Kidney Week

Abstract: FR-PO569

Hospital Admission Rates Are Associated with Depressive Affect and Antidepressant Use in Dialysis Patients

Session Information

• Physical Activity, Body Composition, Metabolism: Clinical
  October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Health Maintenance, Nutrition, and Metabolism

• 1302 Health Maintenance, Nutrition, and Metabolism: Clinical

Authors

• Kim, Billy, Fresenius Rx, Nashville, Tennessee, United States

Billy Kim,

• Lee, Marissa A., Fresenius Rx, Nashville, Tennessee, United States

Marissa A. Lee,

• Chaudhuri, Sheetal, Fresenius Medical Care North America, Waltham, Massachusetts, United States

Sheetal Chaudhuri,

• Han, Hao, Fresenius Medical Care North America, Waltham, Massachusetts, United States

Hao Han,

• Reviriego-Mendoza, Marta, Fresenius Medical Care North America, Waltham, Massachusetts, United States

Marta Reviriego-Mendoza,

• Larkin, John W., Fresenius Medical Care North America, Waltham, Massachusetts, United States

John W. Larkin,

• Usvyat, Len A., Fresenius Medical Care North America, Waltham, Massachusetts, United States

Len A. Usvyat,

• Ketchersid, Terry L., Fresenius Medical Care North America, Waltham, Massachusetts, United States

Terry L. Ketchersid,

• Maddux, Franklin W., Fresenius Medical Care North America, Waltham, Massachusetts, United States

Franklin W. Maddux,

Background

Depression is a common mental health disorder and the leading cause of disability worldwide (WHO 2017). In the general population, antidepressant use has been associated with adverse drug events and frequent emergency room visits (Shehab N, et al. 2016). Little is known about the effects of antidepressant use, drug dialyzability, and associated outcomes in hemodialysis (HD) patients. We aimed to determine if hospitalization rates differ in HD patients by use of antidepressants and the presence of depressive affect (DA).

Methods

We analyzed data from a large dialysis provider on HD patients treated during 2016 to 2018. We stratified patients by antidepressant use and compared hospitalization rates per patient year (ppy). Furthermore, we captured data on patients who completed DA screening via the patient health questionnaire-2 (PHQ2) and compared hospitalization rates for those who were DA positive (PHQ2 score ≥3) or negative, and using an antidepressant or not.

Results

In a population of 268,443 HD patients, 26% of patients were using an antidepressant. Hospitalization rates were higher in those using an antidepressant versus patients not taking any antidepressants (2.18 vs 1.41 admissions ppy, respectively). Overall, there was a 75% response rate to the PHQ2 survey. Among those who completed the PHQ2, 9% were DA positive. Antidepressants were used by 41% of DA positive patients and 22% of DA negative patients. In DA positive patients, hospitalization rates were higher for those using an antidepressant versus patients not using antidepressants (2.66 vs 2.29 admissions ppy, respectively). Similarly, DA negative patients using antidepressants had higher hospitalization rates versus those not using antidepressants (2.4 vs 1.9 admissions ppy, respectively).

Conclusion

Findings indicate that patients taking antidepressants may have higher hospitalization rates when compared to those not taking any medication, irrespective of DA. Antidepressant-related hospitalization rates may be due to drug adverse events and could in part be confounded by indication. Treatment adherence and the presence of major depressive episodes are not addressed in this analysis. Further analyses are warranted.