Easing the Burden of Disease

New study identifies effective depression treatment for dialysis patients

Patients undergoing dialysis for end-stage kidney disease typically must spend three days a week in a clinic connected to a machine that scrubs their blood of toxins - for up to 3 1/2 hours at a time.

So it might not come as much of a surprise to learn that about a third of them are suffering from depression. University of New Mexico researchers joined in newly published research study that might point the way toward the best method for treating depression in these patients.

Their study, appearing this week in the Annals of Internal Medicine, found that a prescription for the antidepressant sertraline (sold commercially as Zoloft) led to a modestly better outcome than cognitive behavioral therapy.

"There's a large body of work relating depression to poor outcomes in dialysis," said Mark Unruh, MD, a kidney specialist and chair of UNM's Department of Internal Medicine. "This is the largest intervention study done to try to treat depression in dialysis."

With an estimated 600,000 Americans undergoing dialysis treatment at any given time, the findings have the potential to help a substantial number of patients, he said.

Unruh and Davin Quinn, MD, associate professor in UNM's Department of Psychiatry & Behavioral Sciences, were joined in the study by collaborators from the University of Washington, the University of Texas Southwestern Medical Center, and other institutions in providing the depression treatments to 120 patients at dialysis clinics in New Mexico, Seattle and Dallas.

Cognitive behavioral therapy, in which a patient is guided in identifying and reframing negative thoughts and beliefs, is generally considered as effective as selective serotonin uptake inhibitors like sertraline in treating depression.

Dialysis patients, who often experienced untreated high blood pressure and diabetes before progressing to kidney failure, may be prescribed a dozen medications or more, Unruh said, creating an additional consideration in terms of depression treatment.

Two groups of 60 were randomly assigned to receive either cognitive behavioral therapy or sertraline. Therapists met one-on-one with patients in the cognitive behavioral therapy group, while the patients assigned to the sertraline arm of the study had prescriptions they could take at home. All of the patients were assessed at six weeks and again at 12 weeks to gauge whether their depression symptoms had lessened.

Overall, the researchers reported, outcomes for the sertraline patients "were modestly better." But both groups of patients had improved over their baseline assessments, the study found.

The three-year study was federally funded through the Patient-Centered Outcomes Research Institute, a program that specifically calls for patient involvement in designing a research protocol.

"It's really a great thing for our patients to participate in studies, because it adds their voice to how people are being cared for," Unruh said. "By these folks having the courage to participate in these trials, we're more informed about how to care for people like them."