Depression screening tools in patients with renal insufficiency

A recent review examines research on the use of depression screening tools in patients with kidney failure. The results will appear in a future issue of BRIGHT.

People with kidney failure suffer from depression at higher rates than the general population. Medicare requires routine depression screening for patients with kidney failure, but no clear guidance on which methods to use.

Karli Kondo, Ph.D. (VA Portland Health Care System and Oregon Health & Science University) and her colleagues conducted a review to identify the appropriate depression screening tools for patients with kidney failure and to better understand the impact of screening for depression in this population.

Researchers identified 16 relevant studies that evaluated the performance characteristics of the depression assessment tools for patients with renal insufficiency. A tool called Beck Depression Inventory II (BDI-II) has been by far the most extensively studied, with 9 studies examining its performance. Other tools included the Cognitive Depression Index (CDI), the Center for Epidemiologic Studies – Depression Scale (CES-D), the Hospital Anxiety and Depression Scale – Depressive Subscale (HADS-D), the Geriatric Depression Scale-15 (GDS- 15), Hamilton Depression Rating Scale (Ham-D), Patient Health Questionnaire 2 (PHQ-2), PHQ-9 and others.

“Our hope was that we would find evidence pointing to an optimal screening tool. This was obviously optimistic, because if there was one that had strong evidence, it would already be in use,” said Dr. Kondo. “We also hoped that we would find evidence to support the use of common tools in practice. And we didn’t. PHQ-2 and -9 are widely used in the medical field and are free. CES -D is another commonly used. We found only one study for PHQ-9 and CES-D, and no studies for PHQ-2. “

Dr. Kondo noted that many of the studies were conducted overseas and it is unclear how applicable they are to patients in the United States. Many of the studies were small, and among the studies examining the same tools, there was not much agreement on the limit values ​​chosen to define depression and its severity.

An accompanying editorial notes that there are multiple practical considerations to consider when considering the best screening tool for identifying depression in renal failure patients on dialysis.

A Patient Voice also accompanies the study and provides the perspective of a veteran with kidney disease diagnosed with depression using the PHQ-9 tool.