International Urology and Nephrology

, Volume 51, Issue 2, pp 303–309 | Cite as

Patterns and predictors of depression treatment among adults with chronic kidney disease and depression in ambulatory care settings in the United States

  • Nina VadieiEmail author
  • Sandipan Bhattacharjee
Nephrology - Original Paper



One in five adults with chronic kidney disease (CKD) in the United States (US) suffers from depression. Comorbid depression in adults with CKD is associated with higher morbidity and mortality. This study used US national survey data to examine patterns and predictors of depression treatment among adults with non-dialysis-dependent CKD in the US.


A retrospective, cross-sectional study was conducted using 2014–2015 National Ambulatory Medical Care Survey (NAMCS) data. The final study sample consisted of visits by 9.02 million adults (unweighted n = 262; age ≥ 18 years) with CKD and depression in the US. Depression treatment was defined as antidepressant use with or without psychotherapy. To identify predictors of depression treatment, multivariable logistic regression analysis was conducted adjusting for predisposing, enabling, and need factors.


Approximately half of adults with CKD and depression received depression treatment. Primary care was the main setting of treatment, and the most commonly prescribed antidepressant class was selective serotonin reuptake inhibitors. Adults being seen for treatment of a chronic problem were 3.2 times more likely to receive depression treatment (OR 3.20; 95% CI 1.38–7.21). In addition, there was a 9% higher likelihood of receiving depression treatment for each unit increase in total number of medications (OR 1.09; 95% CI 1.01–1.19). Finally, adults receiving care in the South were 63% less likely to receive depression treatment (OR 0.37; 95% CI 0.15–0.89).


Depression treatment was recorded in approximately half of US ambulatory care visits involving adults with CKD and depression from 2014 to 2015. Further research is warranted to determine how to appropriately manage treatment of depression in adults with CKD.


Chronic kidney disease Depression Adults Ambulatory care settings Antidepressants 



This research did not receive any grants from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

For this type of study, formal consent is not required.


