Depression and Advance Care Planning Among Japanese Patients Undergoing Hemodialysis: Japanese Dialysis Outcomes and Practice Pattern Study (J-DOPPS)

Rationale & Objective: Advance care planning (ACP) is crucial in end-of-life care. Data on ACP discussion among patients with end-stage kidney disease are limited. One study has suggested that depressive symptoms increase ACP discussion. Study Design: This study aimed to analyze the association between depression and ACP discussion in patients undergoing hemodialysis. Setting & Population: This used data from the Japan Dialysis Outcomes and Practice Patterns Study. Predictor: Both cross-sectional and longitudinal associations between depressive symptoms and ACP discussion were examined. Outcomes: Depressive symptoms were defined as a score of ≥10 points on the 10-item Center for Epidemiologic Studies Depression scale. ACP discussion was defined as discussing ACP with health care providers and family members. Analytical Approach: Generalized estimating equations and generalized linear models based on Poisson distribution and log-link function were used to estimate prevalence (PR) and incidence proportion ratios (IPRs) using robust standard errors, respectively. Results: Data in 2016 and 2017 included 2,443 patients for the cross-sectional analysis and 870 for the longitudinal analysis. ACP discussion was 26% in 2016 and 28% in 2017, with depressive symptoms rates of 45% and 47%, respectively. The cross-sectional analysis indicated a positive association between depressive symptoms and ACP discussion (adjusted PR, 1.20; 95% confidence interval (CI), 1.05-1.37). Depressive symptoms were not significantly associated with ACP discussion in longitudinal analyses (adjusted IPR, 1.10; 95% CI 0.80-1.51). Limitations: Sample size, unadjusted confounding, and generalizability across cultural backgrounds. Conclusions: Our study showed an association between depressive symptoms and ACP in the cross-sectional analysis, but not longitudinally.