Pre-ESRD Depression and Post-ESRD Mortality in Patients with Advanced CKD Transitioning to Dialysis.

Autor:	Molnar MZ; Division of Nephrology, Department of Medicine and.; Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary., Streja E; Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California., Sumida K; Division of Nephrology, Department of Medicine and., Soohoo M; Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California., Ravel VA; Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California., Gaipov A; Division of Nephrology, Department of Medicine and.; Department of Extracorporeal Hemocorrection, National Scientific Medical Research Center, Astana, Kazakhstan; and., Potukuchi PK; Division of Nephrology, Department of Medicine and., Thomas F; Division of Biostatistics, Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee., Rhee CM; Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California., Lu JL; Division of Nephrology, Department of Medicine and., Kalantar-Zadeh K; Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California., Kovesdy CP; Division of Nephrology, Department of Medicine and.; Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, Tennessee.
Jazyk:	angličtina
Zdroj:	Clinical journal of the American Society of Nephrology : CJASN [Clin J Am Soc Nephrol] 2017 Sep 07; Vol. 12 (9), pp. 1428-1437. Date of Electronic Publication: 2017 Jul 05.
DOI:	10.2215/CJN.00570117
Abstrakt:	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 crude mortality rate was similar in patients with 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. (Copyright © 2017 by the American Society of Nephrology.)
Databáze:	MEDLINE
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