We need to talk about depression and dialysis: but what questions should we ask and does anyone know the answers?

Abstract

Depression is common in people with chronic kidney disease (CKD). When diagnosed via a gold standard semi-structured psychiatric interview by culturally-competent staff, depression affects one fifth to one quarter of people with CKD, whether in receipt of maintenance dialysis, with non-dialysis treated CKD, or with a functioning transplant (respective prevalence rates 22.8 (95% confidence interval (CI) 18.6 to 27.6)%, 21.4 (95%CI 11.1 to 37.2)% and 25.7 (95%CI 12.8 to 44.9)%)1. These frequencies are clearly in excess of the average population lifetime risk of ~ 9%2. Potential reasons for the high rates of depression in end stage kidney disease (ESKD) include the overlap of some risk factors for both conditions, the alteration of physiological processes associated with ESKD and the psychosocial consequences of living with ESKD3. Depression in people receiving dialysis is associated with lower quality of life, increased hospitalisations and, likely shortened survival3.