Depression and suicide in end stage kidney disease (on dialysis and kidney transplant recipients): a national-wide population study
Min Seok Kang1, Dong Young Kim1, Sung Hwa Kim2, Jinhee Lee3, Jun Young Lee1,4.
1Nephrology, Yonsei University Wonju College of Medicine, Wonju, Korea; 2Biostatistics, Yonsei University Wonju College of Medicine, Wonju, Korea; 3Psychiatry, Yonsei University Wonju College of Medicine, Wonju, Korea; 4Transplantation Center, Wonju Severance Christian Hospital, Wonju, Korea
Center of Evidence Based Medicine, Institute of Convergence Science, Yonsei University.
Kidney transplantation (KT) improves prognosis not only physically but also psychologically in patients with end stage kidney disease (ESKD). However, there are few comparative studies of psychiatric disorders in patients treated with dialysis and KT in patients with ESKD.
21,809 ESKD patients without depression and insomnia history before starting renal replacement therapy between January 2002- December 2018 were extracted from the Korean National Health Insurance Service database. 17649 patients received dialysis (15537 patients received hemodialysis, 2112 patients received peritoneal dialysis), and 4160 patients received KT. 45.04% (7949) dialysis patients suffer from insomnia whereas 25.72% (1070) KT recipients suffer from insomnia (p<0.001). Compared to KT recipients (8.61%, 358), dialysis patients (22.77%, 4019) were more prescribed anti-depressant medication (p<0.001). Compared KT recipients (0.12%, 5), dialysis patients (0.19%, 33) were more completely suicided (p=0.047). In multivariate-adjusted analysis, the hazards ratio (HR) of depression was 1.82 (95% confidence interval (CI)s, 1.62-2.04). In subgroup analysis insomnia patients (HR 2.15, 95% CI 1.86-2.47), living in rural areas (HR 2.04, 95% CI 1.70-2.36), male patients (HR 1.85 95% CI 1.61-2.13), aged under 65 years old patients (HR 1.90 95% CI 1.68-2.14) more prescribed anti-depressant medication.
KT patients have a lower suicide rate than dialysis patients. In addition, KT is effective in reducing the prevalence of depression in patients with ESKD in Korea, especially for insomnia patients, living in rural areas, male patients, and those aged under 65 years old.
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