of depression treatment, multivariable logistic regression analysis was conducted adjusting for predisposing, enabling, and need factors.
Approximately half of adults with CKD and depression received depression treatment. Primary care was the main setting of treatment, and the most commonly prescribed antidepressant class was selective serotonin reuptake inhibitors. Adults being seen for treatment of a chronic problem were 3.2 times more likely to receive depression treatment (OR 3.20; 95% CI 1.38–7.21). In addition, there was a 9% higher likelihood of receiving depression treatment for each unit increase in total number of medications (OR 1.09; 95% CI 1.01–1.19). Finally, adults receiving care in the South were 63% less likely to receive depression treatment (OR 0.37; 95% CI 0.15–0.89).
Depression treatment was recorded in approximately half of US ambulatory care visits involving adults with CKD and depression from 2014 to 2015. Further research is warranted to determine how to appropriately manage treatment of depression in adults with CKD.
KeywordsChronic kidney disease Depression Adults Ambulatory care settings Antidepressants
This research did not receive any grants from funding agencies in the public, commercial, or not-for-profit sectors.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
For this type of study, formal consent is not required.
- 2.Palmer S, Vecchio M, Craig JC, Tonelli M, Johnson DW, Nicolucci A, Pellegrini F, Saglimbene V, Logroscino G, Fishbane S, Strippoli GF (2013) Prevalence of depression in chronic kidney disease: systematic review and meta-analysis of observational studies. Kidney Int 84(1):179–191. https://doi.org/10.1038/ki.2013.77 CrossRefPubMedGoogle Scholar
- 4.D’Onofrio G, Simeoni M, Rizza P, Caroleo M, Capria M, Mazzitello G, Sacco T, Mazzuca E, Panzino MT, Cerantonio A, Segura-Garcia C, Andreucci M, De Fazio P, Fuiano G (2017) Quality of life, clinical outcome, personality and coping in chronic hemodialysis patients. Ren Fail 39(1):45–53. https://doi.org/10.1080/0886022X.2016.1244077 CrossRefPubMedGoogle Scholar
- 5.Fischer MJ, Kimmel PL, Greene T, Gassman JJ, Wang X, Brooks DH, Charleston J, Dowie D, Thornley-Brown D, Cooper LA, Bruce MA, Kusek JW, Norris KC, Lash JP, Group AS (2011) Elevated depressive affect is associated with adverse cardiovascular outcomes among African Americans with chronic kidney disease. Kidney Int 80(6):670–678. https://doi.org/10.1038/ki.2011.153 CrossRefPubMedPubMedCentralGoogle Scholar
- 6.Kop WJ, Seliger SL, Fink JC, Katz R, Odden MC, Fried LF, Rifkin DE, Sarnak MJ, Gottdiener JS (2011) Longitudinal association of depressive symptoms with rapid kidney function decline and adverse clinical renal disease outcomes. Clin J Am Soc Nephrol 6(4):834–844. https://doi.org/10.2215/CJN.03840510 CrossRefPubMedPubMedCentralGoogle Scholar
- 7.Hedayati SS, Minhajuddin AT, Afshar M, Toto RD, Trivedi MH, Rush AJ (2010) Association between major depressive episodes in patients with chronic kidney disease and initiation of dialysis, hospitalization, or death. JAMA 303(19):1946–1953. https://doi.org/10.1001/jama.2010.619 CrossRefPubMedGoogle Scholar
- 8.Palmer SC, Vecchio M, Craig JC, Tonelli M, Johnson DW, Nicolucci A, Pellegrini F, Saglimbene V, Logroscino G, Hedayati SS, Strippoli GF (2013) Association between depression and death in people with CKD: a meta-analysis of cohort studies. Am J Kidney Dis 62(3):493–505. https://doi.org/10.1053/j.ajkd.2013.02.369 CrossRefPubMedGoogle Scholar
- 10.Chiang HH, Guo HR, Livneh H, Lu MC, Yen ML, Tsai TY (2015) Increased risk of progression to dialysis or death in CKD patients with depressive symptoms: a prospective 3-year follow-up cohort study. J Psychosom Res 79(3):228–232. https://doi.org/10.1016/j.jpsychores.2015.01.009 CrossRefPubMedGoogle Scholar
- 11.Hedayati SS, Gregg LP, Carmody T, Jain N, Toups M, Rush AJ, Toto RD, Trivedi MH (2017) Effect of sertraline on depressive symptoms in patients with chronic kidney disease without dialysis dependence: the CAST randomized clinical trial. JAMA 318(19):1876–1890. https://doi.org/10.1001/jama.2017.17131 CrossRefPubMedPubMedCentralGoogle Scholar
- 16.National Centers for Disease Control and Prevention: National Center for Health Statistics. Ambulatory Health Care DataGoogle Scholar
- 17.Survey NAMC (2014) Data documentation. ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NAMCS/doc2014.pdf. Accessed 4 June 2018
