ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: TH-PO254

Psychosocial Interventions for Preventing and Treating Depression in Dialysis Patients: A Cochrane Review and Meta-Analysis

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Natale, Patrizia, Diaverum, Lund, Sweden
  • Palmer, Suetonia, University of Otago, Christchurch, New Zealand
  • Ruospo, Marinella, Diaverum, Lund, Sweden
  • Hegbrant, Jorgen BA, Diaverum, Lund, Sweden
  • Strippoli, Giovanni F.M., Diaverum, Lund, Sweden
Background

People with end-stage kidney disease treated with dialysis are frequently affected by major depression. Psychological and social support are potential treatments for depression, although a Cochrane review in 2005 identified zero eligible studies. This is an update of the Cochrane review published in 2005 to evaluate the available evidence for using psychosocial interventions to prevent and treat depression in patients treated with dialysis for end-stage kidney disease (ESKD).

Methods

The specialized register of Cochrane Kidney and Transplant was searched for randomized trials (RCTs) reporting psychosocial interventions for prevention and treatment of depression among adults treated with long-term dialysis. Two authors independently screened citations for eligibility, extracted data, and assessed risk of bias using the Cochrane tool. Evidence certainty was evaluated using GRADE.

Results

Thirty-one studies (1820 participants) were eligible. Twenty-four new studies were added to this 2018 update. Seven studies originally excluded from the 2005 review were included as they met updated review eligibility criteria. Trial duration ranged between three weeks and one year. Median study age was 50.8 years. Methodological reporting was incomplete for most studies. Cognitive-behavioural therapy probably improves depression symptoms (mean difference [MD] -6.10, 95% confidence interval [CI] -8.63 to -3.57; moderate certainty) and health-related quality of life (standardized MD [SMD] 0.51, 95% CI 0.19 to 0.83; moderate certainty). Exercise probably improves depression symptoms (MD -7.61, 95% CI -9.59 to -5.63; moderate certainty) and health-related quality of life (MD 3.06, 95% CI 2.29 to 3.83; moderate certainty). Counselling and relaxation techniques probably reduce depressive symptoms (MD - 3.84, 95% CI -6.14 to -1.54; moderate certainty and MD -5.77, 95% CI -8.76 to -2.78; moderate certainty, respectively). In very low certainty evidence, the effects of acupressure, telephone support, and meditation were uncertain. Data on adverse events were sparse.

Conclusion

Cognitive-behavioural therapy, exercise, counselling, or relaxation techniques probably reduce depressive symptoms for adults with ESKD treated with dialysis. Evidence for other psychosocial interventions is uncertain.