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Ethnic Differences in the Association of Depressive Symptoms with Clinical Outcome in Dialysis Patients.

ABSTRACT: BACKGROUND:Studies show mixed results on the association between depressive symptoms and adverse clinical outcomes in patients on dialysis therapy. Ethnicity may play a role in these heterogeneous results. No studies have investigated the interplay between ethnicity and depressive symptoms on clinical outcome in this patient population. This study aims to examine interaction between ethnicity and depressive symptoms on hospitalization and mortality in dialysis patients. METHODS:A multi-ethnic cohort in 10 dialysis centers included 687 dialysis patients between 2012 and 2017, with an average follow-up of 3.2 years. Depressive symptoms were measured using the Beck Depression Inventory. Interaction was assessed by investigating excess risk on an additive scale using both absolute rates and relative risks. Multivariable regression models included demographic, social, and clinical variables. RESULTS:Adverse outcomes are more pronounced in native patients, compared to immigrant patients. The risk for mortality and hospitalization is considerably higher in native patients compared to immigrants. An excess risk on an additive scale indicates the presence of possible causal interaction. CONCLUSIONS:Depressive symptoms are a risk factor for hospitalization and mortality, especially in native dialysis patients. Adverse clinical events associated with depressive symptoms differ among ethnic groups. This differential association could play a role in the conflicting findings in literature. Ethnicity is an important factor when investigating depressive symptoms and clinical outcome in dialysis patients. Future research should focus on the possible mechanisms and pathways involved in these differential associations.

SUBMITTER: Schouten RW

PROVIDER: S-EPMC6736895 | biostudies-literature | 2019 Oct

REPOSITORIES: biostudies-literature

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Ethnic Differences in the Association of Depressive Symptoms with Clinical Outcome in Dialysis Patients.

Schouten Robbert W RW Haverkamp Gerlinde L GL Loosman Wim L WL Chandie Shaw Prataap K PK van Ittersum Frans J FJ Smets Yves F C YFC Vleming Louis-Jean LJ Dekker Friedo W FW Honig Adriaan A Siegert Carl E H CEH

Journal of racial and ethnic health disparities 20190618 5

<h4>Background</h4>Studies show mixed results on the association between depressive symptoms and adverse clinical outcomes in patients on dialysis therapy. Ethnicity may play a role in these heterogeneous results. No studies have investigated the interplay between ethnicity and depressive symptoms on clinical outcome in this patient population. This study aims to examine interaction between ethnicity and depressive symptoms on hospitalization and mortality in dialysis patients.<h4>Methods</h4>A ...[more]

PMID: 31215016

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Project description:This study evaluates whether the associations between social integration, inflammation, and depressive symptoms vary by race/ethnicity in the United States. Our study includes 5,634 respondents age 40 and older from the National Health and Nutrition Examination Survey for 2005-2008. We fit multivariate logistic regression models with interactions between C-reactive protein (CRP) and race/ethnicity as well as social integration and race/ethnicity to test our hypotheses. We find that social integration and CRP operate independently in their associations with depressive symptoms by race/ethnicity. Higher levels of social integration are associated with lower predicted probability of depressive symptoms for White and Black populations. This association is not statistically significant for the Hispanic population. CRP is associated with depressive symptoms for the White population, but not the Black or Hispanic populations. Our results suggest that studying depressive symptoms, and other mental health outcomes, among the US population without considering variation by race/ethnicity may restrict scholarly understanding of health disparities. Population-based assessments of associations between physiological processes or social integration should consider whether these variables operate differently by race/ethnicity and work to explain why differences may emerge. Furthermore, interventions aimed at social integration may improve mental health among older adults in the United States; especially for the least socially integrated. Highlights • Social integration and inflammation operate independently in their associations with depressive symptoms.• Associations between mental health, inflammation, and social integration differ by race/ethnicity.• Inflammation is associated with depressive symptoms for non-Hispanic White but not for non-Hispanic Black or Hispanic populations.• Social integration protects against depressive symptoms for non-Hispanic White and Black populations but not for the Hispanic population.• Approaches to health disparities research should consider variations by subpopulations.

