Antidepressant prescriptions by provider in patients with kidney failure and depression

Abstract

Background. The prevalence of depression is high among patients with end-stage kidney disease (ESKD). Recent studies have indicated under-recognition and -treatment of depression in this population, and little is known about how the specialty of the prescribing clinician may influence clinical outcomes. This study aimed to evaluate whether the prescribing clinician's specialty (psychiatrist vs. non-psychiatrist) is associated with clinical outcomes in patients with ESKD and comorbid depression who receive antidepressant treatment. Methods. We extracted data from the Korean National Health Institute Database System from January 2004 to December 2022. Patients with ESKD and depression who underwent antidepressant therapy after their ESKD diagnosis were included. Patients were followed up for 4.7 +/- 3.5 years. Results. Among 16 756 patients with ESKD and depression [mean age, 67.3 years; 8614 (51.4%) men], 7841 (46.8%) patients were prescribed antidepressants by psychiatrists. After propensity score matching, the 5-year mortality was significantly lower in the psychiatrist (25.8%) than in the non-psychiatrist group (38.2%). After multivariable adjustment, prescription by a psychiatrist remained significantly associated with lower mortality (adjusted hazard ratio, 0.66; 95% confidence interval, 0.62-0.70; P < .001). All-cause mortality was consistent across various subgroups, such as age (above or below 75 years), sex, time from dialysis initiation to depression diagnosis, income level, region of residence, and comorbidity status. This trend remained in 6-month, 1-year, 2-year, and 3-year landmark analyses. Conclusions. Our findings suggest a potential benefit of specialty psychiatric care for improving clinical outcomes in patients with ESKD and depression.