Selective serotonin reuptake inhibitors and tricyclic antidepressants differentially affect heart failure risk in patients with kidney failure

Background Although selective serotonin reuptake inhibitors (SSRIs) are the treatment of choice for dialysis patients, tricyclic antidepressants (TCAs) are still frequently prescribed in clinical practice. No studies have compared the cardiovascular outcomes of patients with kidney failure (KF) and depression prescribed SSRIs and those of patients with KF and depression prescribed TCAs. Methods Data of patients who were diagnosed with depression after being diagnosed with KF between January 2003 and December 2022 were extracted from the Korean National Health Institute Database System. The primary outcome was incident heart failure. Secondary outcomes included all-cause mortality and other cardiovascular outcomes. Results We extracted the data of 3096 patients who were prescribed a single type of antidepressant that was continued throughout the follow-up period. Among these patients, 2169 were prescribed TCAs (mean age, 59.3 years; 57.4% were male), and 927 were prescribed SSRIs (mean age, 60.5 years; 48.8% were male) after KF was diagnosed. After 1:1 propensity score matching, 844 patients remained in each group, and no significant difference in all-cause mortality was observed between patients prescribed TCAs and those prescribed SSRIs. However, the risk of incident heart failure associated with TCA use was higher than that associated with SSRI use (adjusted hazard ratio (HR) 1.21, 95% confidence interval (CI) 1.07–1.36). This result was consistent with those indicated by the unmatched multivariate adjusted analysis and landmark analysis. Conclusions Among patients who were diagnosed with depression after being diagnosed with KF, SSRI use was associated with a lower risk of incident heart failure than TCA use. Individualized antidepressant treatment strategies should be considered for patients at high risk.