An association between depressive symptoms and survival in incident dialysis patients

Background. Depression in end-stage renal disease patients is detrimental to quality of life, and is also associated with adverse clinical outcomes. The aim of this study was to examine whether depression symptoms in 'incident dialysis' patients predicted survival. Methods. One hundred and sixty incident haemodialysis and peritoneal dialysis patients completed a self-report depression questionnaire (Beck Depression Inventory-II, BDI) at a point soon after dialysis initiation. Over the study period (May 2007-December 2009), patients were followed up with all-cause mortality recorded as the end point. Results. The median follow-up time for the cohort was 511 days (min 47 days and max 1027 days). There were 27 deaths (16.9%). Depression symptoms were evaluated both as a continuous variable and using a defined cut-off for depressed patients (BDI >= 16). In a Cox proportional hazards model, adjusted for several covariates including albumin and extra renal comorbidity, depression score was an independent predictor of mortality (HR = 1.07, 95% CI 1.02-1.11, P = 0.002). In an additional adjusted model, a BDI score >= 16 was associated with a 2.7 times increase in the hazard for death (HR = 2.7, 95% CI 1.06-6.8, P = 0.037). Conclusions. The severity of depression symptoms following the start of dialysis treatment is an independent predictor of survival. Further studies will be required to determine whether the treatment of depression would alter health-related outcomes, including survival.