Kidney Res Clin Pract.
2024 Nov;43(6):818-828. 10.23876/j.krcp.22.268.
The impact of severe depression on the survival of older patients with end-stage kidney disease
- Jeon YH
1,2 - Lim JH1,2
- Jeon Y2,3
- Chung YK1,2
- Kim YS2,4
- Kang SW2,5
- Yang CW2,6
- Kim NH2,7
- Jung HY1
- Choi JY1
- Park SH1
- Kim CD1
- Kim YL1
- Cho JH1
- Affiliations
-
- 1Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
- 2Clinical Research Center for End-Stage Renal Disease, Daegu, Republic of Korea
- 3Department of Statistics, College of Natural Science, Kyungpook National University, Daegu, Republic of Korea
- 4Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- 5Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- 6Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- 7Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
- KMID: 2564689
- DOI: http://doi.org/10.23876/j.krcp.22.268
Abstract
- Background
Incidence of depression increases in patients with end-stage kidney disease (ESKD). We evaluated the association between depression and mortality among older patients with ESKD, which has not been studied previously. Methods: This nationwide prospective cohort study included 487 patients with ESKD aged >65 years, who were categorized into minimal, mild-to-moderate, and severe depression groups based on their Beck Depression Inventory-II (BDI-II) scores. Predisposing factors for high BDI-II scores and the association between the scores and survival were analyzed. Results: The severe depression group showed a higher modified Charlson comorbidity index value and lower serum albumin, phosphate, and uric acid levels than the other depression groups. The Kaplan-Meier curve revealed a significantly lower survival in the severe depression group than in the minimal and mild-to-moderate depression groups (p = 0.011). Multivariate Cox regression analysis confirmed that severe depression was an independent risk factor for mortality in the study cohort (hazard ratio, 1.39; 95% confidence interval, 1.01–1.91; p = 0.041). Additionally, BDI-II scores were associated with modified Charlson comorbidity index (p = 0.009) and serum albumin level (p = 0.004) in multivariate linear regression. Among the three depressive symptoms, higher somatic symptom scores were associated with increased mortality. Conclusion: Severe depression among older patients with ESKD increases mortality compared with minimal or mild-to-moderate depression, and patients with concomitant somatic symptoms require careful management of their comorbidities and nutritional status.
