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Psychosocial Intervention Improves Depression, Quality of Life, and Fluid Adherence in Hemodialysis
Open accessAbstract
Patients with ESRD have high rates of depression, which is associated with diminished quality of life and survival. We determined whether individual cognitive behavioral therapy (CBT) reduces depression in hemodialysis patients with elevated depressive affect in a randomized crossover trial. Of 65 participants enrolled from two dialysis centers in New York, 59 completed the study and were assigned to the treatment-first group (n=33) or the wait-list control group (n=26). In the intervention phase, CBT was administered chairside during dialysis treatments for 3 months; participants were assessed 3 and 6 months after randomization. Compared with the wait-list group, the treatment-first group achieved significantly larger reductions in Beck Depression Inventory II (self-reported, P=0.03) and Hamilton Depression Rating Scale (clinician-reported, P<0.001) scores after intervention. Mean scores for the treatment-first group did not change significantly at the 3-month follow-up. Among participants with depression diagnosed at baseline, 89% in the treatment-first group were not depressed at the end of treatment compared with 38% in the wait-list group (Fisher's exact test, P=0.01). Furthermore, the treatment-first group experienced greater improvements in quality of life, assessed with the Kidney Disease Quality of Life Short Form (P=0.04), and interdialytic weight gain (P=0.002) than the wait-list group, although no effect on compliance was evident at follow-up. In summary, CBT led to significant improvements in depression, quality of life, and prescription compliance in this trial, and studies should be undertaken to assess the long-term effects of CBT on morbidity and mortality in patients with ESRD.
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“Pilot studies of CBT have also shown positive effects on mood in patients undergoing dialysis (Duarte et al . 2009; Cukor et al . 2014).”
From Improving Distress in Dialysis (iDiD): A tailored CBT self-management treatment for patients undergoing dialysis. (2016) · cites this paper as Cukor et al . 2014
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“Psychotherapy may also lead to increased engagement in lifestyle behaviors that positively influence physical health327,335.”
From Comorbidity between major depressive disorder and physical diseases: a comprehensive review of epidemiology, mechanisms and management (2023) · cites this paper as [327]
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Self-citationDepression in dialysis patients
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“It has been shown that improving the quality of treatment in patients with ESRD can minimize the development and/or severity of complications and therefore improve patients’ HRQOL [25–27].”
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Self-citationMehrotra, R., Cukor, D., Unruh, M. L., Rue, T. C., Heagerty, P. J., Cohen, S. D., Dember, L. M., Díaz‐Linhart, Y., Dubovsky, A. N., Greene, T., et al. (2019) · Annals of Internal Medicine · doi:10.7326/m18-2229 · Cited by 118
Self-citationMale Sexual Dysfunction and Chronic Kidney Disease
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Flythe, J. E., Hilliard, T. S., Lumby, E., Castillo, G., Orazi, J., Abdel‐Rahman, E. M., Pai, A. B., Rivara, M. B., Peter, W. L. S., Weisbord, S. D., et al. (2018) · Clinical Journal of the American Society of Nephrology · doi:10.2215/cjn.07670618 · Cited by 93
“The meeting focused on physical symptoms because (1) physical symptoms are more common than mood symptoms, (2) treating physical symptoms may improve mood symptoms (4,8), and (3) at least two randomized, controlled trials (RCTs) for depression, the top mood symptom, have been conducted among patients on hemodialysis i…”
BackgroundAfşar, B., Siriopol, D. C., Aslan, G., Eren, Ö. C., Dağel, T., Kılıç, U., Kanbay, A., Burlacu, A., Covic, A. C., & Kanbay, M. (2018) · International Urology and Nephrology · doi:10.1007/s11255-018-1790-4 · Cited by 95
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Depression and All-Cause Mortality in Hemodialysis Patients
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“Nonpharmacologic treatments such as more frequent HD (26,27), CBT (24,25), and exercise (23) have been successful in treating depressive symptoms in patients on HD (Table 2).”
BackgroundInfluentialHudson, J. L., Moss-Morris, R. E., Norton, S., Picariello, F., Game, D. S., Carroll, A., Spencer, J., McCrone, P., Hotopf, M. H., Yardley, L., et al. (2017) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2017.09.009 · Cited by 86
“However, two of these past trials (15, 16) recruited patients with higher baseline 373”
BackgroundResultInfluentialA Conceptual Framework of Palliative Care across the Continuum of Advanced Kidney Disease
Lam, D. Y., Scherer, J. S., Brown, M. A., Grubbs, V., & Schell, J. O. (2019) · Clinical Journal of the American Society of Nephrology · doi:10.2215/cjn.09330818 · Cited by 88
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“The latter study showed 51% clinical utility for treating severe depression (Cukor et al., 2014).”
