Dialysis and Depression: The Reality of End-Stage Renal Disease

• Mental health, depression specifically, is not adequately addressed when it comes to end-stage renal disease (ESRD). 
• Causes of depression in the ESRD community can be both behavioral and biological. 
• Consider how you can help address, and bring awareness to, depression and other mental health diagnoses in the ESRD community. 

Pull up a chair, and let’s have a chat about mental health in the end-stage renal disease community.  

Dialysis comes in different modalities, such as mainstream hemodialysis, lesser-known peritoneal dialysis, home hemodialysis, and kidney transplantation. Dialysis is the removal of toxins and/or fluid from the body, which can be completed outside or inside the body (through hemodialysis or dialysis and peritoneal dialysis or kidney transplantation, respectively). As a tangible process, dialysis can be evaluated through lab work, vital signs, dry weight, medication adherence, and dietary compliance. 

Mental health — more specifically, depression — is an intangible phenomenon that isn’t adequately addressed or discussed. And is barely recognized as something that needs to be discussed in the end-stage renal community.   

So, What is Depression?

The Mayo Clinic defines depression as a mood disorder that causes a persistent feeling of sadness and loss of interest. Why should we bother to discuss depression, and why should we become more aware of how depression affects the ESRD community? Because depression in this community directly affects hospitalization, kidney function decline, increased social isolation, and loss of self-identity, and can be a contributing factor to mortality via suicide. 

Some causes of depression in the ESRD community are behavioral and biological: 

The gold standard to diagnose depression is the clinical interview, which includes:  

1. the Structured Clinical Interview for DSM Disorders (SCID); 
2. The Composite International Diagnostic Interview (CIDI); 
3. The Mini-International Neuropsychiatric Interview (MINI); 
4. Patient Health Questionnaire (PHQ-9);  
5. Beck Depression Inventory (BDI); 
6. Center for Epidemiologic Studies Depression Scale (CESD) and Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR). 

Screening and Diagnosis Among End-State Renal Disease Patients

While these standards exist to diagnose depression, it continues to be an invisible phenomenon not recognized as a visible and tangible disease process that exists in the ESRD population. Sadly, few studies focus on depression in the ESRD minority racial /ethnic groups, such as the Black and Hispanic populations. This group has a higher rate of ESRD compared with non-Hispanic, white individuals, according to a review in the International Society of Nephrology journal. Similarly, few studies have been conducted on depression in peritoneal dialysis patients.  

RELATED COURSE: ESRD and Hemodialysis for the Med-Surg Nurse

Screening for depressive symptoms in patients with ESRD should be done routinely but is not, according to a study published in the journal for the International Society for Peritoneal Dialysis. Ideally, screening for depression in chronic kidney failure patients should begin before the initiation of dialysis and should continue at regular intervals once the patient has started dialysis, the study found. 

The Bottom Line

Who would have thought that an invisible and intangible disease process such as depression could have such a powerful and devasting effect on the ESRD population and, at the same time, be the least understood and the least recognized medical illness that needs to be addressed and needs to be treated?  

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