People with comorbid end-stage renal disease (ESRD) and diabetes are more prone to poor clinical outcomes including increased mortality and hospitalization, poor treatment compliance and quality of life. Self-management of these coexisting conditions is challenging as the treatment regime is complex, burdensome, and nutrition guidelines may conflict. While it is known that each morbidity is known to be associated with an increased risk for depression, limited research has explored the potential compounding effect of comorbidity. To explore this, determinants of depression were compared between a cohort of ESRD patients with and without diabetes.
Data from the American Kidney Fund Health Insurance Premium Program of 63,254 low-income adults with ESRD were analyzed. All demographic and health condition data were collected through self-report. A logistic regression was performed to ascertain the effect of diabetes on the likelihood of depression in individuals with ESRD. Unadjusted and adjusted odds of having depression were calculated in those with and those without diabetes. Age, sex, race/ethnicity, income, marital status, employment status, and health conditions known to be associated with depression including anxiety, cardiovascular disease, insomnia, and sexual problems were included as covariates.
After adjusting for demographic and clinical variables, diabetes remained independently associated with higher odds of depression (1.9; 95% confidence interval: 1.8-2.1) .
Odds of depression significantly increased among adults with ESRD in the presence of diabetes. Screening for depression among people with ESRD is of particular importance to mitigate adverse outcomes and disease progression. Future studies should further examine the mechanisms of depression in both ESRD and diabetes, and test modifiable targets for interventions to prevent and treat depression in these populations.
R. Woolley: None. R. Pierce: None. M. Spigler: None.