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“A subsequent crossover randomized trial by Cukor et al.38 examined the effect of chairside CBT on depression and QOL over 3-month treatment periods in a cohort of 59 patients on chronic hemodialysis.”
MethodInfluentialVijay, V. R., & Kang, H. K. (2021) · Journal of Renal Nutrition · doi:10.1053/j.jrn.2021.11.007 · Cited by 70
Brief Mindfulness Meditation for Depression and Anxiety Symptoms in Patients Undergoing Hemodialysis
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“Other limitations were the lack of an active control group and the fact we did not assess long-term outcomes (41).”
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“Four of these studies measured symptoms in patients (Sharp et al., 2005; Duarte et al., 2009; Rodrigue et al., 2011; Cukor et al., 2014) and one in carers (Chan et al., 2015) (Figure 2).”
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“Psychosocial interventions, such as cognitive behavioral therapy (64, 65) and electronic monitoring (66), to document drug intake have shown promising results in improving adherence in patients with end-stage kidney disease, though there is less evidence on long-term behavior change.”
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“Researchers have found that patientreported quality of life is inversely proportional to the number of troublesome symptoms that patients report, such as pain (17,18), and treatment of symptoms improves patient quality of life (19,20).”
BackgroundDepressive Affect and Hospitalization Risk in Incident Hemodialysis Patients
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“supports using CBT treatment in HD patients, with a successful reduction in major depression disorder (42).”
MethodHedayati, S. S., Daniel, D. M., Cohen, S. D., Comstock, B. A., Cukor, D., Díaz‐Linhart, Y., Dember, L. M., Dubovsky, A. N., Greene, T., Grote, N. K., et al. (2015) · Contemporary Clinical Trials · doi:10.1016/j.cct.2015.11.020 · Cited by 54
“Similarly, >40% of HD patients approached for participation in a recent trial of individual CBT did not wish to undergo treatment for clinically significant depressive symptoms [51].”
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Acceptance of Antidepressant Treatment by Patients on Hemodialysis and Their Renal Providers
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Breaking the adherence barriers: Strategies to improve treatment adherence in dialysis patients
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Opioid Prescription, Morbidity, and Mortality in US Transplant Recipients
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“In contrast to the general population, where CBT has been assessed and found effective for pain management in clinical trials,(29,30) no reports of its efficacy have been published among transplant recipients.(31) In addition, transplant candidates and recipients with pain should be assessed for the presence of coexis…”
ResultSelf-citationZhang, L., Zou, L., & Zhou, L. (2024) · Renal Failure · doi:10.1080/0886022x.2024.2331613 · Cited by 48
“…can effectively reduce the depression level in MhD patients in the short term (< 1 m). the meta-analysis (figure 5) of six studies [18, 36, 39, 43, 47, 48] indicates the medium-term effects of psychoeduca-tional interventions on depression in patients with MhD after the intervention compared…”
BackgroundMethodResultInfluentialPre-ESRD Depression and Post-ESRD Mortality in Patients with Advanced CKD Transitioning to Dialysis
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“(47) performed a small randomized, controlled trial, which indicated that cognitive behavioral therapy led to significant improvement in depression symptoms as well as medication adherence in patients with ESRD.”
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Do psychological interventions reduce depression in hemodialysis patients?
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Palliative Care Disincentives in CKD: Changing Policy to Improve CKD Care
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“[18] Main dominant frequency and median frequency were also calculated.”
MethodDepression in maintenance hemodialysis patients: What do we need to know?
Li, Y., Zhu, B., Shen, J., & Miao, L. (2023) · Heliyon · doi:10.1016/j.heliyon.2023.e19383 · Cited by 46
“It aims to change patients’ bad thoughts, behaviors and negative emotions through classroom teaching, group discussion and scenario simulation [77].”
