Renal and dialysis psychiatry

Meet the patient

A 64-year-old on maintenance haemodialysis is referred for "depression and non-compliance". She has missed her last two sessions, tells you life is not worth living, and her PHQ-9 came back at 19. The dialysis nurses add that she has been "vague and slow" mid-session this week.[1][7]

Two questions are live on this ward round, and the registrar will conflate them: is this depression, or uraemia, or both? and is she safe to drive home and to keep dialysing? A candidate who recites generic MDD criteria fails — the stem hides a medical differential, a dosing trap, a capacity question, and an adherence problem all at once.[4][5][11][13]

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1. [1]Palmer S, Vecchio M, Craig JC, et al. Prevalence of depression in chronic kidney disease: systematic review and meta-analysis of observational studies Kidney Int, 2013.PMID 23486521
2. [2]Palmer SC, Vecchio M, Craig JC, et al. Association between depression and death in people with CKD: a meta-analysis of cohort studies Am J Kidney Dis, 2013.PMID 23623139
3. [3]Hedayati SS, Minhajuddin AT, Toto RD, et al. Prevalence of major depressive episode in CKD Am J Kidney Dis, 2009.PMID 19493599
4. [4]Hedayati SS, Yalamanchili V, Finkelstein FO A practical approach to the treatment of depression in patients with chronic kidney disease and end-stage renal disease Kidney Int, 2012.PMID 22012131
5. [5]Hedayati SS, Gregg LP, Carmody T, et al. Effect of Sertraline on Depressive Symptoms in Patients With Chronic Kidney Disease Without Dialysis Dependence: The CAST Randomized Clinical Trial JAMA, 2017.PMID 29101402
6. [6]Mehrotra R, Cukor D, Unruh M, et al. Comparative Efficacy of Therapies for Treatment of Depression for Patients Undergoing Maintenance Hemodialysis: A Randomized Clinical Trial Ann Intern Med, 2019.PMID 30802897
7. [7]Cukor D, Coplan J, Brown C, et al. Depression and anxiety in urban hemodialysis patients Clin J Am Soc Nephrol, 2007.PMID 17699455
8. [8]Cukor D, Rosenthal DS, Jindal RM, et al. Depression is an important contributor to low medication adherence in hemodialyzed patients and transplant recipients. Kidney Int, 2009.PMID 19242502
9. [9]Kimmel PL Depression in patients with chronic renal disease: what we know and what we need to know J Psychosom Res, 2002.PMID 12377308
10. [10]Cohen SD, Cukor D, Kimmel PL Anxiety in Patients Treated with Hemodialysis Clin J Am Soc Nephrol, 2016.PMID 27660303
11. [11]Cohen LM, Germain MJ, Poppel DM Practical considerations in dialysis withdrawal: "to have that option is a blessing" JAMA, 2003.PMID 12709469
12. [12]Kurella M, Chertow GM, Luan J, et al. Cognitive impairment in chronic kidney disease J Am Geriatr Soc, 2004.PMID 15507063
13. [13]Baghdady NT, Banik S, Swartz SA, et al. Psychotropic drugs and renal failure: translating the evidence for clinical practice Adv Ther, 2009.PMID 19444657
14. [14]Nagler EV, Webster AC, Vanholder R, et al. Antidepressants for depression in stage 3-5 chronic kidney disease: a systematic review of pharmacokinetics, efficacy and safety with recommendations by European Renal Best Practice (ERBP) Nephrol Dial Transplant, 2012.PMID 22859791
15. [15]McKnight RF, Adida M, Budge K, et al. Lithium toxicity profile: a systematic review and meta-analysis Lancet, 2012.PMID 22265699
16. [16]Decker BS, Goldfarb DS, Dargan PI, et al. Extracorporeal Treatment for Lithium Poisoning: Systematic Review and Recommendations from the EXTRIP Workgroup Clin J Am Soc Nephrol, 2015.PMID 25583292