Care pathways for the identification and management of depression in patients with chronic kidney disease: a rapid scoping review
Depression is highly prevalent across the spectrum of Chronic Kidney Disease (CKD) and related to poor clinical outcomes. There is limited evidence regarding the most effective and acceptable interventions to manage depression in people living with kidney disease and little is known about the care pathways for depression in CKD. This review aimed to investigate how depression is identified and managed in adult patients with CKD, since the publication of the NICE clinical guidelines for managing depression in chronic physical health problems published in 2009. Eight relevant databases were utilised to identify appropriate literature, using a systematic search with pre-defined inclusion criteria. Data were extracted which were of relevance to the identification and/or management of depression in CKD. Of 63 articles identified, 40 were included in the sample as relevant records for extraction (spanning 2010-2020). Of these records there were: nineteen cross-sectional questionnaire studies (48%); thirteen review articles (33%); three cohort studies (8%); two RCTs (5%) and one audit. Only two studies referred to the NICE 2009 guidelines. The most frequently utilised depression screening tools included: The Beck Depression Inventory (n=18 studies, 46%); the Patient Health Questionnaire (PHQ-9 and 2 (n=5 studies, 13%) and the Hospital Anxiety and Depression Scale (n=3 studies, 8%). Evidence regarding effective treatments for depression in CKD included: Cognitive Behavioural Therapy (n=4 studies, 10%); psychotherapy (n=1 study, 3%); and counselling (n=1 study, 3% weak evidence). There was limited methodologically strong evidence for pharmacological interventions and adverse events appear common following SSRI initiation. Two RCTs included in this review found no effect of Sertraline on depression and reported more adverse events in this group. Despite this, data from the USA suggests that over forty percent of CKD patients are prescribed antidepressants. In conclusion the identification of depression is commonly evaluated using validated screening tools with appropriate renal specific cut-off scores. The most rigorous RCT studies show no beneficial effect of the use of antidepressants for use in patients with CKD. Psychological therapies have been more widely studied with moderate evidence regarding efficacy and acceptability. Understanding national clinical practice patterns may help facilitate the development of renal specific guidelines for the identification and management of depression in CKD.