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Non-Pharmacological Interventions for Pain Management in Hemodialysis: A Narrative Review
Kassim, M. A. K., Pantazi, A. C., Nori, W., Tuta, L. A., Bălașa, A. L., Mihai, C. M., Mihai, L., Frecuș, C. E., Lupu, V. V., Lupu, A., et al. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12165390 · Cited by 39
“The treatment-first group experienced significantly greater reductions in depression scores (both self-reported and clinician-reported) compared to the waitlist group [35].”
BackgroundResultInfluentialMoura, A., Madureira, J., Alija, P., Fernandes, J. C., Oliveira, J. G., Lopez, M., Filgueiras, M., Amado, L., Faria, M., Miranda, V. M. P., et al. (2014) · Quality of Life Research · doi:10.1007/s11136-014-0854-x · Cited by 31
“Indeed, depression is a common finding in ESRD patients with an estimated prevalence between 20 and 44 % and represents an important comorbidity in these patients [49].”
BackgroundLing, C., Evans, D., Zhang, Y., Luo, J., Hu, Y., Ouyang, Y., Tang, J., & Kuang, Z. (2020) · BMC Psychiatry · doi:10.1186/s12888-020-02754-2 · Cited by 31
Perspectives on mental health among patients receiving dialysis
Nataatmadja, M., Evangelidis, N., Manera, K., Cho, Y., Johnson, D. W., Craig, J. C., Baumgart, A., Hanson, C. S., Shen, J. I., Guha, C., et al. (2020) · Nephrology Dialysis Transplantation · doi:10.1093/ndt/gfaa346 · Cited by 31
Collister, D., Bangdiwala, S. I., Walsh, M. W., Mian, R. I., Lee, S. F., Furukawa, T. A., & Guyatt, G. H. (2021) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2021.01.026 · Cited by 33
Selective Serotonin Reuptake Inhibitor Use and Hip Fracture Risk Among Patients on Hemodialysis
Vangala, C., Niu, J., Montez‐Rath, M. E., Yan, J., Navaneethan, S. D., & Winkelmayer, W. C. (2019) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2019.07.015 · Cited by 30
Depressive Symptoms Associate With Race and All-Cause Mortality in Patients With CKD
Tuot, D. S., Lin, F., Norris, K. C., Gassman, J., Smogorzewski, M. J., & Ku, E. (2018) · Kidney International Reports · doi:10.1016/j.ekir.2018.10.001 · Cited by 30
Technology-assisted cognitive-behavioral therapy intervention for end-stage renal disease
Jakubowski, K., Jhamb, M., Yabes, J. G., Gujral, S., Oberlin, L. E., Bender, F. H., & Steel, J. L. (2019) · Translational Behavioral Medicine · doi:10.1093/tbm/ibz077 · Cited by 29
“Our technology-assisted approach to CBT also has several potential benefits compared to interventions conducted “chairside” in the HD facility [16, 17].”
BackgroundMethodAntidepressant Usage in Haemodialysis Patients: Evidence of Sub‐Optimal Practice Patterns
Guirguis, A., Chilcot, J., Almond, M. K., Davenport, A., Wellsted, D. M., & Farrington, K. (2020) · Journal of Renal Care · doi:10.1111/jorc.12320 · Cited by 29
“On the other hand, benefits of group (Duarte et al., 2009) and chair side (during centre-based HD) CBT have been reported (Cukor et al., 2014).”
BackgroundGriva, K., Lam, K. F. Y., Mooppil, N., Ng, J.-A. H., McBain, H. B., & Newman, S. P. (2018) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2018.07.012 · Cited by 29
Sav, M. Y., Sav, T., Taşçı, E. Ş., & Sav, N. M. (2014) · Hemodialysis International · doi:10.1111/hdi.12171 · Cited by 28
Hanson, C. S., Chadban, S. J., Chapman, J. R., Craig, J. C., Wong, G., & Tong, A. (2015) · Transplantation · doi:10.1097/tp.0000000000000921 · Cited by 28
“Copyright © 2016 Wolters Kluwer H nonadherence, depression, and low social support.(18,39,40) Training to improve interactions with interpreters might alleviate nephrologists' uncertainties during shared decisionmaking with non-English speaking patients.”
