The Effectiveness of Depression Treatment for Adults with End-Stage Kidney Disease: A Systematic Review

Abstract

Adults with dialysis-dependent end-stage kidney disease (ESKD) experience higher rates of depression than the general population, yet efficacy of depression treatments in this population is not well understood. We conducted a systematic review of the benefits and harms of depression treatment in adults with ESKD. We searched multiple data sources through June 2020 for English-language controlled trials that compared interventions for depression in adults with ESKD to another intervention, placebo, or usual care, and reported depression treatment-related outcomes. Observational studies were included for harms. Two investigators independently screened all studies using pre-specified criteria. One reviewer abstracted data on study design, interventions, implementation characteristics, and outcomes, and a second reviewer confirmed. Two reviewers independently assessed study quality and resolved any discords through discussion or a third reviewer. Strength of evidence (SOE) was assessed and agreed upon by review team consensus. We qualitatively analyzed the data and present syntheses in text and tables. We included 26 RCTs and 3 observational studies. SSRIs were the most studied type of drug and the evidence was largely insufficient. We found moderate SOE that long-term, high-dose Vitamin D3 is ineffective for reducing depression severity. Cognitive behavioral therapy (CBT) is more effective than (undefined) psychotherapy and placebo for depression improvement and quality of life (low SOE), and acupressure is more effective than usual care or sham acupressure to reduce depression severity (low SOE). There is limited research evaluating treatment for depression in adults with ESKD, and existing studies may not be generalizable to adults in the US. Studies suffer from limitations related to methodological quality or reporting. More research replicating studies of promising interventions in U.S. populations with larger samples is needed.