  1. 1.
    Hedayati SS, Minhajuddin AT, Toto RD, Morris DW, Rush AJ (2009) Prevalence of major depressive episode in CKD. Am J Kidney Dis 54(3):424–432. PubMedGoogle Scholar
  2. 2.
    Palmer S, Vecchio M, Craig JC, Tonelli M, Johnson DW, Nicolucci A, Pellegrini F, Saglimbene V, Logroscino G, Fishbane S, Strippoli GF (2013) Prevalence of depression in chronic kidney disease: systematic review and meta-analysis of observational studies. Kidney Int 84(1):179–191. PubMedGoogle Scholar
  3. 3.
    Lee YJ, Kim MS, Cho S, Kim SR (2013) Association of depression and anxiety with reduced quality of life in patients with predialysis chronic kidney disease. Int J Clin Pract 67(4):363–368. PubMedGoogle Scholar
  4. 4.
    D’Onofrio G, Simeoni M, Rizza P, Caroleo M, Capria M, Mazzitello G, Sacco T, Mazzuca E, Panzino MT, Cerantonio A, Segura-Garcia C, Andreucci M, De Fazio P, Fuiano G (2017) Quality of life, clinical outcome, personality and coping in chronic hemodialysis patients. Ren Fail 39(1):45–53. PubMedGoogle Scholar
  5. 5.
    Fischer MJ, Kimmel PL, Greene T, Gassman JJ, Wang X, Brooks DH, Charleston J, Dowie D, Thornley-Brown D, Cooper LA, Bruce MA, Kusek JW, Norris KC, Lash JP, Group AS (2011) Elevated depressive affect is associated with adverse cardiovascular outcomes among African Americans with chronic kidney disease. Kidney Int 80(6):670–678. PubMedGoogle Scholar
  6. 6.
    Kop WJ, Seliger SL, Fink JC, Katz R, Odden MC, Fried LF, Rifkin DE, Sarnak MJ, Gottdiener JS (2011) Longitudinal association of depressive symptoms with rapid kidney function decline and adverse clinical renal disease outcomes. Clin J Am Soc Nephrol 6(4):834–844. PubMedGoogle Scholar
  7. 7.
    Hedayati SS, Minhajuddin AT, Afshar M, Toto RD, Trivedi MH, Rush AJ (2010) Association between major depressive episodes in patients with chronic kidney disease and initiation of dialysis, hospitalization, or death. JAMA 303(19):1946–1953. PubMedGoogle Scholar
  8. 8.
    Palmer SC, Vecchio M, Craig JC, Tonelli M, Johnson DW, Nicolucci A, Pellegrini F, Saglimbene V, Logroscino G, Hedayati SS, Strippoli GF (2013) Association between depression and death in people with CKD: a meta-analysis of cohort studies. Am J Kidney Dis 62(3):493–505. PubMedGoogle Scholar
  9. 9.
    Tsai YC, Chiu YW, Hung CC, Hwang SJ, Tsai JC, Wang SL, Lin MY, Chen HC (2012) Association of symptoms of depression with progression of CKD. Am J Kidney Dis 60(1):54–61. PubMedGoogle Scholar
  10. 10.
    Chiang HH, Guo HR, Livneh H, Lu MC, Yen ML, Tsai TY (2015) Increased risk of progression to dialysis or death in CKD patients with depressive symptoms: a prospective 3-year follow-up cohort study. J Psychosom Res 79(3):228–232. PubMedGoogle Scholar
  11. 11.
    Hedayati SS, Gregg LP, Carmody T, Jain N, Toups M, Rush AJ, Toto RD, Trivedi MH (2017) Effect of sertraline on depressive symptoms in patients with chronic kidney disease without dialysis dependence: the CAST randomized clinical trial. JAMA 318(19):1876–1890. PubMedGoogle Scholar
  12. 12.
    Walther CP, Shah AA, Winkelmayer WC (2017) Treating depression in patients with advanced CKD: beyond the generalizability frontier. JAMA 318(19):1873–1874. PubMedGoogle Scholar
  13. 13.
    Duarte PS, Miyazaki MC, Blay SL, Sesso R (2009) Cognitive-behavioral group therapy is an effective treatment for major depression in hemodialysis patients. Kidney Int 76(4):414–421. PubMedGoogle Scholar
  14. 14.
    Lii YC, Tsay SL, Wang TJ (2007) Group intervention to improve quality of life in haemodialysis patients. J Clin Nurs 16(11C):268–275. PubMedGoogle Scholar
  15. 15.
    Rocha Augusto C, Krzesinski JM, Warling X, Smelten N, Etienne AM (2011) [The role of psychological interventions in dialysis: an exploratory study]. Nephrol Ther 7(4):211–218. PubMedGoogle Scholar
  16. 16.
    National Centers for Disease Control and Prevention: National Center for Health Statistics. Ambulatory Health Care DataGoogle Scholar
  17. 17.
    Survey NAMC (2014) Data documentation. Accessed 4 June 2018
  18. 18.
    Survey NAMC (2015) Data documentation. Accessed 4 June 2018
  19. 19.
    Zenlea IS, Milliren CE, Mednick L, Rhodes ET (2014) Depression screening in adolescents in the United States: a national study of ambulatory office-based practice. Acad Pediatr 14(2):186–191. PubMedGoogle Scholar
