title: Depressive disorder in renal transplantation: an analysis of Medicare claims.
abstract: BACKGROUND
  Little is known about depression after kidney transplantation.
  
  
  METHODS
  Retrospective observational study.
  
  
  METHODS
  US Renal Data System data; first kidney-only recipients who underwent transplantation in 1995 to 2003 with Medicare as primary payer (n = 47,899).
  
  
  METHODS
  Demographic and clinical characteristics of recipients (age, sex, race, ethnicity, primary cause of kidney disease, pretransplantation time on dialysis therapy, body mass index, initial immunosuppressive medications, and use of induction antibodies) and donors (age, sex, race, and living or deceased), transplantation year, and number of HLA mismatches.
  
  
  METHODS
  Depression incidence identified in Medicare claims and associations with clinical outcomes during the first 3 years posttransplantation.
  
  
  RESULTS
  Depression was identified in 3,360 transplant recipients in the 3 years posttransplantation. Cumulative incidences were 5.05%, 7.29%, and 9.10% at 1, 2, and 3 years posttransplantation. In Cox proportional hazards analysis, white race, female sex, diabetes as primary cause of kidney disease, more than 3 years on dialysis therapy before transplantation, marked obesity (body mass index >or= 35 kg/m(2)), rapamycin use, antilymphocyte globulin or antithymocyte globulin for antibody induction therapy, donor age of 65 years or older, more recent transplantation, and presence of 6 HLA mismatches were associated with more depression, as identified in claims. Controlling for other known risk factors, time-dependent Cox proportional hazards analysis showed that depression was associated with increased graft failure (hazard ratio, 2.10; 95% confidence interval, 1.94 to 2.27; P < 0.001), return to dialysis therapy (hazard ratio, 1.97; 95% confidence interval, 1.76 to 2.19; P < 0.001), and death with a functioning graft (hazard ratio, 2.24; 95% confidence interval, 2.00 to 2.50; P < 0.001).
  
  
  CONCLUSIONS
  Depression identified through Medicare claims, limiting case ascertainment; limited number of recipient- or donor-related factors explored for potential associations; and limited depression treatment and pretransplantation depression information.
  
  
  CONCLUSIONS
  Depression is associated with several identifiable factors and a 2-fold greater risk of graft failure and death with a functioning graft.
authors.affiliation: Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Belgium. fabienne.dobbels@med.kuleuven.be
authors.forename: Fabienne
authors.initials: F
authors.lastname: Dobbels
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Skeans
authors.forename: Jon J
authors.initials: JJ
authors.lastname: Snyder
authors.forename: Anne V
authors.initials: AV
authors.lastname: Tuomari
authors.forename: J Ross
authors.initials: JR
authors.lastname: Maclean
authors.forename: Bertram L
authors.initials: BL
authors.lastname: Kasiske
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003866:Depressive Disorder / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality / Q000523:psychology*; D008297:Male; D006278:Medicare; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology