Each 5-point increase in depressive symptom scores was independently associated with increased mortality (IRR 1.40), missed hemodialysis treatments, ED visits, and hospitalizations.
Observational (n=286)
Yes
Are depressive symptoms and pain associated with dialysis adherence, health resource utilization, and mortality in patients receiving chronic hemodialysis?
Depressive symptoms and pain are independently associated with dialysis nonadherence, increased health services utilization, and mortality in chronic hemodialysis patients.
Relative Risk: 1.4 (95% CI 1.11–1.77)
BACKGROUND AND OBJECTIVES: Depressive symptoms and pain are common in patients receiving chronic hemodialysis, yet their effect on dialysis adherence, health resource utilization, and mortality is not fully understood. This study sought to characterize the longitudinal associations of these symptoms with dialysis adherence, emergency department (ED) visits, hospitalizations, and mortality. DESIGN, SETTING, PARTICIPANTS, 95% confidence interval 95% CI, 1.10 to 1.33) and abbreviated (IRR, 1.08; 95% CI, 1.03 to 1.14) hemodialysis treatments, ED visits (IRR, 1.24; 95% CI, 1.12 to 1.37), hospitalizations (IRR, 1.19; 95% CI, 1.10 to 1.30), and mortality (IRR, 1.40; 95% CI, 1.11 to 1.77). Pain was independently associated with abbreviated hemodialysis treatments (IRR, 1.03; 95% CI, 1.01 to 1.06) and hospitalizations (IRR, 1.05; 95% CI, 1.00 to 1.10). Severe pain was independently associated with abbreviated hemodialysis treatments (IRR, 1.16; 95% CI, 1.06 to 1.28), ED visits (IRR, 1.58; 95% CI, 1.28 to 1.94), and hospitalizations (IRR, 1.22; 95% CI, 1.03 to 1.45), but not mortality (hazard ratio, 1.71; 95% CI, 0.81 to 2.96). CONCLUSIONS: Depressive symptoms and pain are independently associated with dialysis nonadherence and health services utilization. Depressive symptoms are also associated with mortality. Interventions to alleviate these symptoms have the potential to reduce costs and improve patient-centered outcomes.
Weisbord et al. (2014) conducted an observational in Chronic hemodialysis (n=286). Depressive symptoms and pain vs. Lower symptom scores was evaluated on Mortality (per 5-point increase in PHQ-9 score) (IRR 1.40, 95% CI 1.11 to 1.77). Each 5-point increase in depressive symptom scores was independently associated with increased mortality (IRR 1.40), missed hemodialysis treatments, ED visits, and hospitalizations.