Dialysis Patients with Depressive Symptoms Have Higher Hospitalization Rates

Austin—It has been previously reported that in-center hemodialysis patients with depressive symptoms are less likely to remain adherent to dialysis treatment schedules and more likely experience hospital admission. Researchers for DaVita, Inc., led by Kathryn Aebel-Groesch, MSW, LCSW, recently conducted a study to identify the incidence of depression among patients on peritoneal dialysis and home dialysis and to examine the impact of depression on rates of hospitalization in those patient populations. They reported results of the study during a poster session at the NKFG 2018 Spring Clinical Meetings in a poster titled Hospitalizations among Peritoneal Dialysis and Home Hemodialysis Patients with Symptoms of Depression.

The researchers utilized data from the electronic health records of a large dialysis organization for the period May 2016 to April 2017. Social workers at the dialysis centers performed screenings for depression biannually using the Patient Health Questionnaire-2 (PHQ-2) scale (total score range 0-6). Patients with active diagnoses of depression, bipolar disorder, cognitive impairment, or a language barrier were not included in the screening for the study. Hospital admissions in the 3 months after screening were compared among patients with symptoms of depression (total PHQ-2 score ≥3) with those without depression (PHQ-2 total score ≤2).

In total, 2661 of 40,676 patients on peritoneal dialysis as did 5882 patients on home dialysis. Of those, 6.5% of the peritoneal dialysis patients and 6.0% of the home hemodialysis patients were scored as positive for depressive symptoms. Hospitalization rates were higher among patients with depressive symptoms compared with patients without depressive symptoms in both modalities: 1.9 versus 1.1 admissions per patient-year for peritoneal dialysis patients and 1.9 versus 1.4 admissions per patient-year for home hemodialysis patients.

The researchers summarized their findings: “Symptoms of depression were identified among patients on peritoneal dialysis and home hemodialysis with a frequency similar to that previously observed in in-center hemodialysis patients. Moreover, peritoneal and home hemodialysis patients with symptoms of depression were more likely to be hospitalized than those without, as has been reported for in-center hemodialysis patients. Clinical initiatives to target patients who screen positive for depression should be designed to reach peritoneal dialysis and home hemodialysis patients as well as those receiving in-center hemodialysis.”

Source: Aebel-Groesch K, Dunn D, Major A, Njord L, Tentori F, Benner D. Hospitalizations among peritoneal dialysis and home hemodialysis patients with symptoms of depression. Abstract of a poster presented at the National Kidney Foundation 2018 Spring Clinical Meetings, April 10-14, 2018, Austin, Texas.