Project description:ImportanceMajor depressive disorder (MDD) is prevalent among patients with chronic kidney disease (CKD) and is associated with morbidity and mortality. The efficacy and adverse events of selective serotonin reuptake inhibitors in these patients are unknown.ObjectiveTo determine whether treatment with sertraline improves depressive symptoms in patients with CKD and MDD.Design, setting, and participantsThe Chronic Kidney Disease Antidepressant Sertraline Trial (CAST) was a randomized, double-blind, placebo-controlled trial involving 201 patients with stage 3, 4, or 5 non-dialysis-dependent CKD, who were enrolled at 3 US medical centers. The Mini Neuropsychiatric Interview was used to establish MDD. The first participant was randomized in March 2010 and the last clinic visit occurred in November 2016.InterventionsAfter a 1-week placebo run-in, participants were randomized to sertraline (n = 102) for 12 weeks at an initial dose of 50 mg/d (escalated to a maximum dose of 200 mg/d based on tolerability and response) or matching placebo (n = 99).Main outcomes and measuresThe primary outcome was improvement in depressive symptom severity from baseline to 12 weeks determined by the 16-item Quick Inventory of Depression Symptomatology-Clinician Rated (QIDS-C16) (score range, 0-27; minimal clinically important difference, 2 points). Secondary outcomes included improvement in quality of life (Kidney Disease Quality of Life Survey-Short Form; score range, 0-100; higher scores indicate more favorable quality of life) and adverse events.ResultsThere were 201 patients (mean [SD] age, 58.2 [13.2] years; 27% female) randomized. The primary analysis included 193 patients who had at least 1 outcome assessment after randomization. The mean (SD) baseline QIDS-C16 score was 14.0 (2.4) in the sertraline group (n = 97) and 14.1 (2.4) in the placebo group (n = 96). The median participation time was 12.0 weeks and the median achieved dose was 150 mg/d, which was not significantly different between the groups. The QIDS-C16 score changed by -4.1 in the sertraline group and by -4.2 in the placebo group (between-group difference, 0.1 [95% CI, -1.1 to 1.3]; P = .82). There was no significant between-group difference in change in patient-reported overall health on the Kidney Disease Quality of Life Survey (median score, 0 in the sertraline group vs 0 in the placebo group; between-group difference, 0 [95% CI, -10.0 to 0]; P = .61). Nausea or vomiting occurred more frequently in the sertraline vs placebo group (22.7% vs 10.4%, respectively; between-group difference, 12.3% [95% CI, 1.9% to 22.6%], P = .03), as well as diarrhea (13.4% vs 3.1%; between-group difference, 10.3% [95% CI, 2.7% to 17.9%], P = .02).Conclusions and relevanceAmong patients with non-dialysis-dependent CKD and MDD, treatment with sertraline compared with placebo for 12 weeks did not significantly improve depressive symptoms. These findings do not support the use of sertraline to treat MDD in patients with non-dialysis-dependent CKD.Trial registrationclinicaltrials.gov Identifier: NCT00946998.

