Depression and its association with peritonitis in long-term peritoneal dialysis patients.
BACKGROUND
Depression is the most common psychological disorder among patients with end-stage renal disease and has been associated with mortality in patients maintained on hemodialysis therapy. Peritonitis is the leading cause of technique failure among long-term peritoneal dialysis (PD) patients. This prospective study is designed to examine the relationship between depression and peritonitis.


METHODS
All patients on long-term PD therapy in our unit between January 1, 1997, and January 31, 2002, completed a Beck Depression Inventory (BDI) assessment at 6-month intervals. BDI scores were analyzed 2 ways. First, patients were placed into either group I (BDI score < 10) or group II (BDI score > or = 11) and were reclassified based on subsequent scores. Second, multivariable analysis was performed looking at initial BDI score as a risk factor for peritonitis, adjusting for age older than 65 years, diabetes, coronary artery disease, and race.


RESULTS
One hundred sixty-two patients were enrolled, and 281 individual BDI assessments were completed. There was a significantly greater incidence of diabetes and coronary artery disease in group II. Rates for overall and gram-positive peritonitis were significantly greater in group II patients compared with group I patients. Using Cox regression, only BDI score of 11 or greater was associated with the development of peritonitis (hazard ratio, 2.7; 95% confidence interval, 1.2 to 6.0).


CONCLUSIONS
There is an association between BDI score of 11 or greater and the development of peritonitis. Whether treatment of depression can impact on the rate of peritonitis remains to be examined.
Troidle
Laura
L
Yale University School of Medicine, New Haven, CT, USA.
Watnick
Suzanne
S
Wuerth
Diane B
DB
Gorban-Brennan
Nancy
N
Kliger
Alan S
AS
Finkelstein
Fredric O
FO
D000368:Aged; D015897:Comorbidity; D003327:Coronary Disease / Q000453:epidemiology; D003863:Depression / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology / Q000382:microbiology / Q000523:psychology; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology / Q000382:microbiology / Q000523:psychology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000523:psychology*; D010538:Peritonitis / Q000453:epidemiology* / Q000382:microbiology / Q000523:psychology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011581:Psychological Tests; D012008:Recurrence; D012307:Risk Factors; D012720:Severity of Illness Index