Clin Transplant Res.  2024 Jun;38(2):98-105. 10.4285/ctr.24.0004.

Comparison of depression and suicide between dialysis and kidney transplant recipients in Korea: a nationwide population study

• Kang MS
• Kim DY
• Kim SH
• Kim JS
• Yang JW
• Han BG
• Kang DR
• Lee J
• Lee JY

• KMID: 2557603
• DOI: http://doi.org/10.4285/ctr.24.0004

Abstract

Background
Kidney transplantation (KT) improves physical and psychological prognoses for patients with end-stage kidney disease (ESKD). However, few comparative studies have examined depression and suicide rates among patients with ESKD treated with dialysis versus KT.
Methods
Data on 21,809 patients with ESKD were extracted from the Korean National Health Insurance Service database, extending from January 2002 to December 2018. These patients exhibited no history of depression or insomnia before starting renal replacement therapy. Outcomes were compared between dialysis and KT recipients using 1:2 propensity score matching (PSM).
Results
Of the patients, 17,649 received dialysis (hemodialysis, 15,537; peritoneal dialysis, 2,112), while 4,160 underwent KT. Of those on dialysis, 45.04% (7,949) experienced insomnia, compared to 25.72% (1,070) of KT recipients (P<0.001). Depression was more frequent among dialysis recipients (22.77%, 4,019) than KT recipients (8.61%, 358; P<0.001). Additionally, those on dialysis had a higher incidence of suicide (0.19%, 33) than recipients of KT (0.12%, 5; P=0.047). After PSM, the hazard ratio (HR) for depression in patients on dialysis compared to KT recipients was 1.76 (95% confidence interval [CI], 1.56–1.99). In subgroup analysis, the relative likelihood of depression among dialysis recipients was particularly high for residents of urban areas (HR, 2.10; 95% CI, 1.80–2.44) and patients under 65 years old (HR, 1.82; 95% CI, 1.62–2.09).
Conclusions
KT recipients exhibit a lower suicide rate than patients on dialysis. Furthermore, KT is associated with a lower prevalence of depression among Korean patients with ESKD, particularly urban residents and individuals under 65 years old.

Keyword

Depression; Suicide; Kidney transplantation

Figure

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  Fig. 1 Flow diagram showing selection of the study population from the Korean National Health Insurance Service (NHIS). KT, kidney transplantation; ESKD, end-stage kidney disease.

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  Fig. 2 Kaplan-Meier analysis of the probabilities of (A) suicide and (B) depression, comparing dialysis and kidney transplantation (KT) .

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