  20. 20.
    Hing E, Schappert SM, Burt CW, Shimizu IM (2005) Effects of form length and item format on response patterns and estimates of physician office and hospital outpatient department visits. National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, 2001. Vital Health Stat 2(139):1–32Google Scholar
  21. 21.
    Anderson JG, Bartkus DE (1973) Choice of medical care: a behavioral model of health and illness behavior. J Health Soc Behav 14(4):348–362PubMedGoogle Scholar
  22. 22.
    CDC (2015) Reliability of estimates. Accessed 4 June 2018
  23. 23.
    Fischer MJ, Xie D, Jordan N, Kop WJ, Krousel-Wood M, Kurella Tamura M, Kusek JW, Ford V, Rosen LK, Strauss L, Teal VL, Yaffe K, Powe NR, Lash JP, Investigators CSG (2012) Factors associated with depressive symptoms and use of antidepressant medications among participants in the Chronic Renal Insufficiency Cohort (CRIC) and Hispanic-CRIC Studies. Am J Kidney Dis 60(1):27–38. PubMedGoogle Scholar
  24. 24.
    Nagler EV, Webster AC, Vanholder R, Zoccali C (2012) Antidepressants for depression in stage 3–5 chronic kidney disease: a systematic review of pharmacokinetics, efficacy and safety with recommendations by European Renal Best Practice (ERBP). Nephrol Dial Transplant 27(10):3736–3745. PubMedGoogle Scholar
  25. 25.
    Glassman AH, O’Connor CM, Califf RM, Swedberg K, Schwartz P, Bigger JT Jr, Krishnan KR, van Zyl LT, Swenson JR, Finkel MS, Landau C, Shapiro PA, Pepine CJ, Mardekian J, Harrison WM, Barton D, McLvor M (2002) Sertraline antidepressant heart attack randomized trial. Sertraline treatment of major depression in patients with acute MI or unstable angina. JAMA 288(6):701–709PubMedGoogle Scholar
  26. 26.
    Cohen LM, Tessier EG, Germain MJ, Levy NB (2004) Update on psychotropic medication use in renal disease. Psychosomatics 45(1):34–48. PubMedGoogle Scholar
  27. 27.
    Levy NB, Blumenfield M, Beasley CM Jr, Dubey AK, Solomon RJ, Todd R, Goodman A, Bergstrom RR (1996) Fluoxetine in depressed patients with renal failure and in depressed patients with normal kidney function. Gen Hosp Psychiatry 18(1):8–13PubMedGoogle Scholar
  28. 28.
    Atalay H, Solak Y, Biyik M, Biyik Z, Yeksan M, Uguz F, Guney I, Tonbul HZ, Turk S (2010) Sertraline treatment is associated with an improvement in depression and health-related quality of life in chronic peritoneal dialysis patients. Int Urol Nephrol 42(2):527–536. PubMedGoogle Scholar
  29. 29.
    Kamo T, Horikawa N, Tsuruta Y, Miyasita M, Hatakeyama H, Maebashi Y (2004) Efficacy and pharmacokinetics of fluvoxamine maleate in patients with mild depression undergoing hemodialysis. Psychiatry Clin Neurosci 58(2):133–137PubMedGoogle Scholar
  30. 30.
    Kalender B, Ozdemir AC, Yalug I, Dervisoglu E (2007) Antidepressant treatment increases quality of life in patients with chronic renal failure. Ren Fail 29(7):817–822. PubMedGoogle Scholar
  31. 31.
    Kennedy SH, Craven JL, Rodin GM (1989) Major depression in renal dialysis patients: an open trial of antidepressant therapy. J Clin Psychiatry 50(2):60–63PubMedGoogle Scholar
  32. 32.
    Lee SK, Lee HS, Lee TB, Kim DH, Koo JR, Kim YK, Son BK (2004) The effects of antidepressant treatment on serum cytokines and nutritional status in hemodialysis patients. J Korean Med Sci 19(3):384–389. PubMedGoogle Scholar
  33. 33.
    Koo JR, Yoon JY, Joo MH, Lee HS, Oh JE, Kim SG, Seo JW, Lee YK, Kim HJ, Noh JW, Lee SK, Son BK (2005) Treatment of depression and effect of antidepression treatment on nutritional status in chronic hemodialysis patients. Am J Med Sci 329(1):1–5PubMedGoogle Scholar
  34. 34.
    Turk S, Atalay H, Altintepe L, Guney I, Okudan N, Tonbul HZ, Gokbel H, Kucur R, Yeksan M, Yildiz A (2006) Treatment with antidepressive drugs improved quality of life in chronic hemodialysis patients. Clin Nephrol 65(2):113–118PubMedGoogle Scholar
  35. 35.
    Blumenfield M, Levy NB, Spinowitz B, Charytan C, Beasley CM Jr, Dubey AK, Solomon RJ, Todd R, Goodman A, Bergstrom RF (1997) Fluoxetine in depressed patients on dialysis. Int J Psychiatry Med 27(1):71–80PubMedGoogle Scholar
  36. 36.
    Wuerth D, Finkelstein SH, Kliger AS, Finkelstein FO (2003) Chronic peritoneal dialysis patients diagnosed with clinical depression: results of pharmacologic therapy. Semin Dial 16(6):424–427PubMedGoogle Scholar
