Physician-diagnosed depression as a correlate of hospitalizations in patients receiving long-term hemodialysis.
BACKGROUND
Hospital admissions consume a large proportion of costs for the end-stage renal disease (ESRD) program in the United States. We investigated whether a physician diagnosis of depression increases the risk for hospitalization or death in patients with ESRD receiving long-term hemodialysis (HD), independent of medical comorbidities.


METHODS
Centralized Veterans Affairs (VA) databases were used to identify a population-based prevalence cohort of 1,588 male patients with ESRD receiving long-term HD in VA facilities between September 1, 2000, and September 30, 2000. International Classification of Diseases, Ninth Revision, codes were used to identify comorbidities and depression diagnosis. Negative binomial regression models were used to examine the association between depression diagnosis and number of hospitalizations and cumulative hospital days in a 2-year observation period. Logistic regression models were used to investigate the association between depression diagnosis and hospitalization, death, and death or hospitalization.


RESULTS
The prevalence of physician-diagnosed depression was 14.7%. Patients with a depression diagnosis were more likely to be white and have more comorbidities. Depression diagnosis was associated with increased hospital days (rate ratio for adjusted model, 1.31; 95% confidence interval, 1.04 to 1.66) and increased number of hospitalizations (rate ratio for adjusted model, 1.30; 95% confidence interval, 1.11 to 1.52). Depression diagnosis was not statistically associated with death or the composite of death or hospitalization in adjusted models.


CONCLUSIONS
Physician-diagnosed depression was associated significantly with both increased hospitalization rate and length of stay in patients with ESRD receiving outpatient HD in VA facilities, independent of demographics and comorbidities. Prospective studies should be conducted to assess whether treatment of depression will decrease hospitalization in these patients.
Hedayati
S Susan
SS
Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA. susan.hedayati@med.va.gov
Grambow
Steven C
SC
Szczech
Lynda A
LA
Stechuchak
Karen M
KM
Allen
Andrew S
AS
Bosworth
Hayden B
HB
D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D005006:Ethnicity / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009026:Mortality; D010045:Outpatients / Q000523:psychology*; D015995:Prevalence; D006435:Renal Dialysis / Q000523:psychology* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012306:Risk; D013997:Time Factors; D014481:United States; D014728:Veterans / Q000523:psychology