Depression in pediatric chronic kidney disease

Abstract

Objective: To determine the prevalence of depression in pediatric patients with moderate to severe chronic kidney disease (CKD) and to identify associated patient characteristics. Methods: We performed a cross-sectional study to assess depression in patients aged 9-18 years with CKD stages III-V. Each patient completed the Child Depression Inventory-2 (CDI-2) and a parent completed the parent CDI-2. Criteria for the presence of depression were CDI-2 scores > 64 or a prior diagnoses of depression currently being treated. Relative risks and 95% confidence intervals were calculated to determine the patient characteristics associated with depression. Results: Thirty-one percent of patients (13/42) met the criteria for depression, 18% of those ≤ 12 years and 35% of those >12 years. After adjusting for age and gender, risk of depression was relatively lower for patients with disease for ≤ 3 years (RR .19, 95% CI: .03, 1.23) and for those with CKD stage IV (RR .24, 95% CI .06, 1.02) and CKD stage V (RR .20, 95% CI: .04, 1.05) when compared to those with CKD stage III. In comparison to pre-end stage renal disease (ESRD) patients there was a lower risk for those on dialysis (RR .45, 95% CI: .09, 2.30) and a greater risk for those with a functioning transplant (RR 2.4, 95% CI: .98, 5.9). Conclusion: There is a high prevalence of depression in pediatric patients with CKD. Patients with a functioning transplant or with CKD stage III may be at a relatively greater risk of depression. Our results are limited by statistical uncertainty due to the small sample size.