Depressive Symptoms at Kidney Transplant Evaluation and Access to the Kidney Transplant Waitlist

Xiaomeng Chen; Nadia M Chu; Pragyashree Sharma Basyal; Wasurut Vihokrut; Deidra Crews; Daniel C Brennan; Sarah R Andrews; Tracy D Vannorsdall; Dorry L Segev; Mara A McAdams-DeMarco

doi:10.1016/j.ekir.2022.03.008

Depressive Symptoms at Kidney Transplant Evaluation and Access to the Kidney Transplant Waitlist

Kidney Int Rep. 2022 Mar 15;7(6):1306-1317. doi: 10.1016/j.ekir.2022.03.008. eCollection 2022 Jun.

Authors

Xiaomeng Chen¹, Nadia M Chu^{1

2}, Pragyashree Sharma Basyal³, Wasurut Vihokrut¹, Deidra Crews⁴, Daniel C Brennan⁴, Sarah R Andrews⁵, Tracy D Vannorsdall⁵, Dorry L Segev^{1

6}, Mara A McAdams-DeMarco^{1

6}

Affiliations

¹ Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
² Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
³ Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
⁴ Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
⁵ Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
⁶ Department of Surgery, NYU Grossman School of Medicine, NYU Langone Health, New York, New York, USA.

Abstract

Introduction: Depressive symptoms, even without a clinical diagnosis of depression, are common in kidney failure patients and may be a barrier to completing the complex process of kidney transplant (KT) evaluation. We assessed depressive symptom burden and association between depressive symptoms and access to KT waitlist by age.

Methods: In a prospective cohort of 3728 KT patients (aged 18-88 years), the Center for Epidemiologic Studies-Depression (CES-D) scale was used to measure depressive symptoms at evaluation. Depressive symptom severity was defined as follows: none: 0; minimal: 1 to 15; mild: 16 to 20; moderate: 21 to 25; severe: 26 to 60. Hazard ratios (HRs) of active listing within 1 year after evaluation were estimated using Cox proportional hazards models, adjusted for clinical and social factors.

Results: At evaluation, 85.8% of the patients reported at least minimal depressive symptoms; the proportion was lower among older patients: 18 to 29 years = 92.0%; 30 to 39 years = 88.3%; 40 to 49 years = 87.2%; 50 to 59 years = 87.0%; 60 to 69 years = 83.4%; and ≥70 years = 82.0%. Chance of active listing decreased with more severe depressive symptoms (log-rank, P < 0.001). After adjustment, every 5-point higher CES-D score (more depressive symptoms) was associated with a 13% lower chance of listing (HR = 0.87, 95% CI: 0.85-0.90); the strongest association was found among patients aged ≥70 years (adjusted HR [aHR] = 0.73, 95% CI: 0.62-0.86). Furthermore, minimal (HR = 0.69, 95% CI: 0.60-0.79), mild (HR = 0.57, 95% CI: 0.44-0.72), moderate (HR = 0.53, 95% CI: 0.39-0.71), and severe (HR = 0.44, 95% CI: 0.34-0.57) depressive symptoms were all associated with a lower chance of listing.

Conclusion: Older candidates were less likely to report depressive symptoms at KT evaluation. Regardless of age, candidates who did report depressive symptoms, and even minimal symptoms, had a lower chance of listing. Transplant centers should routinely screen patients for depressive symptoms and refer the affected patients to mental health services to improve access to KT.

Keywords: age; depressive symptoms; end-stage kidney disease; kidney transplantation; waitlisting.

Abstract

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