Pre-esrd depression and post-ESRD mortality in patients with advanced CKD transitioning to dialysis

M. Molnár, Elani Streja, Keiichi Sumida, Melissa Soohoo, Vanessa A. Ravel, Abduzhappar Gaipov, Praveen K. Potukuchi, Fridtjof Thomas, Connie M. Rhee, Jun Ling Lu, Kamyar Kalantar-Zadeh, Csaba P. Kovesdy

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background and objectives Depression in patients with nondialysis-dependent CKD is often undiagnosed, empirically overlooked, and associated with higher risk of death, progression to ESRD, and hospitalization. However, there is a paucity of evidence on the association between the presence of depression in patients with advanced nondialysis-dependent CKD and post-ESRD mortality, particularly among those in the transition period from late-stage nondialysis-dependent CKD to maintenance dialysis. Design, setting, participants, & measurements From a nation-wide cohort of 45,076 United States veterans who transitioned to ESRD over 4 contemporary years (November of 2007 to September of 2011), we identified 10,454 (23%) patients with a depression diagnosis during the predialysis period. We examined the association of pre-ESRD depression with all-cause mortality after transition to dialysis using Cox proportional hazards models adjusted for sociodemographics, comorbidities, and medications. Results Patients were 72±11 years old (mean±SD) and included 95% men, 66% patients with diabetes, and 23% blacks. The crudemortality ratewas similar in patientswith depression (289/1000 patient-years; 95%confidence interval, 282 to 297) versus patients without depression (286/1000 patient-years; 95% confidence interval, 282 to 290). Compared with patients without depression, patients with depression had a 6% higher all-cause mortality risk in the adjusted model (hazard ratio, 1.06; 95% confidence interval, 1.03 to 1.09). Similar results were found across all selected subgroups as well as in sensitivity analyses using alternate definitions of depression. Conclusion Pre-ESRD depression has a weak association with post-ESRD mortality in veterans transitioning to dialysis.

Original languageEnglish
Pages (from-to)1428-1437
Number of pages10
JournalClinical Journal of the American Society of Nephrology
Volume12
Issue number9
DOIs
Publication statusPublished - Sep 7 2017

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Chronic Kidney Failure
Dialysis
Mortality
Veterans
Confidence Intervals
Proportional Hazards Models
Comorbidity
Hospitalization
Maintenance

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

Cite this

Pre-esrd depression and post-ESRD mortality in patients with advanced CKD transitioning to dialysis. / Molnár, M.; Streja, Elani; Sumida, Keiichi; Soohoo, Melissa; Ravel, Vanessa A.; Gaipov, Abduzhappar; Potukuchi, Praveen K.; Thomas, Fridtjof; Rhee, Connie M.; Ling Lu, Jun; Kalantar-Zadeh, Kamyar; Kovesdy, Csaba P.

In: Clinical Journal of the American Society of Nephrology, Vol. 12, No. 9, 07.09.2017, p. 1428-1437.

Research output: Contribution to journalArticle

Molnár, M, Streja, E, Sumida, K, Soohoo, M, Ravel, VA, Gaipov, A, Potukuchi, PK, Thomas, F, Rhee, CM, Ling Lu, J, Kalantar-Zadeh, K & Kovesdy, CP 2017, 'Pre-esrd depression and post-ESRD mortality in patients with advanced CKD transitioning to dialysis', Clinical Journal of the American Society of Nephrology, vol. 12, no. 9, pp. 1428-1437. https://doi.org/10.2215/CJN.00570117
Molnár, M. ; Streja, Elani ; Sumida, Keiichi ; Soohoo, Melissa ; Ravel, Vanessa A. ; Gaipov, Abduzhappar ; Potukuchi, Praveen K. ; Thomas, Fridtjof ; Rhee, Connie M. ; Ling Lu, Jun ; Kalantar-Zadeh, Kamyar ; Kovesdy, Csaba P. / Pre-esrd depression and post-ESRD mortality in patients with advanced CKD transitioning to dialysis. In: Clinical Journal of the American Society of Nephrology. 2017 ; Vol. 12, No. 9. pp. 1428-1437.
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abstract = "Background and objectives Depression in patients with nondialysis-dependent CKD is often undiagnosed, empirically overlooked, and associated with higher risk of death, progression to ESRD, and hospitalization. However, there is a paucity of evidence on the association between the presence of depression in patients with advanced nondialysis-dependent CKD and post-ESRD mortality, particularly among those in the transition period from late-stage nondialysis-dependent CKD to maintenance dialysis. Design, setting, participants, & measurements From a nation-wide cohort of 45,076 United States veterans who transitioned to ESRD over 4 contemporary years (November of 2007 to September of 2011), we identified 10,454 (23{\%}) patients with a depression diagnosis during the predialysis period. We examined the association of pre-ESRD depression with all-cause mortality after transition to dialysis using Cox proportional hazards models adjusted for sociodemographics, comorbidities, and medications. Results Patients were 72±11 years old (mean±SD) and included 95{\%} men, 66{\%} patients with diabetes, and 23{\%} blacks. The crudemortality ratewas similar in patientswith depression (289/1000 patient-years; 95{\%}confidence interval, 282 to 297) versus patients without depression (286/1000 patient-years; 95{\%} confidence interval, 282 to 290). Compared with patients without depression, patients with depression had a 6{\%} higher all-cause mortality risk in the adjusted model (hazard ratio, 1.06; 95{\%} confidence interval, 1.03 to 1.09). Similar results were found across all selected subgroups as well as in sensitivity analyses using alternate definitions of depression. Conclusion Pre-ESRD depression has a weak association with post-ESRD mortality in veterans transitioning to dialysis.",
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T1 - Pre-esrd depression and post-ESRD mortality in patients with advanced CKD transitioning to dialysis

