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. 2018 Mar;93(3):321-332.
doi: 10.1016/j.mayocp.2017.12.008.

Younger Adults Initiating Hemodialysis: Antidepressant Use for Depression Associated With Higher Health Care Utilization

Diana L Vork  1 , Terry D Schneekloth  2 , Adam C Bartley  3 , Lisa E Vaughan  3 , Maria I Lapid  2 , Sheila G Jowsey-Gregoire  2 , Ziad M El-Zoghby  4 , Sandra M Herrmann  4 , Cheryl L Tran  5 , Robert C Albright  4 , LaTonya J Hickson  6
Affiliations

Younger Adults Initiating Hemodialysis: Antidepressant Use for Depression Associated With Higher Health Care Utilization

Diana L Vork et al. Mayo Clin Proc. 2018 Mar.

Abstract

Objective: To examine associations between antidepressant use and health care utilization in young adults beginning maintenance hemodialysis (HD) therapy.

Patients and methods: Antidepressant use, hospitalizations, and emergency department (ED) visits were examined in young adults (N=130; age, 18-44 years) initiating HD (from January 1, 2001, through December 31, 2013) at a midwestern US institution. Primary outcomes included hospitalizations and ED visits during the first year.

Results: Depression diagnosis was common (47; 36.2%) at HD initiation, yet only 28 patients (21.5%) in the cohort were receiving antidepressant therapy. The antidepressant use group was more likely to have diabetes mellitus (18 [64.3%] vs 33 [32.4%]), coronary artery disease (8 [28.6%] vs 12 [11.8%]), and heart failure (9 [32.1%] vs 15 [14.7%]) (P<.05 for all) than the untreated group. Overall, 68 (52.3%) had 1 or more hospitalizations and 33 (25.4%) had 1 or more ED visits in the first year. The risk of hospitalization during the first year was higher in the antidepressant use group (hazard ratio, 2.35; 95% CI, 1.39-3.96; P=.001), which persisted after adjustment for diabetes, coronary artery disease, and heart failure (hazard ratio, 1.94; 95% CI, 1.22-3.10; P=.006). Emergency department visit rates were similar between the groups.

Conclusion: Depression and antidepressant use for mood indication are common in young adult incident patients initiating HD and and are associated with higher hospitalization rates during the first year. Further research should determine whether antidepressants are a marker for other comorbidities or whether treated depression affects the increased health care use in these individuals.

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Conflict of interest statement

Conflict of Interest

C.L.T. has received grant support from Questcor pharmaceuticals.

Figures

Figure 1
Figure 1
Hospitalization events within the first year among young, adult incident patients, according to antidepressant use at hemodialysis initiation.
Figure 2
Figure 2
Causes of hospitalizations within the first year by antidepressant use at hemodialysis initiation.
Figure 3
Figure 3
a. Mosaic plot of hospitalizations within the first year after dialysis start in patients receiving antidepressant therapy at hemodialysis initiation. Units represent individual events per patient. b. Mosaic plot of Emergency Department visits within the first year after dialysis start in patients receiving antidepressant therapy at hemodialysis initiation. Units represent individual events per patient.
Figure 3
Figure 3
a. Mosaic plot of hospitalizations within the first year after dialysis start in patients receiving antidepressant therapy at hemodialysis initiation. Units represent individual events per patient. b. Mosaic plot of Emergency Department visits within the first year after dialysis start in patients receiving antidepressant therapy at hemodialysis initiation. Units represent individual events per patient.
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