title: Association between depression and death in people with CKD: a meta-analysis of cohort studies.
abstract: BACKGROUND
  Depression occurs relatively commonly in people with chronic kidney disease (CKD), but it is uncertain whether depression is a risk factor for premature death in this population. Interventions to reduce mortality in CKD consistently have been ineffective and new strategies are needed.
  
  
  METHODS
  Systematic review and meta-analysis of cohort studies.
  
  
  METHODS
  Adults with CKD.
  
  
  METHODS
  Cohort studies identified in Ovid MEDLINE through week 3 December 2012 without language restriction.
  
  
  METHODS
  Depression status as determined by physician diagnosis, clinical coding, or self-reported scales.
  
  
  METHODS
  All-cause and cardiovascular mortality. Outcomes were summarized as relative risks (RRs) with 95% CIs using random-effects meta-analysis.
  
  
  RESULTS
  22 studies (83,381 participants) comprising 12,063 cases of depression (mean prevalence, 27.4%; 95% CI, 20.0%-36.3%) with a follow-up of 3 months to 6.5 years were included. Methodological quality generally was good or fair. Depression consistently increased the risk of death from any cause (RR, 1.59; 95% CI, 1.35-1.87), but had less certain effects on cardiovascular mortality (RR, 1.88; 95% CI, 0.84-4.19). Associations for mortality were similar regardless of the diagnostic method used for depression, but were weaker in analyses controlled for preexisting cardiovascular disease (RR, 1.36; 95% CI, 1.23-1.50).
  
  
  CONCLUSIONS
  Meta-analyses adjusting for antidepressant medication use were not possible, and data for kidney transplant recipients and individuals with earlier stages of CKD not treated with dialysis were limited.
  
  
  CONCLUSIONS
  Depression is associated with a substantially increased risk of death in people with CKD. Effective treatment for depression in people with CKD may reduce mortality.
authors.affiliation: Department of Medicine, University of Otago Christchurch, New Zealand.
authors.forename: Suetonia C
authors.initials: SC
authors.lastname: Palmer
authors.forename: Mariacristina
authors.initials: M
authors.lastname: Vecchio
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Craig
authors.forename: Marcello
authors.initials: M
authors.lastname: Tonelli
authors.forename: David W
authors.initials: DW
authors.lastname: Johnson
authors.forename: Antonio
authors.initials: A
authors.lastname: Nicolucci
authors.forename: Fabio
authors.initials: F
authors.lastname: Pellegrini
authors.forename: Valeria
authors.initials: V
authors.lastname: Saglimbene
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Logroscino
authors.forename: S Susan
authors.initials: SS
authors.lastname: Hedayati
authors.forename: Giovanni F M
authors.initials: GF
authors.lastname: Strippoli
mesh_terms: D015331:Cohort Studies; D003863:Depression / Q000401:mortality* / Q000523:psychology*; D006801:Humans; D009026:Mortality / Q000639:trends; D016032:Randomized Controlled Trials as Topic; D006435:Renal Dialysis / Q000401:mortality / Q000639:trends; D051436:Renal Insufficiency, Chronic / Q000401:mortality* / Q000523:psychology* / Q000628:therapy
keywords: Depression; dialysis; mortality; outcomes