Project description:BACKGROUND:Abnormalities in serum potassium are risk factors for sudden cardiac death and arrhythmias among dialysis patients. Although a previous study in hemodialysis patients has shown that race/ethnicity may impact the relationship between serum potassium and mortality, the relationship remains unclear among peritoneal dialysis (PD) patients where the dynamics of serum potassium is more stable. METHODS:Among 17,664 patients who started PD between January 1, 2007 and December 31, 2011 in a large US dialysis organization, we evaluated the association of serum potassium levels with all-cause and arrhythmia-related deaths across race/ethnicity using time-dependent Cox models with adjustments for demographics. We also used restricted cubic spline functions for serum potassium levels to explore non-linear associations. RESULTS:Baseline serum potassium levels were the highest among Hispanics (4.2 ± 0.7 mEq/L) and lowest among non-Hispanic blacks (4.0 ± 0.7 mEq/L). Among 2,949 deaths during the follow-up of median 2.2 (interquartile ranges 1.3-3.2) years, 683 (23%) were arrhythmia-related deaths. Overall, both hyperkalemia and hypokalemia (i.e., serum potassium levels >5.0 and <3.5 mEq/L, respectively) were associated with higher all-cause and arrhythmia-related mortality. In a stratified analysis according to race/ethnicity, the association of hypokalemia with all-cause and arrhythmia-related mortality was consistent with an attenuation for arrhythmia-related mortality in non-Hispanic blacks. Hyperkalemia was associated with all-cause and arrhythmia-related mortality in non-Hispanic whites and non-Hispanic blacks, but no association was observed in Hispanics. CONCLUSION:Among incident PD patients, hypokalemia was consistently associated with all-cause and arrhythmia-related deaths irrespective of race/ethnicity. However, while hyperkalemia was associated with both death outcomes in non-Hispanic blacks and whites, it was not associated with either death outcome in Hispanic patients. Further studies are needed to demonstrate whether different strategies should be followed for the management of serum potassium levels according to race/ethnicity.

Project description:BACKGROUND:Instrumental Activities of Daily Living (IADL) is an indicator of whether a community-dwelling elderly can live independently. IADL decline was reported to be associated with aging and depression. The present study aimed to investigate whether the association between IADL decline and depressive symptoms differs with aging, using two age groups of community-dwelling Japanese elderly in their 70s and 80s. METHODS:We conducted longitudinal analysis among participants in their 70s and 80s at the baseline from Septuagenarians, Octogenarians, Nonagenarians Investigation with Centenarians (SONIC) study. IADL was assessed by The Tokyo Metropolitan Institute of Gerontology (TMIG) index of competence. As a main predictor, depressive symptoms were measured by the five-item version of the Geriatrics Depression Scale (GDS-5). As possible confounders, we considered cognitive function, body mass index, solitary living, education, economic status, medical history of stroke and heart disease, hypertension, dyslipidemia, diabetes, and sex. We obtained odds ratios (ORs) of IADL decline for having depressive symptoms in each age group (70s/80s) and tested interactions between depressive symptoms and age groups in relation to IADL decline in 3?years by logistic regression. Additionally, to confirm age group differences, we conducted multiple group analysis. RESULTS:There were 559 participants in their 70s and 519 in their 80s. Compared to participants without depressive symptoms, those with depressive symptoms had higher OR of IADL decline in 70s (OR [95% CI]?=?2.33 [1.13, 4.78]), but not in 80s (OR [95% CI]?=?0.85 [0.46, 1.53]). There were significant interactions between depressive symptoms and age groups in relation to IADL decline (p-value?=?0.03). Multiple group analyses showed differences between the age groups by Akaike information criterion (AIC), and ORs (95%CI) decline for depressive symptoms was 2.33 (1.14, 4.77) in 70s and 0.85 (0.47, 1.54) in 80s. CONCLUSION:The association of depressive symptoms and IADL decline during the 3?years was significantly different between the 70s and 80s age groups, and significant association was found only in people in their 70s. Detecting depressive symptoms may be a key for preventing IADL decline in people in their 70s and not for those in their 80s.

