Impact of depression on long-term outcome after renal transplantation:  a prospective cohort study.
BACKGROUND
Renal transplantation is the treatment of choice for end stage renal disease. Although there is more depression in wait-listed versus transplant patients, depression persists after transplantation. We investigated the determinants of depression in renal transplantation recipients (RTRs) and the association with cardiovascular (CV) and all-cause-mortality and graft failure.


METHODS
RTR were investigated between 2001 and 2003. Depression was assessed using the Depression Subscale of the Symptom Checklist (SCL-90). Mortality and graft failure were recorded until May 2009.


RESULTS
A total of 527 RTR (age, 51±12 years; 55% men) were studied; 31% of the RTR were indicated with depression. Independent variables associated with depression were medically unfit for work, proteinuria, lower physical activity level, and longer dialysis duration. During follow-up for 7.0 (6.2-7.5) years, 114 RTR (59 CV) died. In Cox regression analyses, depression was strongly associated with increased risk for CV (HR=2.12 [1.27-3.53], P=0.004) and all-cause mortality (HR=1.96 [1.36-2.84], P<0.001). Adjustments for confounders did not materially change these associations. The association with graft failure (HR=1.77 [1.01-3.10]. P=0.047) disappeared after adjustment for kidney function (P=0.6).


CONCLUSIONS
Although our study has several limitations, including the lack of pretransplant depression status, we identified medically unfit for work, proteinuria, lower physical activity level, and longer dialysis duration as independent variables associated with depression. We furthermore found that depression is associated with CV and all-cause mortality in RTR.
Department of Nephrology, University of Groningen, University Medical Center Groningen, The Netherlands. d.m.zelle@umcg.nl
Dorien M
DM
Zelle
Heleen F
HF
Dorland
Judith G M
JG
Rosmalen
Eva
E
Corpeleijn
Reinold O B
RO
Gans
Jaap J
JJ
Homan van der Heide
Willem J
WJ
van Son
Gerjan
G
Navis
Stephan J L
SJ
Bakker
D000328:Adult; D002318:Cardiovascular Diseases / Q000453:epidemiology; D015331:Cohort Studies; D003863:Depression / Q000150:complications*; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology* / Q000523:psychology*; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000601:surgery; D016030:Kidney Transplantation / Q000401:mortality / Q000523:psychology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors