What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Chronic kidney disease and depression (n=79691). Primary outcome: Overall pooled prevalence of clinical depression (95% CI 23.9-31.5, p=<0.001 for heterogeneity).

July 2, 2024

Global prevalence of depression in chronic kidney disease: a systematic review and meta-analysis

Q: What are the key findings of this study?

The overall pooled prevalence of clinically diagnosed depression in the global chronic kidney disease population was 27.6%.

Key Result

The overall pooled prevalence of clinically diagnosed depression in the global chronic kidney disease population was 27.6%.

Study Design

Type

Meta-Analysis (n=79,691)

Structured PICO

Population

79,691 adult and pediatric patients with chronic kidney disease (CKD) and kidney failure (pre-dialysis and dialysis) from 61 studies across 26 countries. Mean age ranged from 11.0 to 76.3 years.

Outcome

Pooled prevalence of clinical depression

Clinical depression is highly prevalent in the global CKD population, affecting over a quarter of patients, with higher rates observed in those on hemodialysis compared to pre-dialysis or peritoneal dialysis.

Main Result

p-value: p=<0.001 for heterogeneity

Limitations

Only a few studies determined the prevalence of depression in the early stages of CKD.
Studies reporting depression prevalence among kidney transplant patients were not included.
The number of studies in the paediatric population was limited.

Abstract

BACKGROUND: Chronic kidney disease (CKD) is commonly associated with psychosocial problems, especially depression, contributing to poor overall outcomes. Depression has not been given adequate priority in the management of CKD patients despite its significant adverse impact on all major outcomes. This systematic review and meta-analysis determined the pooled prevalence of clinical depression in the global CKD population and sub-populations. METHODS: PubMed, African Journals Online (AJOL), and EMBASE were systematically searched to identify published articles with relevant data. The pooled prevalence of clinical depression in the global CKD population was determined using random effects meta-analytic techniques. The study protocol was registered with PROSPERO (CRD42022382708). RESULTS: Sixty-five articles were included in this review, comprising 80,932 individuals with CKD from 27 countries. The participants' mean age ranged from 11.0 to 76.3 years. Most (70.4%) of the studies had medium methodological quality. The overall pooled prevalence of depression was 26.5% (95% CI 23.1-30.1%). Studies using the Diagnostic Statistical Manual for Mental Diseases (DSM) and International Classification of Disease (ICD) returned a pooled prevalence of 25.5% and 39.6%, respectively, p = 0.03. There was a significant difference in the pooled prevalence across regions; p = 0.002.The prevalence of depression was higher among individuals on chronic hemodialysis compared to pre-dialysis patients (29.9% versus 18.5%; p = 0.01) and among those on hemodialysis compared to peritoneal dialysis (30.6% versus 20.4%; p = 0.04). There was no significant difference between adults and children (26.8% versus 15.9%, p = 0.21). There was an increasing temporal trend in depression prevalence, though this did not achieve statistical significance (p = 0.16). CONCLUSION: Depression is common in patients with CKD. The findings of this study highlight the need for clinicians to make efforts to evaluate individuals with CKD for depression, especially those with advanced stages of the disease.

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