Depression predicts hospitalization in patients with coexisting diabetes and end-stage renal disease: a prospective study

Abstract

BACKGROUND: Patients with comorbid diabetes and end stage renal disease (DM ESRD) represent the fastest growing and most frail segment of dialysis population, with elevated rates of hospitalization and mortality. It is important to examine psychosocial factors that may compromise health outcomes. We evaluated whether depressive symptoms (hereafter "depression") are associated with hospitalization and mortality. METHODS: Depression was assessed in a prospective outpatient cohort of patients with DM ESRD and defined as scores ≥ 8 on the Hospital Anxiety and Depression Scale (HADS). Primary outcome was all-cause admission (number of events; days of hospitalization, emergency department visits) or mortality over 12 months. Negative binomial or Cox regressions were used to model risk factors for hospitalization and mortality respectively. FINDINGS: Of 221 participants [median age 59 years, 39.4% women, 54.8% Chinese], 95 (43.0%) screened positive for depression. Risk for derpession was higher for Chinese patients (OR 2.499, 95%CI 1.436 - 4.349, P = .001). Compared with non-depressed patients, those with depression were more frequently hospitalized in the ensuring 12 months: [Incidence rate ratio (IRR) = 1.436 (1.019 - 2.024), p = 0.039]], adjusted for age, comorbidity, time on dialysis and housing. The association with mortality was not significant. DISCUSSION: Depression is common, under-recognized and predicts hospitalization rates independent of clinical risk factors. Additional research is warranted to ascertain if effective interventions for depression in patients with multimorbidity could reduce the risk of hospitalizations and associated adverse events.