Depressive Symptoms Linked to Increased Hospitalization in Patients with CKD

Thiratest Leesutipornchai, MD

Credit: Hawaii Residency Programs

Depressive symptoms are associated with an increased risk of hospitalization among patients with chronic kidney disease (CKD), according to findings from a recent systematic review and meta-analysis.

Data presented at the American Society of Nephrology Kidney Week 2023 by Thiratest Leesutipornchai, MD, of the University of Hawaii at Manoa John A Burns School of Medicine, showed both dialysis and non-dialysis patients who exhibited depressive symptoms had a greater risk of hospitalization.¹

“Depressive symptoms are relatively common in patients with chronic kidney disease (CKD). Recent studies showed that depressive disorders are associated with increased mortality risk in patients with CKD. However, evidence regarding the impact of depression on the risk of hospitalization in the CKD population is still limited,” wrote investigators.¹

An estimated 37 million adults in the US have CKD. Affected individuals may experience decreased energy, trouble concentrating, poor appetite, trouble sleeping, and other symptoms that may also have a negative impact on mental health. One of the most common mental disorders in the US, depression affects an estimated 21 million adults and has been linked to an elevated risk of mortality, especially among those with chronic diseases and other health behaviors.^2,3

According to recent data, the prevalence of depression is 3 to 4 times greater in patients with CKD compared to the general population without CKD, although information about the impact of depression and CKD on hospitalization is limited.²

The present systematic review and meta-analysis was not the only research on factors affecting health outcomes in patients with CKD presented at ASN Kidney Week 2023. Multiple other studies from the annual meeting put a spotlight on the impact of food insecurity, social deprivation, and distance to transplant centers, highlighting various influences on patient health.

To examine the association between depressive symptoms and the risk of hospitalization in patients with CKD, Leesutipornchai and a team of investigators searched the MEDLINE, EMBASE, and Cochrane Library databases for cohort studies assessing the association of depressive symptoms on hospitalization rate among CKD patients. For inclusion in the meta-analysis, studies were required to use the random-effects model to calculate risk ratios (RR) and 95% confidence intervals (CIs).¹

In total, investigators identified 6 cohort studies published between 2005 and 2015 with a total of 11,258 CKD patients to be included in the analysis. Among all study participants, 7404 had depressive symptoms and 4122 did not have depressive symptoms.¹

Upon analysis, patients with depressive symptoms had an increased risk of hospitalization (pooled RR, 1.139; 95% CI, 1.055–1.229; P = .001; I2 = 51.1%) compared to those without depressive symptoms. In a subgroup analysis of 3 studies, depressive symptoms were associated with an increased risk of hospitalization in patients with CKD who were not receiving dialysis (pooled RR, 1.432; 95% CI, 1.204-1.704; P < .001; I2 = 0.0%). Further analysis revealed CKD patients who exhibited depressive symptoms and were receiving dialysis also faced an increased risk of hospitalization (pooled RR, 1.088; 95% CI, 1.057-1.119; P < .001; I2 = 0.0%).¹

“Our meta-analysis demonstrated that depressive symptoms were associated with an increased risk of hospitalization. This possible association is essential given the implication of depression screening to improve the quality of life in CKD patients,” investigators concluded.¹

References:

1. Leesutipornchai T, Arayangkool C, Tanariyakul M, Aiumtrakul N. Depressive Symptoms Are Associated with Increased Hospitalization Rate in CKD Patients: A Systematic Review and Meta-Analysis of Cohort Studies. Paper Presented at: American Society of Nephrology Kidney Week 2023. November 1-5, 2023.
2. Shirazian S, Grant CD, Aina O, Mattana J, Khorassani F, Ricardo AC. Depression in Chronic Kidney Disease and End-Stage Renal Disease: Similarities and Differences in Diagnosis, Epidemiology, and Management. Kidney Int Rep. 2016;2(1):94-107. Published 2016 Sep 20. doi:10.1016/j.ekir.2016.09.005
3. Pratt LA, Druss BG, Manderscheid RW, Walker ER. Excess mortality due to depression and anxiety in the United States: results from a nationally representative survey. Gen Hosp Psychiatry. 2016;39:39-45. doi:10.1016/j.genhosppsych.2015.12.003