Abstract: FR-PO865

Depression Is Associated with Mortality Independent of Previous Screenings

Session Information

Category: Dialysis

  • 607 Dialysis: Epidemiology, Outcomes, Clinical Trials - Non-Cardiovascular

Authors

  • Sy, John, UCSF Medical Center, San Francisco, California, United States
  • Johansen, Kirsten L., University of California, San Franicsco, San Francisco, California, United States
Background

Depression affects up to 40% of dialysis patients and is associated with 50% higher risk of mortality, but it is not known whether changes in depressive symptoms mitigate the risk. We used a longitudinal cohort to analyze the association between depressive symptoms and changes in symptoms with mortality.

Methods

We examined the association between depression screening (at baseline and 12 months) and mortality using Cox models among 762 prevalent dialysis patients enrolled from 6/2009 to 8/2011 in the ACTIVE/ADIPOSE prospective cohort. The CES-D Scale was used as a screening tool for depression. Death was ascertained through linkage with the USRDS as of 3/31/2014. Among 687 patients with paired baseline and 12m data, differences in mortality risk were assessed in 4 groups defined according to depression screening at baseline and 12 m (neg to neg; neg to pos; pos to pos; pos to neg). Models were adjusted for age, sex, race, frailty, comorbidities, and inflammatory makers.

Results

30.0% screened positive for depression at baseline. After adjustment, screening positive at baseline (HR 1.73, 95% CI 1.28 – 2.34) or 12m (HR 3.50, 95% CI 2.59 – 4.74) was associated with higher mortality risk. Compared to those who never screened positive for depression, those who screened positive at 12m were at statistically significantly higher risk of mortality regardless of baseline depression status (figure). To formally test whether trajectory predicted mortality independently of depression at follow-up, we adjusted for CES-D scores at 12m. Screening positive for depression at 12m was associated with higher mortality, but trajectory was not.

Conclusion

Positive depression screening was associated with higher mortality risk at any time point regardless of changes over the preceding 12 months. Results suggest that effective treatment of depression has the potential to improve outcomes.

Funding

  • Veterans Affairs Support