- 18.Survey NAMC (2015) Data documentation. ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NAMCS/doc2015.pdf. Accessed 4 June 2018
- 20.Hing E, Schappert SM, Burt CW, Shimizu IM (2005) Effects of form length and item format on response patterns and estimates of physician office and hospital outpatient department visits. National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, 2001. Vital Health Stat 2(139):1–32Google Scholar
- 22.CDC (2015) Reliability of estimates. https://www.cdc.gov/nchs/ahcd/ahcd_estimation_reliability.htm. Accessed 4 June 2018
- 23.Fischer MJ, Xie D, Jordan N, Kop WJ, Krousel-Wood M, Kurella Tamura M, Kusek JW, Ford V, Rosen LK, Strauss L, Teal VL, Yaffe K, Powe NR, Lash JP, Investigators CSG (2012) Factors associated with depressive symptoms and use of antidepressant medications among participants in the Chronic Renal Insufficiency Cohort (CRIC) and Hispanic-CRIC Studies. Am J Kidney Dis 60(1):27–38. https://doi.org/10.1053/j.ajkd.2011.12.033 CrossRefPubMedPubMedCentralGoogle Scholar
- 24.Nagler EV, Webster AC, Vanholder R, Zoccali C (2012) Antidepressants for depression in stage 3–5 chronic kidney disease: a systematic review of pharmacokinetics, efficacy and safety with recommendations by European Renal Best Practice (ERBP). Nephrol Dial Transplant 27(10):3736–3745. https://doi.org/10.1093/ndt/gfs295 CrossRefPubMedGoogle Scholar
- 25.Glassman AH, O’Connor CM, Califf RM, Swedberg K, Schwartz P, Bigger JT Jr, Krishnan KR, van Zyl LT, Swenson JR, Finkel MS, Landau C, Shapiro PA, Pepine CJ, Mardekian J, Harrison WM, Barton D, McLvor M (2002) Sertraline antidepressant heart attack randomized trial. Sertraline treatment of major depression in patients with acute MI or unstable angina. JAMA 288(6):701–709CrossRefPubMedGoogle Scholar
- 28.Atalay H, Solak Y, Biyik M, Biyik Z, Yeksan M, Uguz F, Guney I, Tonbul HZ, Turk S (2010) Sertraline treatment is associated with an improvement in depression and health-related quality of life in chronic peritoneal dialysis patients. Int Urol Nephrol 42(2):527–536. https://doi.org/10.1007/s11255-009-9686-y CrossRefPubMedGoogle Scholar
- 38.Shirazian S, Grant CD, Aina O, Mattana J, Khorassani F, Ricardo AC (2017) Depression in chronic kidney disease and end-stage renal disease: similarities and differences in diagnosis, epidemiology, and management. Kidney Int Rep 2(1):94–107. https://doi.org/10.1016/j.ekir.2016.09.005 CrossRefPubMedGoogle Scholar
- 46.Angermann CE, Gelbrich G, Stork S, Gunold H, Edelmann F, Wachter R, Schunkert H, Graf T, Kindermann I, Haass M, Blankenberg S, Pankuweit S, Prettin C, Gottwik M, Bohm M, Faller H, Deckert J, Ertl G, Investigators M-HS, Committee M (2016) Effect of escitalopram on all-cause mortality and hospitalization in patients with heart failure and depression: the MOOD-HF randomized clinical trial. JAMA 315(24):2683–2693. https://doi.org/10.1001/jama.2016.7635 CrossRefPubMedGoogle Scholar
- 47.O’Connor CM, Jiang W, Kuchibhatla M, Silva SG, Cuffe MS, Callwood DD, Zakhary B, Stough WG, Arias RM, Rivelli SK, Krishnan R, Investigators S-C (2010) Safety and efficacy of sertraline for depression in patients with heart failure: results of the SADHART-CHF (sertraline against depression and heart disease in chronic heart failure) trial. J Am Coll Cardiol 56(9):692–699. https://doi.org/10.1016/j.jacc.2010.03.068 CrossRefPubMedPubMedCentralGoogle Scholar
- 48.Cipriani A, Furukawa TA, Salanti G, Geddes JR, Higgins JP, Churchill R, Watanabe N, Nakagawa A, Omori IM, McGuire H, Tansella M, Barbui C (2009) Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis. Lancet 373(9665):746–758. https://doi.org/10.1016/S0140-6736(09)60046-5 CrossRefPubMedGoogle Scholar
- 49.Hedayati SS, Daniel DM, Cohen S, Comstock B, Cukor D, Diaz-Linhart Y, Dember LM, Dubovsky A, Greene T, Grote N, Heagerty P, Katon W, Kimmel PL, Kutner N, Linke L, Quinn D, Rue T, Trivedi MH, Unruh M, Weisbord S, Young BA, Mehrotra R (2016) Rationale and design of A trial of sertraline vs. cognitive behavioral therapy for end-stage renal disease patients with depression (ASCEND). Contemp Clin Trials 47:1–11. https://doi.org/10.1016/j.cct.2015.11.020 CrossRefPubMedGoogle Scholar
- 52.Bhattacharjee S, Axon DR, Goldstone L, Lee JK (2018) Patterns and predictors of depression treatment among stroke survivors with depression in ambulatory settings in the United States. J Stroke Cerebrovasc Dis 27(3):563–567. https://doi.org/10.1016/j.jstrokecerebrovasdis.2017.09.047 CrossRefPubMedGoogle Scholar