title: Depression and all-cause and cardiovascular mortality in patients on haemodialysis: a multinational cohort study.
abstract: Depression and early death are both common in adults with Stage 5 chronic kidney disease. Studies have shown an association between depression and total mortality, but the association between depression and cardiovascular death is less certain.
  
  
  
  We conducted a prospective multinational cohort study involving adults who were treated with long-term haemodialysis within a single dialysis network between April and November 2010. Depression was considered present when patients reported a Beck Depression Inventory (BDI) II score ≥14 at baseline. Sensitivity analyses considered a BDI II score ≥20 to identify moderate depression. Multivariable Cox proportional hazards regression was used to assess adjusted hazards for all-cause and cardiovascular mortality at 12 months.
  
  
  
  Three thousand and eighty-six participants in the network received the BDI II questionnaire, and 2278 (73%) provided complete responses to the survey questions. Among these, 1047 (46%) reported depression. During a mean follow-up of 11 (standard deviation: 2.5) months (2096 person-years), we recorded 175 deaths, of which 66 were attributable to cardiovascular causes. Depression (BDI score ≥14) was not associated with all-cause mortality [adjusted hazard ratio: 1.26 (95% confidence interval: 0.93–1.71)] or cardiovascular mortality [0.82 (0.50–1.34)]. When a higher BDI score (BDI score ≥20) was used to identify moderate depression, depression was associated with total mortality [1.40 (1.02–1.93)] but not cardiovascular mortality [1.05 (0.63–1.77)].
  
  
  
  The association between depression and cardiovascular mortality in adults with kidney failure treated with haemodialysis is uncertain. Depression is a heterogeneous disorder and may only be a risk factor for premature death when at least of moderate severity.
authors.affiliation: Diaverum Medical Scientific Office, Lund, Sweden.
authors.forename: Valeria
authors.initials: V
authors.lastname: Saglimbene
authors.affiliation: University of Otago, Christchurch, New Zealand.
authors.forename: Suetonia
authors.initials: S
authors.lastname: Palmer
authors.affiliation: Center for Outcomes, Research and Clinical Epidemiology, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Scardapane
authors.affiliation: University of Sydney, Sydney, Australia.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Craig
authors.affiliation: Diaverum Medical Scientific Office, Lund, Sweden.|Amedeo Avogadro University of Eastern Piedmont, Novara, Italy.
authors.forename: Marinella
authors.initials: M
authors.lastname: Ruospo
authors.affiliation: Diaverum Medical Scientific Office, Lund, Sweden.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Natale
authors.affiliation: Diaverum Medical Scientific Office, Lund, Sweden.
authors.forename: Letizia
authors.initials: L
authors.lastname: Gargano
authors.affiliation: Diaverum Medical Scientific Office, Lund, Sweden.
authors.forename: Miguel
authors.initials: M
authors.lastname: Leal
authors.affiliation: Diaverum Medical Scientific Office, Lund, Sweden.|Medical University of Lublin, Lublin, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Bednarek-Skublewska
authors.affiliation: Diaverum Medical Scientific Office, Lund, Sweden.|Medical University of Silesia, SHS, Katowice, Poland.
authors.forename: Jan
authors.initials: J
authors.lastname: Dulawa
authors.affiliation: Diaverum Medical Scientific Office, Lund, Sweden.
authors.forename: Tevfik
authors.initials: T
authors.lastname: Ecder
authors.affiliation: Diaverum Medical Scientific Office, Lund, Sweden.
authors.forename: Paul
authors.initials: P
authors.lastname: Stroumza
authors.affiliation: Diaverum Medical Scientific Office, Lund, Sweden.
authors.forename: Angelo
authors.initials: A
authors.lastname: Marco Murgo
authors.affiliation: Diaverum Medical Scientific Office, Lund, Sweden.
authors.forename: Staffan
authors.initials: S
authors.lastname: Schön
authors.affiliation: Diaverum Medical Scientific Office, Lund, Sweden.
authors.forename: Charlotta
authors.initials: C
authors.lastname: Wollheim
authors.affiliation: Diaverum Medical Scientific Office, Lund, Sweden.
authors.forename: Jörgen
authors.initials: J
authors.lastname: Hegbrant
authors.affiliation: Diaverum Medical Scientific Office, Lund, Sweden.|University of Sydney, Sydney, Australia.|University of Bari, Bari, Italy.|Diaverum Academy, Bari, Italy.
authors.forename: Giovanni F M
authors.initials: GF
authors.lastname: Strippoli
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality* / Q000523:psychology; D003863:Depression / Q000209:etiology* / Q000401:mortality / Q000523:psychology; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis / Q000401:mortality* / Q000523:psychology*; D012307:Risk Factors; D011795:Surveys and Questionnaires; D015996:Survival Rate
keywords: depression; end-stage kidney disease; haemodialysis; mortality; prevalence