How Kidney Care Providers Can Play a Role in Depression Screening—and Why It Matters

Interwell Health, a kidney care management company that provides holistic, value-based care, recently conducted a data analysis suggesting that there are substantial benefits to identifying depression in patients with chronic kidney disease (CKD), thereby enabling treatment and follow-up.

The results were dramatic when depression was spotted and a comprehensive care plan to address mental health was executed: In a review of 1561 patients identified with signs of moderate to severe depressive symptoms in 2022, more than 71% improved to mild or no depressive symptoms during a subsequent screening. By allowing for appropriate interventions, screening for depression in patients with CKD can improve overall well-being, slow disease progression, reduce hospitalizations, and lower the total cost of care, Interwell believes.

Involving nephrology practices in depression screening may not be a standard practice, but it seems logical given that research has shown a link between CKD and depression, and the US Preventive Services Task Force recommends depression screening for all adults. “If we can understand the link between depression and kidney disease and treat that, then we’re more likely to be successful in treating the patient’s [CKD],” said Jessica Demaline, senior vice president of health care operations at Interwell Health and a licensed social worker. “Physical conditions, including kidney disease, can be made worse by poor mental health or poor behavioral health.”

Screening, of course, is only the first step. As a provider of holistic care, Interwell Health can also connect patients to treatment resources. “We have an interdisciplinary team that includes clinical social workers who sometimes assist the patients with social determinants of health, maybe socioeconomic or cultural barriers,” Demaline explained. “They also can provide virtual supportive counseling to patients or connect them with local community resources.”

Nephrologists also receive training on identifying and helping to coordinate treatment for depression. “That is very challenging and not something that I would say nephrologists always are comfortable doing without some additional support,” Demaline said. It has proven to be important, though, particularly in rural areas where community resources are limited. “We embed coordinators in nephrology offices, and then we are able to assist the nephrologists by providing them with resources and treatment guidelines so that they can help patients who might otherwise go undiagnosed, untreated, or undertreated because of the lack of resources in the community.”

This is a model that other kidney care providers could adopt. “We do see that some other companies focus on starting to treat the patient once they’ve seen a nephrologist,” Demaline remarked. Yet she sees an opportunity to identify and start treatment even earlier.

Interwell uses proprietary predictive models to detect and treat kidney disease earlier, which also provides an opportunity to treat depression earlier. “We feel like we need to go further upstream, be more proactive, and reach out to patients who may have never seen a nephrologist to start that nephrology care and that holistic care model that includes assessing and treating depression and social determinants of health,” Demaline said.