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Kidney Week

Abstract: TH-PO316

Outcomes of Incident Peritoneal Dialysis Patients with Depressive Symptoms

Session Information

  • Home Dialysis - I
    November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 802 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

  • Hussein, Wael F., Satellite Healthcare, San Jose, California, United States
  • Weinhandl, Eric D., Satellite Healthcare, San Jose, California, United States
  • Watson, Emily, Satellite Healthcare, San Jose, California, United States
  • Green, Gopa B., Satellite Healthcare, San Jose, California, United States
  • Abra, Graham E., Satellite Healthcare, San Jose, California, United States
Background

In 2016, CMS introduced annual depression screening as a reporting measure under the QIP. For incident dialysis patients, screening surveys are typically administered by social workers in the fourth month of modality initiation. This study aimed to explore the outcomes related to depressive symptoms in a contemporary cohort of incident peritoneal dialysis (PD) patients.

Methods

A retrospective observational study was conducted on patients starting PD for the first time between January 2017 and December 2022 at dialysis units managed by a mid-sized U.S. non-profit dialysis provider. Those who completed the PHQ2 survey within 150 days after starting PD were followed for 365 days from the date of survey completion. A PHQ2 score equal to or greater than 3 was considered positive. Univariate and age- and sex-adjusted Fine-Gray models were used to examine the association between time to transfer to hemodialysis (HD) or death, and time to first hospitalization, while Poisson regression was used for rate ratios.

Results

A total of 2,215 patients were included. Mean age was 58.7 ± 15.9 years, with 38% being female. PHQ2 surveys were positive in 75 (3.4%) patients. During the follow-up period, 16.3% transferred to HD, 3.7% died, and 6.5% received a kidney transplant. Patients with a positive PHQ2 survey were found more likely to experience transfer to HD or death (hazard ratios (HR): 1.99; 95% CI: 1.33 – 2.97, and 2.02; 95% CI: 1.35 – 3.03 in the unadjusted and adjusted models respectively). The hospitalization event rate was 1.45 and 0.75 events per patient-year for those with positive and negative PHQ2 results, respectively (Rate Ratio (RR) 1.95, 95% CI: 1.53 – 2.45). Similarly, hospital days per year were 11.06 and 5.44 days per patient-year for the PHQ2 positive and negative patients, respectively (RR: 2.03, 95% CI: 1.87 – 2.20). Lastly, a higher hazard for time to first hospitalization was observed in those with a positive PHQ2 survey (HR 1.62, 95% CI: 1.14 – 2.31, and 1.62, 95% CI: 1.14 – 2.30).

Conclusion

Among incident peritoneal dialysis patients, depression symptoms are associated with increased risk of transfer to HD or death and of hospitalization. This represents a potentially addressable risk factor for poor clinical outcomes that may be amenable to intervention.