Abstract: FR-PO866
Adverse Outcomes of Subsequent Depression in ESKD Patients Undergoing Peritoneal Dialysis: A Longitudinal Prospective Study
Session Information
- Dialysis: Epidemiology, Outcomes, Clinical Trials - Non-Cardiovascular - II
November 03, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Dialysis
- 607 Dialysis: Epidemiology, Outcomes, Clinical Trials - Non-Cardiovascular
Authors
- nochaiwong, surapon, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
- Ruengorn, Chidchanok, Facultty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
- Koyratkoson, Kiatkriangkrai, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
- Chaisai, Chayutthaphong, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
- Noppakun, Kajohnsak, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Awiphan, Ratanaporn -, Facultty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
- Chongruksut, Wilaiwan -, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Nanta, Sirisak, Maesai District Hospital, Chiang Rai, Thailand, Chiang Rai, Thailand
Group or Team Name
- Thai Renal Outcomes Research (THOR) Investigators
Background
Existing epidemiological studies demonstrated that depression subsequently predicts adverse outcomes in various populations. Nevertheless, evidences were inconclusive and limited with regard to dialysis patients, particularly in patients on peritoneal dialysis (PD).
Methods
We conducted a prospective single cohort study from the Kidney Center, general hospital, Chiang Mai, Thailand from May 2012 to December 2014, involving adults treated with long-term PD. Participants were followed up until December 2016. Depression was defined by the Beck Depression Inventory (BDI) II score ≥ 14 at baseline. Adverse outcomes of interest included all-cause mortality, cardiovascular (CV) mortality, CV hospitalization, and health-related quality of life (HRQOL). Multivariable Cox regression analyses were used to estimate mortality and hospitalization risk. HRQOL scores using the Kidney Disease Quality of Life (KDQOL-36) instrument were also compared by linear regression. Baseline sociodemographics and known risk factors were adjusted in the models.
Results
Our cohort consisted of 409 PD patients with mean age of 59.3 ± 12.4 years and 44.0% were female. Depression presented in 28.6% at recruitment. After a median follow-up of 1.73 years (835.2 person-year), 139 (34%) participants had died, of which 50 (36%) were attributable to CV death.
Conclusion
Depression is common in PD patients and is strongly associated with increased risk of death, CV hospitalization, and worse HRQOL scores. Further investigation is warranted to establish whether recognition and treatment of depression can improve patient outcomes.
Adverse outcomes for depressive disorder (BDI-II ≥ 14) versus non-depressive disorders (BDI-II < 14)
| Clinical Adverse Outcomes | No. of Events | Unadjusted HR (95% CI) | Adjusted HR (95% CI) |
| ● All-cause mortality | 139 | 2.61 (1.87 – 3.64) | 2.54 (1.61 – 4.02) |
| ● CV mortality | 50 | 3.42 (1.96 – 5.97) | 3.36 (1.43 – 7.87) |
| ● CV hospitalization | 86 | 2.78 (1.82 – 4.25) | 2.96 (1.67 – 5.26) |
| Patient-Reported HRQOL | Outcome Mean | Unadjusted Difference (95% CI) | Adjusted Difference (95% CI) |
| ● KDQOL-36 physical component | 49.9 | -5.1 (-8.9 to -1.2) | -5.4 (-9.6 to -1.1) |
| ● KDQOL-36 mental component | 64.3 | -4.2 (-7.8 to -0.5) | -4.7 (-8.6 to -0.8) |
| ● KDQOL-36 kidney disease burden | 74.2 | -4.5 (-7.5 to -1.4) | -5.3 (-8.6 to -2.1) |
| ● Summary KDQOL-36 scores | 62.8 | -4.6 (-7.8 to -1.3) | -5.1 (-8.6 to -1.7) |
CI, confidence interval; HR, hazard ratio
Funding
- Government Support - Non-U.S.