Michael J Fischer1, Elani Streja2, Jui-Ting Hsiung3, Susan T Crowley4, Csaba P Kovesdy5, Kamyar Kalantar-Zadeh2, Wissam M Kourany6. 1. Center of Innovation for Complex Chronic Healthcare, Research Service, Edward Hines Jr VA Hospital, Hines, IL, USA. 2. Division of Nephrology and Hypertension, School of Medicine, Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine, Orange, CA, USA. 3. Tibor Rubin VA Medical Center, Long Beach, CA, USA. 4. VA Connecticut Healthcare System, West Haven, CT, USA. 5. Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA. 6. Veteran Affairs Durham Healthcare System, Durham, NC, USA.
Abstract
BACKGROUND: Transitioning to maintenance hemodialysis (HD) is a vulnerable period for persons with end-stage renal disease (ESRD), punctuated by high rates of depression, hospitalizations and death. Screening for depression during this time may help to improve patient outcomes but formal inquiry has yet to be conducted. Among a national Veteran cohort, we examined whether depression screening in the year prior to HD initiation led to improved outcomes in the year thereafter. METHODS: Associations between pre-ESRD depression screening and post-ESRD outcomes were examined with Cox proportional hazards models (mortality) and Poisson regression models (hospitalization). Hierarchal adjustment models accounted for sociodemographic, clinical, pre-ESRD care and dialysis characteristics. RESULTS: The final analytic cohort of the study was 30 013 Veterans of whom 64% underwent pre-ESRD depression screening. During the 12 months post-transition, the crude all-cause mortality rate was 0.32 person-year for those screened and 0.35 person-year for those not screened, while the median (interquartile range) hospitalizations were 2 (2, 2) per year for both groups. In fully adjusted models, pre-ESRD depression screening was associated with a lower risk of mortality [hazard ratio (95% confidence interval): 0.94 (0.90-0.99)] and hospitalization [incidence rate ratio (95% confidence interval): 0.97 (0.9-0.99)]. CONCLUSION: Depression screening among adults prior to maintenance HD transition may be associated with better outcomes during the following year. Published by Oxford University Press on behalf of ERA-EDTA 2021.
BACKGROUND: Transitioning to maintenance hemodialysis (HD) is a vulnerable period for persons with end-stage renal disease (ESRD), punctuated by high rates of depression, hospitalizations and death. Screening for depression during this time may help to improve patient outcomes but formal inquiry has yet to be conducted. Among a national Veteran cohort, we examined whether depression screening in the year prior to HD initiation led to improved outcomes in the year thereafter. METHODS: Associations between pre-ESRD depression screening and post-ESRD outcomes were examined with Cox proportional hazards models (mortality) and Poisson regression models (hospitalization). Hierarchal adjustment models accounted for sociodemographic, clinical, pre-ESRD care and dialysis characteristics. RESULTS: The final analytic cohort of the study was 30 013 Veterans of whom 64% underwent pre-ESRD depression screening. During the 12 months post-transition, the crude all-cause mortality rate was 0.32 person-year for those screened and 0.35 person-year for those not screened, while the median (interquartile range) hospitalizations were 2 (2, 2) per year for both groups. In fully adjusted models, pre-ESRD depression screening was associated with a lower risk of mortality [hazard ratio (95% confidence interval): 0.94 (0.90-0.99)] and hospitalization [incidence rate ratio (95% confidence interval): 0.97 (0.9-0.99)]. CONCLUSION: Depression screening among adults prior to maintenance HD transition may be associated with better outcomes during the following year. Published by Oxford University Press on behalf of ERA-EDTA 2021.
Authors: Rajnish Mehrotra; Daniel Cukor; Mark Unruh; Tessa Rue; Patrick Heagerty; Scott D Cohen; Laura M Dember; Yaminette Diaz-Linhart; Amelia Dubovsky; Tom Greene; Nancy Grote; Nancy Kutner; Madhukar H Trivedi; Davin K Quinn; Nisha Ver Halen; Steven D Weisbord; Bessie A Young; Paul L Kimmel; S Susan Hedayati Journal: Ann Intern Med Date: 2019-02-26 Impact factor: 25.391
Authors: Virginia Wang; Cynthia J Coffman; Karen M Stechuchak; Theodore S Z Berkowitz; Paul L Hebert; David Edelman; Ann M O'Hare; Susan T Crowley; Hollis J Weidenbacher; Matthew L Maciejewski Journal: J Am Soc Nephrol Date: 2018-12-07 Impact factor: 10.121
Authors: Elani Streja; Csaba Pal Kovesdy; Melissa Soohoo; Yoshitsugu Obi; Connie M Rhee; Christina Park; Joline L T Chen; Tracy Nakata; Danh V Nguyen; Alpesh N Amin; Steven J Jacobsen; John J Sim; Kamyar Kalantar-Zadeh Journal: Clin J Am Soc Nephrol Date: 2018-06-14 Impact factor: 8.237
Authors: Rasheed A Balogun; Emaad M Abdel-Rahman; Seki A Balogun; Evan H Lott; Jun Ling Lu; Sandra M Malakauskas; Jennie Z Ma; Kamyar Kalantar-Zadeh; Csaba P Kovesdy Journal: Clin J Am Soc Nephrol Date: 2012-08-16 Impact factor: 8.237
Authors: Steven D Weisbord; Maria K Mor; Mary Ann Sevick; Anne Marie Shields; Bruce L Rollman; Paul M Palevsky; Robert M Arnold; Jamie A Green; Michael J Fine Journal: Clin J Am Soc Nephrol Date: 2014-07-31 Impact factor: 8.237
Authors: Patrizia Natale; Suetonia C Palmer; Marinella Ruospo; Valeria M Saglimbene; Kannaiyan S Rabindranath; Giovanni Fm Strippoli Journal: Cochrane Database Syst Rev Date: 2019-12-02