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The association of depressive symptoms with survival in a Dutch cohort of patients with end-stage renal disease.

AIM
To evaluate the prevalence and the influence on survival of depressive symptoms in a European cohort of end-stage renal disease (ESRD) patients on renal replacement therapy (RRT).


METHODS
In a prospective fashion, symptoms of depression were evaluated in ESRD patients on RRT using the depression subscore of the Hospital Anxiety and Depression Scale (HADS). Fatal and non-fatal clinical events were determined during a 1-year follow-up.


RESULTS
Of 101 patients with ESRD, 42% showed manifest depressive symptoms, defined as a HADS-D score > or =7. No association was found between depressive symptoms and severity of somatic disease. During follow-up, all-cause mortality was significantly higher in patients with depressive symptoms above threshold (n = 42, mortality: 26%) compared to patients with depressive symptoms below threshold (n = 59, mortality 8%), (crude HR 3.3, CI 1.2-9.6, P = 0.02). The excess in mortality was mainly caused by a higher incidence of septicaemia (0 versus 12%, P = 0.01). After adjustment for clinical parameters, this association between depressive symptoms and mortality became even stronger. There was no significant difference observed in the incidence of cardiovascular events.


CONCLUSIONS
Patients with ESRD treated with dialysis show a high level of depressive symptoms that is independently associated with poor survival. Future research should address appropriate therapeutic regimens.