ASCENDing to New Heights in Our Understanding of the Treatment of Depression Among Individuals Receiving Hemodialysis
Authors: Jennifer E. Flythe
Journal: Annals of Internal Medicine (2019)

Editorials19 March 2019ASCENDing to New Heights in Our Understanding of the Treatment of Depression Among Individuals Receiving HemodialysisJennifer E. Flythe, MD, MPHJennifer E. Flythe, MD, MPHUniversity of North Carolina School of Medicine and University of North Carolina, Chapel Hill, North Carolina (J.E.F.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M19-0526 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Depression is the most common psychiatric condition among patients receiving maintenance hemodialysis. Depression negatively affects functional status and quality of life and is associated with increased treatment nonadherence, hospitalizations, and mortality (1). Despite the clinical and patient-reported significance of depression, clinicians often underrecognize and undertreat depressive symptoms (2, 3).In 2016, the Centers for Medicare & Medicaid Services mandated that dialysis clinics screen and document follow-up plans for depression. Although these steps should increase depression recognition, clinicians must be prepared to respond to positive screening results. Guidelines recommend either cognitive behavioral therapy (CBT) or second-generation antidepressants (such as selective serotonin ...References1. Hedayati SS, Yalamanchili V, Finkelstein FO. A practical approach to the treatment of depression in patients with chronic kidney disease and end-stage renal disease. Kidney Int. 2012;81:247-55. [PMID: 22012131] doi:10.1038/ki.2011.358 CrossrefMedlineGoogle Scholar2. Weisbord SD, Fried LF, Mor MK, Resnick AL, Unruh ML, Palevsky PM, et al. Renal provider recognition of symptoms in patients on maintenance hemodialysis. Clin J Am Soc Nephrol. 2007;2:960-7. [PMID: 17702730] CrossrefMedlineGoogle Scholar3. Flythe JE, Hilliard T, Castillo G, Ikeler K, Orazi J, Abdel-Rahman E, et al. Symptom prioritization among adults receiving in-center hemodialysis: a mixed methods study. Clin J Am Soc Nephrol. 2018;13:735-745. [PMID: 29559445] doi:10.2215/CJN.10850917 CrossrefMedlineGoogle Scholar4. Qaseem A, Barry MJ, Kansagara D; Clinical Guidelines Committee of the American College of Physicians. Nonpharmacologic versus pharmacologic treatment of adult patients with major depressive disorder: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2016;164:350-9. [PMID: 26857948]. doi:10.7326/M15-2570 LinkGoogle Scholar5. Cukor D, Ver Halen N, Asher DR, Coplan JD, Weedon J, Wyka KE, et al. Psychosocial intervention improves depression, quality of life, and fluid adherence in hemodialysis. J Am Soc Nephrol. 2014;25:196-206. [PMID: 24115478] doi:10.1681/ASN.2012111134 CrossrefMedlineGoogle Scholar6. Palmer SC, Natale P, Ruospo M, Saglimbene VM, Rabindranath KS, Craig JC, et al. Antidepressants for treating depression in adults with end-stage kidney disease treated with dialysis. Cochrane Database Syst Rev. 2016:CD004541. [PMID: 27210414] doi:10.1002/14651858.CD004541.pub3 CrossrefMedlineGoogle Scholar7. Mehrotra R, Cukor D, Unruh M, Rue T, Heagerty P, Cohen SD, et al. Comparative efficacy of therapies for treatment of depression for patients undergoing maintenance hemodialysis. A randomized clinical trial. Ann Intern Med. 2019;170:369-79. doi:10.7326/M18-2229 LinkGoogle Scholar8. Hedayati SS, Daniel DM, Cohen S, Comstock B, Cukor D, Diaz-Linhart Y, et al. Rationale and design of a trial of sertraline vs. cognitive behavioral therapy for end-stage renal disease patients with depression (ASCEND). Contemp Clin Trials. 2016;47:1-11. [PMID: 26621218] doi:10.1016/j.cct.2015.11.020 CrossrefMedlineGoogle Scholar9. Gartlehner G, Gaynes BN, Forneris C, Lohr KN. Comparative benefits and harms of antidepressant, psychological, complementary, and exercise treatments for major depression. Ann Intern Med. 2016;165:454. [PMID: 27653717]. doi:10.7326/L16-0209 LinkGoogle Scholar10. Costa AS, Tiffin-Richards FE, Holschbach B, Frank RD, Vassiliadou A, Krüger T, et al. Clinical predictors of individual cognitive fluctuations in patients undergoing hemodialysis. Am J Kidney Dis. 2014;64:434-42. [PMID: 24679895] doi:10.1053/j.ajkd.2014.02.012 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: University of North Carolina School of Medicine and University of North Carolina, Chapel Hill, North Carolina (J.E.F.)Acknowledgment: The author thanks Adeline Dorough, MPH, for her editorial assistance.Grant Support: By grant K23 DK109401 from the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health.Disclosures: The author has disclosed no conflicts of interest. The form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-0526.Corresponding Author: Jennifer E. Flythe, MD, MPH, University of North Carolina Kidney Center, 7024 Burnett-Womack CB #7155, Chapel Hill, NC 27599; e-mail, [email protected]unc.edu.This article was published at Annals.org on 26 February 2019. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoComparative Efficacy of Therapies for Treatment of Depression for Patients Undergoing Maintenance Hemodialysis Rajnish Mehrotra , Daniel Cukor , Mark Unruh , Tessa Rue , Patrick Heagerty , Scott D. Cohen , Laura M. Dember , Yaminette Diaz-Linhart , Amelia Dubovsky , Tom Greene , Nancy Grote , Nancy Kutner , Madhukar H. Trivedi , Davin K. Quinn , Nisha ver Halen , Steven D. Weisbord , Bessie A. Young , Paul L. Kimmel , and S. Susan Hedayati Metrics Cited byDepression and anxiety symptoms among patients receiving maintenance hemodialysis: a single center cross-sectional study 19 March 2019Volume 170, Issue 6Page: 414-415KeywordsDepressionDrug therapyMedical dialysisRenal diseasesRenal failureSleepStatistical dataTreatment guidelines ePublished: 26 February 2019 Issue Published: 19 March 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...