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Ann Intern Med. 2019 Feb 26. doi: 10.7326/M18-2229. [Epub ahead of print]

Comparative Efficacy of Therapies for Treatment of Depression for Patients Undergoing Maintenance Hemodialysis: A Randomized Clinical Trial.

Author information

1
University of Washington, Seattle, Washington (R.M., T.R., P.H., A.D., N.G.).
2
State University of New York Downstate Medical Center, Brooklyn, New York (D.C., N.V.).
3
University of New Mexico, Albuquerque, New Mexico (M.U., D.K.Q.).
4
George Washington University, Washington, DC (S.D.C.).
5
University of Pennsylvania, Philadelphia, Pennsylvania (L.M.D.).
6
Boston University, Boston, Massachusetts (Y.D.).
7
University of Utah, Salt Lake City, Utah (T.G.).
8
Emory University, Atlanta, Georgia (N.K.).
9
University of Texas Southwestern, Dallas, Texas (M.H.T., S.S.H.).
10
Veterans Affairs Pittsburgh Healthcare System and University of Pittsburgh, Pittsburgh, Pennsylvania (S.D.W.).
11
Veterans Affairs Puget Sound Health Care System and University of Washington, Seattle, Washington (B.A.Y.).
12
National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland (P.L.K.).

Abstract

Background:

Although depression is common among patients receiving maintenance hemodialysis, data on their acceptance of treatment and on the comparative efficacy of various therapies are limited.

Objective:

To determine the effect of an engagement interview on treatment acceptance (phase 1) and to compare the efficacy of cognitive behavioral therapy (CBT) versus sertraline (phase 2) for treating depression in patients receiving hemodialysis.

Design:

Multicenter, parallel-group, open-label, randomized controlled trial. (ClinicalTrials.gov: NCT02358343).

Setting:

41 dialysis facilities in 3 U.S. metropolitan areas.

Participants:

Patients who had been receiving hemodialysis for at least 3 months and had a Beck Depression Inventory-II score of 15 or greater; 184 patients participated in phase 1, and 120 subsequently participated in phase 2.

Interventions:

Engagement interview versus control visit (phase 1) and 12 weeks of CBT delivered in the dialysis facility versus sertraline treatment (phase 2).

Measurements:

The primary outcome for phase 1 was the proportion of participants who started depression treatment within 28 days. For phase 2, the primary outcome was depressive symptoms measured by the Quick Inventory of Depressive Symptoms-Clinician-Rated (QIDS-C) at 12 weeks.

Results:

The proportion of participants who initiated treatment after the engagement or control visit did not differ (66% vs. 64%, respectively; P = 0.77; estimated risk difference, 2.1 [95% CI, -12.1 to 16.4]). Compared with CBT, sertraline treatment resulted in lower QIDS-C depression scores at 12 weeks (effect estimate, -1.84 [CI, -3.54 to -0.13]; P = 0.035). Adverse events were more frequent in the sertraline than the CBT group.

Limitation:

No randomized comparison was made with no treatment, and persistence of treatment effect was not assessed.

Conclusion:

An engagement interview with patients receiving maintenance hemodialysis had no effect on their acceptance of treatment for depression. After 12 weeks of treatment, depression scores were modestly better with sertraline treatment than with CBT.

Primary Funding Source:

Patient-Centered Outcomes Research Institute, Dialysis Clinic, Kidney Research Institute, and National Institute of Diabetes and Digestive and Kidney Diseases.

PMID:
30802897
DOI:
10.7326/M18-2229

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