Depression Treatment for Dialysis Patients

A patient with chronic renal disease usually spends three days a week in a clinic with needles in their arms, lying still for up to four hours at a time while a dialysis machine filters waste materials and excess fluid from their blood. Not unexpectedly, one-quarter of dialysis patients are diagnosed with depression, which can lead to decreased motivation and make it difficult for them to adhere to their treatment plan.

“If you look at the outcomes of people who are depressed on dialysis, they’re challenging,” said nephrologist Mark Unruh, MD, chair of The University of New Mexico’s Department of Internal Medicine. “Their quality of life is lower, adherence is poorer and hospitalization and mortality is higher.” 

Unruh and colleagues from the University of Washington and the Rogosin Institute conducted the ASCEND trial a few years ago, which compared provider-assisted cognitive behavioral therapy (CBT) with a course of sertraline (an SSRI medicine sold under the brand name Zoloft).

In a 2019 report published in the Annals of Internal Medicine, researchers discovered that CBT and sertraline were roughly equally effective in treating depression symptoms, offering relief to approximately 40% of patients who participated.

The findings of the study are now being turned into a real-world intervention, thanks to a $2.1 million implementation grant from the government funded Patient-Centered Outcomes Research Institute (PCORI).

Around 8,350 Satellite Healthcare dialysis patients in 87 facilities in seven states will now have easy access to depression treatment. “They’re incorporating our educational interventions, checklists, and metrics into their standard processes,” Unruh explained.

He estimates that more than 500,000 persons in the United States are on dialysis at any given moment (4,000-5,000 in New Mexico). The use of these depression-management measures in Satellite’s dialysis units lays the path for other dialysis providers to follow suit. Only eight organizations in the United States care for 90 percent of patients.

“You do these studies and you publish the papers and nothing happens, usually,” Unruh said. “With PCORI there’s a pathway for the study to be applied through dissemination grants and implementation trials. It’s touching as many people as possible. Basically, you’re taking what you did and applying it really broadly.” 

The original study enrolled 184 patients at 41 dialysis centers in three major U.S. cities, with 120 completing a 12-week treatment course. According to Unruh, the idea of delivering point-of-care depression treatment to patients represents an increasing tendency in dialysis care toward treating the full patient.

The connection between dialysis and depression “is incompletely understood,” he said. “There’s a lot of overlap between symptoms of kidney failure and depression.” But until now the problem has not been studied in depth. 

Next, he and his partners want to secure funding for the next phase of research. “I’d really like to have an answer for the 60 percent of people that don’t get better” using standard treatments, Unruh said. 

With the advent of new drug therapies for depression, he is optimistic about finding ways to help additional dialysis patients. “For depression it’s a really exciting time, with really new therapies for the first time in a long time.” 

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