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Abstract: FR-OR148

Comparative Efficacy of Therapies for Depression for Patients Undergoing Hemodialysis

Session Information

Category: Dialysis

  • No subcategory defined

Authors

  • Mehrotra, Rajnish, University of Washington, Seattle, Washington, United States
  • Cukor, Daniel, SUNY Downstate Medical Center, Brooklyn, New York, United States
  • Unruh, Mark L., University of New Mexico, Los Ranchos, New Mexico, United States
  • Rue, Tessa, University of Washington, Seattle, Washington, United States
  • Heagerty, Patrick James, University of Washington, Seattle, Washington, United States
  • Cohen, Scott D., George Washington University, Washington, District of Columbia, United States
  • Dember, Laura M., University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States
  • Diaz-Linhart, Yaminette, Brandeis University, Cambridge, Massachusetts, United States
  • Dubovsky, Amelia, University of Washington, Seattle, Washington, United States
  • Greene, Tom, University of Utah, Salt Lake City, Utah, United States
  • Grote, Nancy K., University of Washington, Seattle, Washington, United States
  • Kutner, Nancy G., Emory University School of Medicine, Atlanta, Georgia, United States
  • Trivedi, Madhukar, UT Southwestern Medical Center, Dallas, Texas, United States
  • Quinn, Davin, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States
  • Ver halen, Nisha, SUNY Downstate Medical Center, Brooklyn, New York, United States
  • Weisbord, Steven D., University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
  • Young, Bessie A., University of Washington, Seattle, Washington, United States
  • Kimmel, Paul L., National Institute of Diabetes and Digestive Kidney Diseases (NIDDK), Bethesda, Maryland, United States
  • Hedayati, Susan, University of Texas Southwestern, Dallas, Texas, United States
Background

Depression is common in patients undergoing hemodialysis but limited data exist on increasing treatment acceptance or efficacy of various anti-depressant therapies. We sought to determine the effect of an engagement interview on treatment acceptance, and compare efficacy of cognitive behavioral therapy (CBT) or sertraline for treating major depressive disorder (MDD) or dysthymia in patients undergoing hemodialysis.

Methods

In a multi-center randomized controlled trial, 2569 patients in 41 dialysis facilities in 3 metropolitan areas were screened with Beck Depression Inventory (BDI). In those who scored ≥ 15, MDD/dysthymia was diagnosed using MINI Neuropsychiatric Interview. Participants were randomized to engagement interview, to increase treatment acceptance, vs. control visit, with proportion starting anti-depressant treatment within 28 days as the primary outcome. Willing individuals were further randomized to 12-weeks of CBT or sertraline, with Quick Inventory of Depressive Symptoms (QIDS-C) at 12 weeks as the primary outcome.

Results

Of 636 patients with BDI score ≥ 15, 310 (49%) eligible subjects were evaluated further, 184 were randomized to engagement vs. control, and 120 subsequently randomized to CBT vs. sertraline. There was no difference in the proportion initiating treatment for depression in engagement arm or control (66% vs. 64%, respectively, p=0.77). Compared with CBT, sertraline resulted in a greater decrease in depressive symptoms (12-week QIDS-C, -1.84, (-3.54, -0.13), p=0.04). There was also greater improvement in 5 of 9 secondary patient-reported outcomes with sertraline (BDI, Sheehan Disability, SF-36 Energy/Vitality, Satsifaction with Life, and Pittsburgh Sleep Quality Index scales). The incidence of serious adverse events was similar but non-serious adverse events were more frequent with sertraline (56 events, 25 patients) than with CBT (17 events, 12 patients).

Conclusion

In participants undergoing hemodialysis, there was no effect of an engagement interview on patients’ acceptance of treatment for depression. There was greater improvement in depressive symptoms and other patient-reported outcomes with sertraline compared to CBT.

Funding

  • NIDDK Support – Dialysis Clinic, Inc.