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Abstract: FR-PO453

The Impact of Depressive Symptoms on Outcomes in Incident Hemodialysis Patients

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent 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
  • Abra, Graham E., Satellite Healthcare, San Jose, California, United States
  • Green, Gopa B., Satellite Healthcare, San Jose, California, United States
Background

Dialysis is associated with increased physical and psychosocial burden. This study explored the association of depressive symptoms with mortality and hospitalization among incident hemodialysis (HD) patients.

Methods

Incident in-center HD patients who began dialysis between Jan 2017 and Dec 2022 at centers managed by a mid-size non-profit dialysis provider, and who completed the PHQ2 depression screening within 150 days of initiating dialysis, were followed up for one year post-survey completion for death and for hospital admissions. Observation was continued until the end of April 2023. PHQ2 score ≥ 3 was considered positive. For time to event analysis, univariate and age- and sex-adjusted Cox regression were used, while Poisson regression was used to compute rate ratios.

Results

A total of 6,203 patients were included. Mean age was 61 ± 15 years, and 39% were female. The PHQ2 survey was positive in 230 (3.7%) patients. During follow-up, 295 (4.8%) patients died. The hazard ratio (HR) for death was 1.44 (95% CI: 0.86 -2.43) and 1.67 (95% CI: 0.99 – 2.81) in univariate and adjusted analysis respectively. The rates of hospital admissions were 1.88 per patient-year for those with a negative survey, and 1.22 for those with a positive survey (RR: 1.54, 95% CI: 1.38 – 1.72). As shown in the figure, the HR for time to first hospitalization was 1.42 (95% CI: 1.18 – 1.70) for those with a positive survey compared to those with a negative one, in both the univariate and adjusted analyses. Furthermore, patients with a positive survey spent more days in the hospital (13.08 versus 8.15 days per patient-year, RR 1.61, 95% CI: 1.54 to 1.67).

Conclusion

Depressive symptoms appear to be correlated with an increased risk of hospitalization among incident HD patients. This finding provides an opportunity to enhance patient care and potentially reduce associated healthcare costs.

Figure: Survival of incident hemodialysis patients from completion of depression survey to first hospital admission