BackgroundPatient Education and Support During CKD Transitions: When the Possible Becomes Probable
Green, J. A., & Boulware, L. E. (2016) · Advances in Chronic Kidney Disease · doi:10.1053/j.ackd.2016.04.004 · Cited by 27
Alsaraireh, F. A., Aloush, S., AlAzzam, M., & ALBashtawy, M. (2018) · Issues in Mental Health Nursing · doi:10.1080/01612840.2017.1406022 · Cited by 27
“Studies report that depression in patients undergoing haemodialysis is associated with low quality of life, decreased adherence to the dialysis prescription, comorbidity, and increased mortality (Chilcot, Davenport, Wellsted, Firth, & Farrington, 2010; Cukor et al., 2014).”
BackgroundMethodTao, W., Tao, X., Wang, Y., & Bi, S. (2020) · Journal of Clinical Nursing · doi:10.1111/jocn.15301 · Cited by 29
Prioritizing Patient‐Centered Care Implementation and Research for Patients with Kidney Disease
Cavanaugh, K. L. (2014) · Seminars in Dialysis · doi:10.1111/sdi.12326 · Cited by 27
“The optimal treatment strategies including medication and nonpharmacologic approaches (54) remain unknown.”
BackgroundOk, E., & Kutlu, Y. (2020) · Clinical Nursing Research · doi:10.1177/1054773820974158 · Cited by 26
“, 2012), and psychosocial intervention (Cukor et al., 2014) also reported improvements in the quality of life.”
BackgroundMethodInfluentialInfluence of depression and anxiety on hemodialysis patients: The value of multidisciplinary care
Delgado-Domínguez, C. J., Sanz-Gómez, S., López-Herradón, A., Díaz Espejo, B., Lamas González, O., de los Santos Roig, M., Berdud Godoy, I., Rincón Bello, A., & Ramos Sánchez, R. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18073544 · Cited by 26
Holvoet, E., Verhaeghe, S. T. L., Davies, S., Combes, G., François, K., Johnson, D. W., Biesen, W. V., & Humbeeck, L. V. (2020) · Peritoneal Dialysis International · doi:10.1177/0896860819896219 · Cited by 25
Pereira, R. A., Alvarenga, M. D. S., Avesani, C. M., & Cuppari, L. (2020) · Nephrology Dialysis Transplantation · doi:10.1093/ndt/gfaa177 · Cited by 30
Bossola, M., Pepe, G., Antocicco, M., Severino, A., & Stasio, E. D. (2022) · Journal of Nephrology · doi:10.1007/s40620-022-01450-6 · Cited by 25
Valsaraj, B. P., Bhat, S. M., Prabhu, R., & Kamath, A. (2021) · Sultan Qaboos University medical journal · doi:10.18295/squmj.2021.21.01.008 · Cited by 24
Pearce, C. J., Hall, N., Hudson, J. L., Farrington, K., Tucker, M. J. R., Wellsted, D. M., Jones, J., Sharma, S., Norton, S., Ormandy, P., et al. (2023) · Journal of Renal Care · doi:10.1111/jorc.12458 · Cited by 27
“Most CBT interventions [ n = 12] [Bahmani et al., 2015; Bargiel ‐ Matusiewicz et al., 2019; Chan et al., 2016; J. Chen & Xie, 2018; Cukor et al., 2014; Griva et al., 2018; Hou et al., 2014; Lerma et al., 2017; Picariello et al., 2021; Sohn et al., 2018; Valsaraj et al., 2016; Zhianfar et al.,…”
Roumelioti, M., Steel, J. L., Yabes, J. G., Vowles, K. E., Yoram Vodovotz, B., Beach, S. R., Rollman, B. L., Weisbord, S. D., Unruh, M. L., & Jhamb, M. (2018) · Contemporary Clinical Trials · doi:10.1016/j.cct.2018.09.002 · Cited by 23
Is successful treatment of depression in dialysis patients an achievable goal?
Chilcot, J., & Hudson, J. L. (2018) · Seminars in Dialysis · doi:10.1111/sdi.12755 · Cited by 23
“of life, and daily fluid adherence compared with a waiting list control group (n = 33).(36) The third study compared 5 weeks of individual CBT with usual care in 60 dialysis patients with mild to moderate depression and anxiety symptoms.”
Shirazian, S., Smaldone, A. M., Jacobson, A. M., Fazzari, M. J., & Weinger, K. (2023) · PLoS ONE · doi:10.1371/journal.pone.0285156 · Cited by 22
“In patients on HD, cognitive behavioral therapy (CBT)-based interventions delivered by psychologists have successfully treated depression (a major component of QOL) and led to secondary improvements in self-care [10, 11].”
