Depression and chronic kidney disease: A review for clinicians

Objective: To review the recent academic literature surrounding the prevalence, aetiopathology, associations and management of depression in chronic kidney disease (CKD), in order to provide a practical and up-to-date resource for clinicians. Methods: We conducted electronic searches of the following databases: MEDLINE, EMBASE and PsycINFO. The main search terms were: depression, mood disorders, depressive disorder, mental illness, in combination with kidney disease, renal insufficiency, dialysis, kidney failure. Separate searches were conducted regarding antidepressant use in CKD. Results: A number of recent, large and well-conducted studies have confirmed markedly raised rates of depression amongst those with CKD, with meta-analysis suggesting the prevalence of interview-defined depression to be approximately 20%. The interactions between depression and CKD are complex, bidirectional and multifactorial. Depression in CKD has been shown to be associated with multiple poor outcomes, including increased mortality and hospitalisation rates, as well as poorer treatment compliance and quality of life. Clinical evaluation of depression in patients with CKD can be challenging; however, once a diagnosis is made, a range of treatment modalities can be considered. Conclusions: Depression is common in CKD and is associated with a significant risk of adverse outcomes. Given the importance of this issue, there is now an urgent need for well-conducted randomised trials of interventions for depression in CKD in order to provide information on the safety and efficacy of treatments.