Original InvestigationDialysisAssociation Between Depression and Mortality in Patients Receiving Long-term Dialysis: A Systematic Review and Meta-analysis
Section snippets
Criteria for Selection of Studies
All observational studies published in either abstract or full form that included an assessment of the ability of depressive symptoms or clinical depression to predict mortality were included. Studies were included if they recruited adult participants 18 years or older who were receiving dialysis (hemodialysis and peritoneal dialysis modalities) as a long-term renal replacement therapy. Non-English articles were considered for inclusion provided that an abstract in English was available.
Search Results
The search yielded 2,528 records, of which 63 were potentially relevant. The κ index for agreement between the 2 reviewers was 0.96. The selected reports were screened for eligibility for inclusion. Authors were contacted for additional information; attempts were successful in 7 cases with additional data provided by authors. Thirty-two studies were excluded, and 31 articles were included for qualitative synthesis (Fig 1).
Table 1 is a summary of 31 studies included in the review (N = 67,075; mean
Discussion
Using meta-analytical techniques, we have shown an independent association between depression and increased mortality risk in the dialysis population. The magnitude of the increased risk was 1.5 times in the presence of depressive symptoms. This magnitude was slightly smaller when the risk of publication bias was incorporated using the trim-and-fill analysis. Studies with repeated measurements of depressive symptoms (longitudinal assessment) demonstrated a 1.66 times higher mortality risk with
Acknowledgements
We thank Dr Prakesh Shah for excellent guidance, and the authors of the reviewed publications who contributed to our work: Rasheed Balogun, Joseph Chilcot, Konstadina Griva, Eduardo Lacson, Rolf Peterson, Cheuk-Chun Szeto, Melissa Thong, and Tessa van den Beukel.
Support: None.
Financial Disclosure: The authors declare that they have no relevant financial interests.
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