BackgroundPeer Navigator Intervention for Latinos on Hemodialysis: A Single-Arm Clinical Trial
Cervantes, L., Chonchol, M., Hasnain‐Wynia, R., Steiner, J. F., Havranek, E. P., Hull, M. L., Rice, J. D., Kendrick, J., Alamillo, X., Camacho, C. G., et al. (2019) · Journal of Palliative Medicine · doi:10.1089/jpm.2018.0439 · Cited by 22
“KDQOL-36 SF, mean (SD) Burden of kidney disease 33 (27) Symptoms/problems 68 (21) SF-12 physical health composite 33 (1) SF-23 mental health composite 45 (13)”
BackgroundDecreasing hospitalizations in patients on hemodialysis: Time for a paradigm shift
Golestaneh, L. (2018) · Seminars in dialysis · doi:10.1111/sdi.12675 · Cited by 19
“designed to improve self-efficacy improved dialysis adherence in the short term.(93) Other interventions, such as cognitive behavioral therapy as a means to improve perception of illness burden and social”
BackgroundSingle Questions for the Screening of Anxiety and Depression in Hemodialysis
Collister, D., Rodrigues, J. C., Mazzetti, A., Salisbury, K., Morosin, L., Rabbat, C., Brimble, K. S., & Walsh, M. W. (2019) · Canadian Journal of Kidney Health and Disease · doi:10.1177/2054358118825441 · Cited by 20
Nassim, M., Park, H., Dikaios, E., Potes, A., Elbaz, S., McVeigh, C., Lipman, M. L., Novák, M., Trinh, E., Alam, A., et al. (2021) · Healthcare · doi:10.3390/healthcare9060659 · Cited by 19
“Our study also suggests that brief program formatting (400 total minutes), while about 40–70% shorter than most psychosocial interventions [23,25,26,40], may lead to similar benefits.”
BackgroundHernández, R., Wilund, K., Solai, K., Tamayo, D., Fast, D., Venkatesan, P., Lash, J. P., Lora, C. M., Martinez, L., Alemañy, G. M., et al. (2023) · JMIR Research Protocols · doi:10.2196/45100 · Cited by 19
“Although cognitive behavioral therapy shows promise in reducing symptoms of depression and improved compliance of fluid intake [11,12], this approach presents significant challenges given the complexity and intensiveness needed for deployment, which requires highly trained and skilled clinicians…”
Muscat, P., Chilcot, J., Weinman, J. A., & Hudson, J. L. (2018) · Journal of Renal Care · doi:10.1111/jorc.12243 · Cited by 36
“Similarly, Cukor et al. (2014) demonstrated progress in the level of depression, quality of life and prescription compliance following a CBT-based intervention versus standard care.”
Background
Metadata
- Authors
- Cukor, D., Ver Halen, N., Asher, D. R., Coplan, J. D., Weedon, J., Wyka, K. E., Saggi, S. J., & Kimmel, P. L.
- Affiliations
- SUNY Downstate Health Sciences University (US)
- Weill Cornell Medical Center (US)
- George Washington University (US)
- Corresponding author
- Cukor, Daniel
- Coplan, Jeremy D.
- Venue
- Journal of the American Society of Nephrology
- Published
- 2014-01
- Volume
- 25
- Issue
- 1
- Pages
- 196-206
- ISSN
- 1046-6673 (ISSN-L)
- PMC
- PMC3871769
- OpenAlex
- W2169214416
- Cited by
- 263
- References
- 50
- Citations by year
- 2026: 10 · 2025: 28 · 2024: 16 · 2023: 20 · 2022: 15 · 2021: 24 · 2020: 30 · 2019: 27 · 2018: 26 · 2017: 15 · 2016: 24 · 2015: 11 · 2014: 16
- FWCI
- 12.89
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Society of Nephrology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- National Institute of Diabetes and Digestive and Kidney Diseases (K23DK076980)
- Topics
- Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- depression, end-stage renal disease, hemodialysis, cognitive behavioral therapy, psychosocial interventions, quality of life, interdialytic weight gain, medication adherence, dialysis
- MeSH terms
- Depression, Female, Renal Dialysis, Humans, Kidney Failure, Chronic, Male, Patient Compliance, Quality of Life, Water-Electrolyte Balance, Cognitive Behavioral Therapy, Cross-Over Studies
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