TY - JOUR
T1 - Association between depression and death in people with CKD
T2 - A meta-analysis of cohort studies
AU - Palmer, Suetonia
AU - Vecchio, Mariacristina
AU - Craig, Jonathan
AU - Tonelli, Marcello
AU - Johnson, David
AU - Nicolucci, Antonio
AU - Pellegrini, Fabio
AU - Saglimbene, Valeria
AU - Logroscino, Giancarlo
AU - Hedayati, Susan
AU - Strippoli, Giovanni
PY - 2013/9
Y1 - 2013/9
N2 - Background: Depression occurs relatively commonly in people with chronic kidney disease (CKD), but it is uncertain whether depression is a risk factor for premature death in this population. Interventions to reduce mortality in CKD consistently have been ineffective and new strategies are needed. Study Design: Systematic review and meta-analysis of cohort studies. Setting & Population: Adults with CKD. Selection Criteria for Studies: Cohort studies identified in Ovid MEDLINE through week 3 December 2012 without language restriction. Predictor: Depression status as determined by physician diagnosis, clinical coding, or self-reported scales. Selection Criteria for Studies: All-cause and cardiovascular mortality. Outcomes were summarized as relative risks (RRs) with 95% CIs using random-effects meta-analysis. Results: 22 studies (83,381 participants) comprising 12,063 cases of depression (mean prevalence, 27.4%; 95% CI, 20.0%-36.3%) with a follow-up of 3 months to 6.5 years were included. Methodological quality generally was good or fair. Depression consistently increased the risk of death from any cause (RR, 1.59; 95% CI, 1.35-1.87), but had less certain effects on cardiovascular mortality (RR, 1.88; 95% CI, 0.84-4.19). Associations for mortality were similar regardless of the diagnostic method used for depression, but were weaker in analyses controlled for preexisting cardiovascular disease (RR, 1.36; 95% CI, 1.23-1.50). Limitations: Meta-analyses adjusting for antidepressant medication use were not possible, and data for kidney transplant recipients and individuals with earlier stages of CKD not treated with dialysis were limited. Conclusions: Depression is associated with a substantially increased risk of death in people with CKD. Effective treatment for depression in people with CKD may reduce mortality.
AB - Background: Depression occurs relatively commonly in people with chronic kidney disease (CKD), but it is uncertain whether depression is a risk factor for premature death in this population. Interventions to reduce mortality in CKD consistently have been ineffective and new strategies are needed. Study Design: Systematic review and meta-analysis of cohort studies. Setting & Population: Adults with CKD. Selection Criteria for Studies: Cohort studies identified in Ovid MEDLINE through week 3 December 2012 without language restriction. Predictor: Depression status as determined by physician diagnosis, clinical coding, or self-reported scales. Selection Criteria for Studies: All-cause and cardiovascular mortality. Outcomes were summarized as relative risks (RRs) with 95% CIs using random-effects meta-analysis. Results: 22 studies (83,381 participants) comprising 12,063 cases of depression (mean prevalence, 27.4%; 95% CI, 20.0%-36.3%) with a follow-up of 3 months to 6.5 years were included. Methodological quality generally was good or fair. Depression consistently increased the risk of death from any cause (RR, 1.59; 95% CI, 1.35-1.87), but had less certain effects on cardiovascular mortality (RR, 1.88; 95% CI, 0.84-4.19). Associations for mortality were similar regardless of the diagnostic method used for depression, but were weaker in analyses controlled for preexisting cardiovascular disease (RR, 1.36; 95% CI, 1.23-1.50). Limitations: Meta-analyses adjusting for antidepressant medication use were not possible, and data for kidney transplant recipients and individuals with earlier stages of CKD not treated with dialysis were limited. Conclusions: Depression is associated with a substantially increased risk of death in people with CKD. Effective treatment for depression in people with CKD may reduce mortality.
KW - Depression
KW - dialysis
KW - mortality
KW - outcomes
UR - http://www.scopus.com/inward/record.url?scp=84883253381&partnerID=8YFLogxK
U2 - 10.1053/j.ajkd.2013.02.369
DO - 10.1053/j.ajkd.2013.02.369
M3 - Review article
SN - 0272-6386
VL - 62
SP - 493
EP - 505
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 3
ER -