  37. 37.
    Palmer SC, Natale P, Ruospo M, Saglimbene VM, Rabindranath KS, Craig JC, Strippoli GF (2016) Antidepressants for treating depression in adults with end-stage kidney disease treated with dialysis. Cochrane Database Syst Rev. Google Scholar
  38. 38.
    Shirazian S, Grant CD, Aina O, Mattana J, Khorassani F, Ricardo AC (2017) Depression in chronic kidney disease and end-stage renal disease: similarities and differences in diagnosis, epidemiology, and management. Kidney Int Rep 2(1):94–107. PubMedGoogle Scholar
  39. 39.
    Cohen SD, Norris L, Acquaviva K, Peterson RA, Kimmel PL (2007) Screening, diagnosis, and treatment of depression in patients with end-stage renal disease. Clin J Am Soc Nephrol 2(6):1332–1342. PubMedGoogle Scholar
  40. 40.
    Hedayati SS, Yalamanchili V, Finkelstein FO (2012) A practical approach to the treatment of depression in patients with chronic kidney disease and end-stage renal disease. Kidney Int 81(3):247–255. PubMedGoogle Scholar
  41. 41.
    Doyle GD, Laher M, Kelly JG, Byrne MM, Clarkson A, Zussman BD (1989) The pharmacokinetics of paroxetine in renal impairment. Acta Psychiatr Scand Suppl 350:89–90PubMedGoogle Scholar
  42. 42.
    Eyler RF, Unruh ML, Quinn DK, Vilay AM (2015) Psychotherapeutic agents in end-stage renal disease. Semin Dial 28(4):417–426. PubMedGoogle Scholar
  43. 43.
    Anttila SA, Leinonen EV (2001) A review of the pharmacological and clinical profile of mirtazapine. CNS Drug Rev 7(3):249–264PubMedGoogle Scholar
  44. 44.
    Marin H, Menza MA (2005) The management of fatigue in depressed patients. Essent Psychopharmacol 6(4):185–192PubMedGoogle Scholar
  45. 45.
    Foley KF, DeSanty KP, Kast RE (2006) Bupropion: pharmacology and therapeutic applications. Expert Rev Neurother 6(9):1249–1265. PubMedGoogle Scholar
  46. 46.
    Angermann CE, Gelbrich G, Stork S, Gunold H, Edelmann F, Wachter R, Schunkert H, Graf T, Kindermann I, Haass M, Blankenberg S, Pankuweit S, Prettin C, Gottwik M, Bohm M, Faller H, Deckert J, Ertl G, Investigators M-HS, Committee M (2016) Effect of escitalopram on all-cause mortality and hospitalization in patients with heart failure and depression: the MOOD-HF randomized clinical trial. JAMA 315(24):2683–2693. PubMedGoogle Scholar
  47. 47.
    O’Connor CM, Jiang W, Kuchibhatla M, Silva SG, Cuffe MS, Callwood DD, Zakhary B, Stough WG, Arias RM, Rivelli SK, Krishnan R, Investigators S-C (2010) Safety and efficacy of sertraline for depression in patients with heart failure: results of the SADHART-CHF (sertraline against depression and heart disease in chronic heart failure) trial. J Am Coll Cardiol 56(9):692–699. PubMedGoogle Scholar
  48. 48.
    Cipriani A, Furukawa TA, Salanti G, Geddes JR, Higgins JP, Churchill R, Watanabe N, Nakagawa A, Omori IM, McGuire H, Tansella M, Barbui C (2009) Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis. Lancet 373(9665):746–758. PubMedGoogle Scholar
  49. 49.
    Hedayati SS, Daniel DM, Cohen S, Comstock B, Cukor D, Diaz-Linhart Y, Dember LM, Dubovsky A, Greene T, Grote N, Heagerty P, Katon W, Kimmel PL, Kutner N, Linke L, Quinn D, Rue T, Trivedi MH, Unruh M, Weisbord S, Young BA, Mehrotra R (2016) Rationale and design of A trial of sertraline vs. cognitive behavioral therapy for end-stage renal disease patients with depression (ASCEND). Contemp Clin Trials 47:1–11. PubMedGoogle Scholar
  50. 50.
    Blane D, Williams C, Morrison J, Wilson A, Mercer S (2013) Cognitive behavioural therapy: why primary care should have it all. Br J Gen Pract 63(607):103–104. PubMedGoogle Scholar
  51. 51.
    Chiu YW, Teitelbaum I, Misra M, de Leon EM, Adzize T, Mehrotra R (2009) Pill burden, adherence, hyperphosphatemia, and quality of life in maintenance dialysis patients. Clin J Am Soc Nephrol 4(6):1089–1096. PubMedGoogle Scholar
  52. 52.
    Bhattacharjee S, Axon DR, Goldstone L, Lee JK (2018) Patterns and predictors of depression treatment among stroke survivors with depression in ambulatory settings in the United States. J Stroke Cerebrovasc Dis 27(3):563–567. PubMedGoogle Scholar

Copyright information

© Springer Nature B.V. 2018

Authors and Affiliations

  1. 1.Department of Pharmacy Practice and Science, College of PharmacyThe University of ArizonaTucsonUSA

Personalised recommendations