Depressive Symptoms and Mortality in Patients After Kidney Transplantation: A Prospective Prevalent Cohort Study

Objective: To analyze in a prospective cohort study if depressive symptoms are an independent predictor of mortality in kidney transplant recipients. Methods: Data from 840 transplanted patients followed at a single outpatient transplant center were analyzed. Sociodemographic parameters and clinical data were collected at enrollment (between August 2002 and February 2003). Participants completed the Center for Epidemiologic Studies-Depression (CES-D) scale. Depression was defined as CES-D score of ≥18. Data on 5-year outcomes (death censored graft loss or mortality) were collected. Results: The prevalence of depression was 22%. Mortality was higher (21% versus 13%; p = .004) in patients with versus without depression. In a multivariate Cox proportional hazard model, both the baseline CES-D score (hazard ratiofor each 1-point increase = 1.02; 95% confidence interval, 1.00–1.04) and the presence of depression at baseline (hazard ratiopresence = 1.66; 95% confidence interval, 1.12–2.47) were significantly associated with mortality. The baseline CES-D score also significantly predicted death censored graft loss (hazard ratiofor each 1-point increase = 1.03; 95% confidence interval, 1.01–1.05). Conclusion: Depressive symptoms are an independent predictor of mortality in kidney transplanted patients. CES-D = Center for Epidemiologic Studies-Depression scale; CKD = chronic kidney disease; CNI = calcineurin inhibitor; CRP = C-reactive protein; CsA = cyclosporine A; DOPPS = Dialysis Outcomes and Practice Patterns Study; GFR = estimated glomerular filtration rate; ESRD = end-stage renal disease; ESRD-SI = End-Stage Renal Disease Severity Index; Hb = hemoglobin; HLA = human leukocyte antigen; HR = hazard ratio; IQR = interquartile range.