AU - Molnár, M.

AU - Streja, Elani

AU - Sumida, Keiichi

AU - Soohoo, Melissa

AU - Ravel, Vanessa A.

AU - Gaipov, Abduzhappar

AU - Potukuchi, Praveen K.

AU - Thomas, Fridtjof

AU - Rhee, Connie M.

AU - Ling Lu, Jun

AU - Kalantar-Zadeh, Kamyar

AU - Kovesdy, Csaba P.

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Y1 - 2017/9/7

N2 - Background and objectives Depression in patients with nondialysis-dependent CKD is often undiagnosed, empirically overlooked, and associated with higher risk of death, progression to ESRD, and hospitalization. However, there is a paucity of evidence on the association between the presence of depression in patients with advanced nondialysis-dependent CKD and post-ESRD mortality, particularly among those in the transition period from late-stage nondialysis-dependent CKD to maintenance dialysis. Design, setting, participants, & measurements From a nation-wide cohort of 45,076 United States veterans who transitioned to ESRD over 4 contemporary years (November of 2007 to September of 2011), we identified 10,454 (23%) patients with a depression diagnosis during the predialysis period. We examined the association of pre-ESRD depression with all-cause mortality after transition to dialysis using Cox proportional hazards models adjusted for sociodemographics, comorbidities, and medications. Results Patients were 72±11 years old (mean±SD) and included 95% men, 66% patients with diabetes, and 23% blacks. The crudemortality ratewas similar in patientswith depression (289/1000 patient-years; 95%confidence interval, 282 to 297) versus patients without depression (286/1000 patient-years; 95% confidence interval, 282 to 290). Compared with patients without depression, patients with depression had a 6% higher all-cause mortality risk in the adjusted model (hazard ratio, 1.06; 95% confidence interval, 1.03 to 1.09). Similar results were found across all selected subgroups as well as in sensitivity analyses using alternate definitions of depression. Conclusion Pre-ESRD depression has a weak association with post-ESRD mortality in veterans transitioning to dialysis.

AB - Background and objectives Depression in patients with nondialysis-dependent CKD is often undiagnosed, empirically overlooked, and associated with higher risk of death, progression to ESRD, and hospitalization. However, there is a paucity of evidence on the association between the presence of depression in patients with advanced nondialysis-dependent CKD and post-ESRD mortality, particularly among those in the transition period from late-stage nondialysis-dependent CKD to maintenance dialysis. Design, setting, participants, & measurements From a nation-wide cohort of 45,076 United States veterans who transitioned to ESRD over 4 contemporary years (November of 2007 to September of 2011), we identified 10,454 (23%) patients with a depression diagnosis during the predialysis period. We examined the association of pre-ESRD depression with all-cause mortality after transition to dialysis using Cox proportional hazards models adjusted for sociodemographics, comorbidities, and medications. Results Patients were 72±11 years old (mean±SD) and included 95% men, 66% patients with diabetes, and 23% blacks. The crudemortality ratewas similar in patientswith depression (289/1000 patient-years; 95%confidence interval, 282 to 297) versus patients without depression (286/1000 patient-years; 95% confidence interval, 282 to 290). Compared with patients without depression, patients with depression had a 6% higher all-cause mortality risk in the adjusted model (hazard ratio, 1.06; 95% confidence interval, 1.03 to 1.09). Similar results were found across all selected subgroups as well as in sensitivity analyses using alternate definitions of depression. Conclusion Pre-ESRD depression has a weak association with post-ESRD mortality in veterans transitioning to dialysis.

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