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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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“evaluated the effects of 10 individual CBT sessions in participants with elevated depressive affect (BDI-II > 10), delivered by a psychologist over 3 months.(94) At the end of treatment, only 11% of patients in the treatment-first group were depressed, compared with 62% in the waitlist group.”
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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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