Project description:BACKGROUND:Patients with end-stage renal disease (ESRD) receiving dialysis have poor health-related quality of life. Physical symptoms are highly prevalent among dialysis-dependent patients and play important roles in health-related quality of life. A range of symptom assessment tools have been used in dialysis-dependent patients, but there has been no previous systematic assessment of the existing symptom measures' content, validity, and reliability. STUDY DESIGN:Systematic review of the literature. SETTINGS & POPULATION:Patients with ESRD on maintenance dialysis therapy. SELECTION CRITERIA FOR STUDIES:Instruments with 3 or more physical symptoms previously used in dialysis-dependent patients and evidence of validity or reliability testing. INTERVENTION:Patient-reported physical symptom assessment instrument. OUTCOMES:Instrument symptom-related content, validity, and reliability. RESULTS:From 3,148 screened abstracts, 89 full-text articles were eligible for review. After article exclusion and further article identification by reference reviews, 58 articles on 23 symptom assessment instruments with documented reliability or validity testing were identified. Of the assessment instruments, 43.5% were generic and 56.5% were ESRD specific. Symptoms most frequently assessed were fatigue, shortness of breath, insomnia, nausea and vomiting, and appetite. Instruments varied widely in respondent time burden, recall period, and symptom attributes. Few instruments considered recall periods less than 2 weeks and few assessed a range of symptom attributes. Psychometric testing was completed for congruent validity (70%), known-group validity (25%), responsiveness (30%), internal consistency (78%), and test-retest reliability (65%). Content validity was assessed in dialysis populations in 57% of the 23 instruments. LIMITATIONS:Consideration of physical symptoms only and exclusion of single symptom-focused instruments. CONCLUSIONS:The number of available instruments focused exclusively on physical symptoms in dialysis patients is limited. Few symptom-containing instruments have short recall periods, assess diverse symptom attributes, and have undergone comprehensive psychometric testing. Improved symptom-focused assessment tools are needed to improve symptom evaluation and symptom responsiveness to intervention among dialysis-dependent patients.

Project description:Unlabelled?BackgroundCost is always a big issue for dialysis patients. In the present study, we analyzed the effect of different payment schemes on dialysis adequacy and clinical outcome in our peritoneal dialysis program. ?MethodsThis is a single-center cohort study. A total of 175 patients who began dialysis from January 2006 to December 2007 were included. Baseline data, including volume status, dietary intake and nutrition status, dialysis adequacy, and sodium removal were collected at 6 months after peritoneal dialysis. Based on the different payment schemes, the patients were divided into 2 groups, higher payment group (GHP, 130 cases, with more than 85% reimbursement), and lower payment group (GLP, 45 cases, with less than 50% payment or totally self-paid). Patients were followed up until dropout or until December 31, 2013. ?ResultsAt baseline, patients in the 2 groups had nearly the same residual renal function. But the GLP group patients dialyzed at a lower dose (4,516.91 ± 1,768.20 mL vs 6,058.17 ± 2,013.43 mL, p < 0.001). They had lower creatinine clearance (51.64 ± 24.23 L/w vs 70.54 ± 30.27 L/w, p < 0.001), sodium removal (2.23 ± 1.29 g vs 2.77 ± 1.29 g, p = 0.027), and fluid removal (970.33 ± 545.97 mL vs 1,146.66 ± 460.93 mL, p = 0.038). Normalized by height (in meters), the GLP group patients still had a lower normalized dialysis dose (2,890.61 ± 1084.44 mL/m vs 3,761.34 ± 1,237.10 mL/m, p < 0.001). Baseline nutritional and dietary parameters were comparable except that a lower daily protein intake (42.73 ± 10.99 g vs 47.26 ± 14.30 g, p = 0.032) and higher serum urea level (23.43 ± 6.88 mmol/L vs 19.84 ± 5.92 mmol/L, p < 0.001) were presented in the GLP group. There was no difference in volume status. During the follow-up, Kaplan-Meier analysis showed that there was no significant difference in patient survival and technique survival. In multivariate Cox regression analysis, after adjusting for related factors, payment was again not a strong predictor of survival in the study population. ?ConclusionOur study found that GLP group patients were adherent to lifestyle modification with lower dialysis doses, and they also had nearly the same long-term clinical outcome as the GHP group patients. Thus, lower dialysis doses combined with controlled dietary intake may be an effective approach to solve the dialysis problem for the low socio-economic status (SES) population.

Dataset Information

Ethnic Differences in the Association of Depressive Symptoms with Clinical Outcome in Dialysis Patients.

Publications

Ethnic Differences in the Association of Depressive Symptoms with Clinical Outcome in Dialysis Patients.

Similar Datasets

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