Older adults are less likely to report depressive symptoms compared with younger adults at evaluations for kidney transplant, according to data published in Kidney International Reports.
Further, investigators found patients of any age who report any degree of depressive symptoms are unlikely to achieve kidney transplant listing.
“Although extensive research sheds light on the high burden and poor clinical outcomes of depressive symptoms in dialysis population, it is unclear whether kidney failure patients who present depressive symptoms have obstacles in seeking kidney transplant,” Xiaomeng Chen, MSPH, from the department of surgery at Johns Hopkins University School of Medicine in Maryland, and colleagues wrote.
They added, “The goals of this study included: 1) to evaluate the severity of depressive symptoms by age, 2) to identify risk factors of depressive symptoms and 3) to estimate the association of depressive symptom severity with kidney transplant listing among adults of all ages being evaluated for kidney transplant.”
In a prospective cohort study, researchers evaluated 3,879 adults with kidney failure. At the time of the study, all patients were being examined for kidney transplants at Johns Hopkins Hospital.
Using the Center for Epidemiologic Studies-Depression (CES-D) scale, researchers measured self-reported depressive symptoms at kidney transplant evaluation, considering depressive symptom severity as: none (0), minimal (1 to 15), mild (16 to 20), moderate (21 to 25) and severe (26 to 60).
Adjusting for clinical and social factors, researchers conducted Cox proportional hazards models to determine the hazard ratios of active transplant listing within a year of evaluation. Researchers followed patients until their first listing, administrative censoring on March 2, 2011, or 1 year following evaluation.
Among the 3,879 patients, 3,728 were included in the final analyses (median age was 56 years; 40.7% were women; 46.7% were Black; 70.6% received dialysis). At evaluation, 85.8% of patients reported depressive symptoms, and reported symptoms declined with age (18-29 years old=92%; 30-39 years old=88.3%; 40-49 years old=87.2%; 50-59 years old=87%; 60-69 years old=83.4%; and 70 years old=82%). Older adults were less likely to report depressive symptoms compared with younger patients.
Analyses revealed a patient’s chance of active listing decreased as the patient reported more severe depressive symptoms. Specifically, every five-point higher CES-D score reported correlated with a 13% lower chance of listing.
“Our findings indicate that despite the relatively lower burden of depressive symptoms, older kidney failure patients with higher CES-D scores may be more vulnerable to limited access to kidney transplant,” Chen and colleagues wrote. “Therefore, there is a need to routinely screen for depressive symptoms among kidney failure patients to improve their access to kidney transplant.”
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