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Abstract: FR-PO427

Depression Screening Is Associated with Lower Mortality and Hospitalization Among Adults Initiating Chronic Hemodialysis

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Fischer, Michael J., Jesse Brown VA Medical Center, Chicago, Illinois, United States
  • Streja, Elani, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
  • Hsiung, Jui-Ting, University of California Irvine, School of Medicine, Orange, California, United States
  • Crowley, Susan T., Veterans Health Administration, West Haven, Connecticut, United States
  • Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Kalantar-Zadeh, Kamyar, University of California Irvine, School of Medicine, Orange, California, United States
  • Kourany, Wissam M., Veterans Affairs Durham Healthcare System, Durham, North Carolina, United States
Background

Transitioning to chronic hemodialysis (HD) continues to be a vulnerable period for adults with end-stage renal disease (ESRD). Depression commonly develops among these patients and negatively impacts quality of life, treatment adherence, hospitalization, and mortality. Depression screening may be an important tool in identifying depression and improving outcomes. Among a large national cohort of Veterans, we examined whether depression screening in the year prior to chronic HD transition led to lower mortality and hospitalization in the first year of HD.

Methods

Using data from the USRDS Transition of Care in CKD study, an observational study that focuses on Veterans who transitioned to chronic dialysis between 2007 to 2015, we identified adults with an outpatient nephrology, geriatric or primary care visit in the year prior to transition to HD. Pre-ESRD depression screening was defined as completion of a Patient Health Questionnaire-2 (PHQ-2) in the 12 months prior to transition. The main outcomes were all-cause mortality and hospitalization in the 12 months post transition. Associations were examined with Cox proportional hazards models (mortality) and Poisson regression models (hospitalization). Hierarchal adjustment models were used to account for sociodemographics, comorbidity and laboratory values, pre-ESRD care intensity, and post-ESRD dialysis characteristics.

Results

After excluding adults with a diagnosis/treatment of depression, bipolar disease, or dementia prior to the index outpatient visit, the final analytic cohort consisted of 30,013 Veterans who transitioned to HD. Sixty-one percent of patients had PHQ-2 screening during the 12 months prior to HD transition. During the 12 months post-transition, the crude all-cause mortality rate was 32/100 person-year for those screened and 35/100 person-year for those not screened, while the median (IQR) hospitalizations were 2 (2,2) per year for both groups. In fully adjusted models, PHQ-2 screening was associated with a significantly lower risk of mortality (HR 0.94, 95% CI: 0.90-0.98) and hospitalization (IRR 0.97, 95% CI: 0.95-0.99).

Conclusion

Screening for depression among adults with ESRD in the year prior to transition to chronic hemodialysis was associated with improved outcomes after dialysis initiation.

Funding

  • NIDDK Support