Depression Management With Sertraline in Maintenance Hemodialysis Patients
ISN-ACT Global Trials Focus Subgroup member Marimar Contreras Nieves summarizes the design and outcomes of one of the latest ISN-ACT Global Trials Focus (GTF) selections.
The Efficacy and Safety of Sertraline in Maintenance Hemodialysis Patients With Depression: A Randomized Controlled Study
Zhang et al., J Affect Disord, 2024 May, 1:353:60-66
Summary
This study evaluated the efficacy and safety of sertraline in 125 maintenance hemodialysis patients with depression, defined as Hamilton Depression Rating Scale (HAMD) scores of 8 or higher.
Participants were randomized (1:1) to the treatment group (sertraline, initial dose 25-50 mg daily and up-titrated to response) or the control group (no antidepressants). Parameters compared after 12 weeks included HAMD, Medication Adherence Report Scale-5 (MARS-5), Mini Nutritional Assessment short-form (MNA-SF), and Kidney Disease Quality of Life-36 (KDQOL-36) scores, along with clinical and laboratory indicators and drug-related adverse reactions.
At baseline, the groups had no significant demographic or clinical differences. After 12 weeks, HAMD scores in the treatment group decreased from baseline (96.8% effective rate, z=-6.8, p<0.001) and were lower than those in the control group (z=- 6.2, p<0.001). The KDQOL-36, MARS-5, and MNA-SF scores in the treatment group significantly improved from pretreatment levels and were superior to those in the control group. Albumin and hemoglobin levels in the treatment group significantly increased, while C-reactive protein significantly decreased. Twelve patients in the treatment group experienced mild nausea, and one experienced somnambulism, but most could continue treatment with dose adjustments.
Commentary
Depression is a common, often overlooked mental health disorder in maintenance hemodialysis patients, seriously affecting their quality of life and contributing to higher cardiovascular risk and mortality.
There are few evidence-based pharmacologic and non-pharmacologic treatments for depression in people on hemodialysis. This study adds to current evidence for sertraline use in such patients, showing an effective and safe reduction of depressive symptoms and improving quality of life, treatment adherence, nutritional status, chronic inflammation, and anemia. However, this is a small, single-center study with a short follow-up period. Larger multicenter trials are needed to confirm these findings.
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