BACKGROUND: Hospital admissions consume a large proportion of costs for the end-stage renal disease (ESRD) program in the United States. We investigated whether a physician diagnosis of depression increases the risk for hospitalization or death in patients with ESRD receiving long-term hemodialysis (HD), independent of medical comorbidities. METHODS: Centralized Veterans Affairs (VA) databases were used to identify a population-based prevalence cohort of 1,588 male patients with ESRD receiving long-term HD in VA facilities between September 1, 2000, and September 30, 2000. International Classification of Diseases, Ninth Revision, codes were used to identify comorbidities and depression diagnosis. Negative binomial regression models were used to examine the association between depression diagnosis and number of hospitalizations and cumulative hospital days in a 2-year observation period. Logistic regression models were used to investigate the association between depression diagnosis and hospitalization, death, and death or hospitalization. RESULTS: The prevalence of physician-diagnosed depression was 14.7%. Patients with a depression diagnosis were more likely to be white and have more comorbidities. Depression diagnosis was associated with increased hospital days (rate ratio for adjusted model, 1.31; 95% confidence interval, 1.04 to 1.66) and increased number of hospitalizations (rate ratio for adjusted model, 1.30; 95% confidence interval, 1.11 to 1.52). Depression diagnosis was not statistically associated with death or the composite of death or hospitalization in adjusted models. CONCLUSION: Physician-diagnosed depression was associated significantly with both increased hospitalization rate and length of stay in patients with ESRD receiving outpatient HD in VA facilities, independent of demographics and comorbidities. Prospective studies should be conducted to assess whether treatment of depression will decrease hospitalization in these patients.
BACKGROUND: Hospital admissions consume a large proportion of costs for the end-stage renal disease (ESRD) program in the United States. We investigated whether a physician diagnosis of depression increases the risk for hospitalization or death in patients with ESRD receiving long-term hemodialysis (HD), independent of medical comorbidities. METHODS: Centralized Veterans Affairs (VA) databases were used to identify a population-based prevalence cohort of 1,588 male patients with ESRD receiving long-term HD in VA facilities between September 1, 2000, and September 30, 2000. International Classification of Diseases, Ninth Revision, codes were used to identify comorbidities and depression diagnosis. Negative binomial regression models were used to examine the association between depression diagnosis and number of hospitalizations and cumulative hospital days in a 2-year observation period. Logistic regression models were used to investigate the association between depression diagnosis and hospitalization, death, and death or hospitalization. RESULTS: The prevalence of physician-diagnosed depression was 14.7%. Patients with a depression diagnosis were more likely to be white and have more comorbidities. Depression diagnosis was associated with increased hospital days (rate ratio for adjusted model, 1.31; 95% confidence interval, 1.04 to 1.66) and increased number of hospitalizations (rate ratio for adjusted model, 1.30; 95% confidence interval, 1.11 to 1.52). Depression diagnosis was not statistically associated with death or the composite of death or hospitalization in adjusted models. CONCLUSION: Physician-diagnosed depression was associated significantly with both increased hospitalization rate and length of stay in patients with ESRD receiving outpatientHD in VA facilities, independent of demographics and comorbidities. Prospective studies should be conducted to assess whether treatment of depression will decrease hospitalization in these patients.
Authors: Michael J Fischer; Paul L Kimmel; Tom Greene; Jennifer J Gassman; Xuelei Wang; Deborah H Brooks; Jeanne Charleston; Donna Dowie; Denyse Thornley-Brown; Lisa A Cooper; Marino A Bruce; John W Kusek; Keith C Norris; James P Lash Journal: Kidney Int Date: 2011-06-01 Impact factor: 10.612
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Authors: S Susan Hedayati; Abu T Minhajuddin; Masoud Afshar; Robert D Toto; Madhukar H Trivedi; A John Rush Journal: JAMA Date: 2010-05-19 Impact factor: 56.272
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Authors: Linda Y Belayev; Maria K Mor; Mary Ann Sevick; Anne Marie Shields; Bruce L Rollman; Paul M Palevsky; Robert M Arnold; Michael J Fine; Steven D Weisbord Journal: Hemodial Int Date: 2014-11-18 Impact factor: 1.812
Authors: Fredric O Finkelstein; Kelli L Arsenault; Ana Taveras; Kwabena Awuah; Susan H Finkelstein Journal: Nat Rev Nephrol Date: 2012-10-23 Impact factor: 28.314
Authors: S Susan Hedayati; Abu T Minhajuddin; Robert D Toto; David W Morris; A John Rush Journal: Am J Kidney Dis Date: 2009-06-03 Impact factor: 8.860
Authors: S Susan Hedayati; Abu T Minhajuddin; Robert D Toto; David W Morris; A John Rush Journal: Am J Kidney Dis Date: 2009-06-03 Impact factor: 8.860
Authors: Mark L Unruh; Brett Larive; Glenn M Chertow; Paul W Eggers; Amit X Garg; Jennifer Gassman; Maria Tarallo; Fredric O Finkelstein; Paul L Kimmel Journal: Am J Kidney Dis Date: 2013-01-15 Impact factor: 8.860