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Kidney Week

Abstract: FR-PO429

Patient Treatment Adherence in the ASCEND Trial for Depression in Patients Undergoing Maintenance Hemodialysis

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Cukor, Daniel, Rogosin Institute, NY, New York, United States
  • Rue, Tessa, University of Washington, Seattle, Washington, United States
  • Unruh, Mark L., University of New Mexico, Los Ranchos, New Mexico, 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, Weill Cornell Medicine/New York-Presbyterian, New York, 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
  • Mehrotra, Rajnish, University of Washington, Seattle, Washington, United States

The multi-center clinical trial, ASCEND, demonstrated a modestly larger effect of 12-week treatment with sertraline (SER) on depression scores, compared with cognitive behavioral therapy (CBT).


We undertook a post-hoc analysis to characterize patient adherence to these treatments and to examine the association of patient treatment adherence with depression scores at the end of the intervention.


The average age of participants (n=120) was 51 ± 13 years, 57% were male, and 43% were white. Among those randomized to CBT, 82% completed at least 7 of the 10 sessions, 72% were rated by the therapist as engaged in at least 7 CBT sessions and 47% of the participants attempted/completed CBT homework > 50% of the time. SER dose titration was done algorithmically; 73% of participants randomized to drug, took their prescribed dose for at least 8 weeks. Depression was assessed by the Quick Inventory of Depression Scores, Clinician Rated (QIDS-C) at 12 weeks. There was a weak negative association between number of CBT sessions attended and QIDS-C score (R=-0.19) and number of days SER was taken and QIDS-C score (R=-0.27).

We examined the association of baseline parameters (demographics, depression diagnosis, severity, and history, participation in a pre-enrollment motivational interviewing session, and initial treatment preference) with treatment adherence separately for CBT and SER. The only significant predictor for CBT adherence was a history of depression; participants with no history of depression attended on average 1.8 more sessions and were 26% more likely to attend a session (p=.02) than participants with a history of depression. There was no relationship between baseline parameters and SER use.


High levels of treatment adherence for depression, with both CBT and SER, can be achieved in patients on maintenance hemodialysis. Baseline characteristics are generally poor predictors of future adherence to treatment. The identification of patient and treatment level factors that promote adherence to treatments for depression are needed.


  • NIDDK Support