Hemodialysis and Depression

Depression is often seen in patients on maintenance hemodialysis. Rajnish Mehrotra, MD, MS, and colleagues conducted a multicenter, parallel-group, open-label, randomized controlled trial designed to examine the effect of an engagement interview on acceptance of treatment for depression (phase 1) and to compare the efficacy of cognitive behavioral therapy (CBT) versus sertraline (phase 2) for the treatment of depression in that patient population.

In phase 1, participants were randomized to the engagement interview group or the control group; in phase 2, participants received either 12 weeks of CBT delivered in the dialysis facility or treatment with sertraline. The primary outcome of interest for phase 1 was the proportion of patients who initiated depression treatment within 28 days; for phase 2, the primary outcome was depressive symptoms measured by the Quick Inventory of Depressive Symptoms–Clinician-Rated (QIDS-C) at 12 weeks.

There was no difference between the two groups in the proportion of patients who began treatment for depression following the engagement interview or the control visit (66% vs 64%, respectively; P=.77; estimated risk difference, 2.1 (95% confidence interval [CI], –12.1 to 16.4). In phase 2, compared with CBT, sertraline treatment resulted in lower QIDS-C depression scores at 12 weeks (effect estimate, –1.84; 95% CI, –3.54 to –0.13; P=.035). There were more adverse events in the sertraline group than in the CBT group.

In conclusion, the researchers said, “An engagement interview with patients receiving maintenance hemodialysis had no effect on their acceptance of treatment for depression. After 12 weeks of treatment, depression scores were modestly better with sertraline treatment than with CBT.”

Annals of Internal Medicine. doi:10.7326/M18-2229