End-stage Renal Disease and Depression: A Systematic Review

AIM: We conducted a systematic review to evaluate the performance characteristics of screening tools for depression in Veterans with end-stage renal disease (ESRD), and to better understand the impact, benefits, and harms of depression screening and subsequent treatment for depression. METHODS: We searched electronic databases, clinical trial registries, and reference lists through April 2019 for diagnostic accuracy studies of depression tools for patients with ESRD and for trials examining the effectiveness of interventions for the treatment of depression in patients with ESRD. We abstracted data on study design, interventions, and outcomes. Dual assessment of a study’s full text, quality, and strength of evidence (SOE) was agreed upon by consensus using pre-specified criteria. RESULTS: We included 20 treatment RCTs and 16 diagnostic accuracy studies. The best-studied tool was the Beck Depression Inventory-II (BDI-II). Across 4 BDI-II studies, a cutoff of ≥16 provides the best balance between sensitivity and specificity. The BDI-II performed reasonably well when compared to a gold standard clinical interview. 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 treatment as usual (TAU) or sham to reduce depression severity (low SOE). CONCLUSION: There is limited research evaluating the diagnostic accuracy of most screening tools for depression in patients with ESRD. The BDI-II with a cutoff of ≥16 provides a good balance of sensitivity and specificity. More research is needed to support the use of other tools. We found low SOE that CBT, sertraline, and acupressure may be beneficial. There is moderate SOE that high-dose Vitamin D3 is ineffective. More research is needed.