Abstract: FR-PO967
Effect of Social Support on Response to Treatment of Depression in Patients with CKD
Session Information
- CKD Interventions: Trials and Quality Improvement
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Lackey, Blake Neal, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
- Wang, Tianyi, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
- Carmody, Thomas, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
- McAdams, Meredith C., The University of Texas Southwestern Medical Center, Dallas, Texas, United States
- Hedayati, Susan, The University of Texas Southwestern Medical Center, Dallas, Texas, United States
Background
The Chronic Kidney Disease Antidepressant Sertraline Trial (CAST) was a randomized, double-blind, placebo-controlled trial of sertraline vs. placebo in patients with nondialysis CKD, which did not reveal a statistically significant improvement in depressive symptoms. Using the validated Kidney Disease Quality of Life Questionnaire (KDQOL) and Quick Inventory of Depressive Symptomatology-Clinician Rated scale (QIDS-C), we investigated whether higher baseline social support would affect adherence to study drug by pill count and improve response to antidepressant treatment
Methods
Two-hundred-and-one patients with stages 3b-5 non–dialysis CKD were enrolled. The primary outcome was improvement in depressive symptoms from baseline to 12 weeks by QIDS-C (higher score, more depression), stratified by baseline social function tertiles (higher tertile, higher social function). The interaction of treatment group (sertraline vs. placebo) by social function was also tested.
Results
Mean age was 58.2±13.2 years. Those in the highest tertile of social function were more likely to be older (p=0.0002), male (p=0.01), live alone (p=0.04), and be less educated (p=0.009) than the lowest tertile. Baseline CKD stage or eGFR did not differ between tertiles. Participants with the highest level of social function at baseline had the largest decrease in QIDS-C score if treated with placebo (-6.13), but participants with the lowest level of social functionhad the largest decrease in QIDS-C if treated with sertraline (-5.87), interaction p=0.03. There was a stepwise increase in percent of drug taken (88%, 95%, and 97%) for lowest, middle and highest tertiles of social function in the sertraline group (p=0.008) which was not observed in the placebo group. In addition, there was a significant interaction such that participants assigned to sertraline took a higher percent of their study drug if their social function was better at baseline, but this was not true of placebo, interaction p=0.01.
Conclusion
Sertraline may be more effective than placebo for improving depression in those with non-dialysis CKD with worse social functioning at baseline, even though participants with lower social function may be less adherent to antidepressant medications.