title: Increased risk of progression to dialysis or death in CKD patients with depressive symptoms: A prospective 3-year follow-up cohort study.
abstract: OBJECTIVE
  Comorbid depressive symptoms are common and undertreated in patients with renal diseases. It remains uncertain whether it is an independent risk factor for poor clinical outcome in patients with chronic kidney disease (CKD). This 3-year study investigated the association of depressive symptoms with long-term outcomes, including initiation of dialysis and all-cause mortality, in a population of CKD patients from Taiwan.
  
  
  METHODS
  This prospective cohort study enrolled 262 CKD subjects, none of whom were undergoing dialysis, from a hospital in Taiwan during 2010-2011 and followed them for 3years. At enrollment, all subjects underwent a structured interview with the Taiwan Depression Questionnaire to ascertain the baseline presence of depressive symptoms. Primary end points were initiation of dialysis and all-cause mortality.
  
  
  RESULTS
  A total of 21.4% of enrolled patients (56/262) reported the presence of depressive symptoms at baseline. After 3-year follow-up, the risk of composite events (dialysis or death) was significantly higher in CKD patients with depressive symptoms than in those without depressive symptoms (adjusted hazard ratio [AHR]=2.95, 95% confidence interval [CI]: 1.86-4.72). Depressive symptoms at baseline could independently predict the risk of initiation of dialysis (AHR=2.25, 95% CI: 1.27-4.98) or all-cause mortality (AHR=3.08, 95% CI: 1.69-7.06).
  
  
  CONCLUSIONS
  Depressive symptoms at baseline were independently associated with increased risk of poor clinical outcomes in CKD patients, which suggested that the prompt provision of appropriate psycho-social care may improve the holistic clinical outcomes for CKD patients.
authors: Department of Nursing, Dalin Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, Chiayi, Taiwan; College of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan.
authors: Hsin-Hung
authors: HH
authors: Chiang
authors: Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
authors: How-Ran
authors: HR
authors: Guo
authors: Rehabilitation Counseling Program, Portland State University, USA.
authors: Hanoch
authors: H
authors: Livneh
authors: Division of Allergy, Immunology and Rheumatology, Dalin Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, Chiayi, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan.
authors: Ming-Chi
authors: MC
authors: Lu
authors: Department of Nursing, Dalin Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, Chiayi, Taiwan.
authors: Mei-Ling
authors: ML
authors: Yen
authors: Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Medical Research, Dalin Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, Chiayi, Taiwan; Department of Nursing, Tzu Chi College of Technology, Hualien, Taiwan. Electronic address: dm732024@tzuchi.com.tw.
authors: Tzung-Yi
authors: TY
authors: Tsai
mesh_terms: D000328:Adult; D002423:Cause of Death; D003863:Depression / Q000209:etiology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000401:mortality* / Q000523:psychology* / Q000628:therapy; D057566:Self Report; D013624:Taiwan / Q000453:epidemiology
keywords: Chronic kidney disease; Cohort study; Dialysis; Mortality; Taiwan