(051) Utilization of antidepressants in patients with chronic kidney disease: A nationwide cohort study

Publication Number: 714

Background: Mental disorder, chronic pain and insomnia are highly prevalent (nearly 30%-60%) in patients with chronic kidney disease (CKD), and antidepressants are used to be indicated. However, research on the utilization patterns of antidepressants among CKD patients in Taiwan is underrepresented.

Methods: Using the Taiwan National Health Insurance Database, we identified patients enrolled in the CKD care programs or undergoing chronic dialysis (receiving dialysis treatment for at least three successive months) between January 2015 and December 2018. Antidepressants new users were absentees of any antidepressants prescription a year before the first prescription (index date), and the first prescription date should follow after the cohort entry date. We stratified patients into three groups: the early-CKD group (CKD stage 1-2 with proteinuria and stage 3a), the pre-ESRD group (CKD stage 3b-5 without dialysis treatment) and the ESRD group (end stage renal disease with dialysis treatment). To describe utilization pattern, individuals were followed for 365 days from index date. To compare categorical and continuous variables, we utilized chi-squared test and t test. Comparing to ESRD group, standardized mean difference (SMD) above 0.1 would be recognized as imbalance between groups.

Results: During the observation periods, a total of 778,481 patients were enrolled in the CKD care programs or undergoing chronic dialysis. Of these patients, 116,315 fulfilled the inclusion criteria as antidepressant new users (mean age 68.5, 48.7% male). Prevalence of antidepressants prescribing was 22.4%, and the incidence rate was 55.7/1000 person-years in overall CKD population. Furthermore, as renal function deteriorated, the incidence rate of antidepressants increased gradually, from 53.18 per 1000 person-years in the early-CKD group to 65.13 per 1000 person-years in the pre-ESRD group, and 78.85 per 1000 person-years in the ESRD group. Median time from cohort entry date to the first antidepressants prescription was 369 days (IQR 151-730) in the ESRD group, 514 days (IQR 233-924, SMD= 0.28) in the early-CKD group and 522 days (IQR 232-939, SMD= 0.3) in the pre-ESRD group. The most commonly prescribed class were tricyclic antidepressants, accounting for 45.3% of the early-CKD group, 43.2% of the pre-ESRD group and 38.8% of the ESRD group. SSRIs and SARIs both accounted for approximately 20% of each group.

Conclusions: In this large cohort of patients with CKD, we found the initiation of first antidepressants were more than a year since the onset of CKD, and the prevalence of antidepressants prescription was high, especially tricyclic and tetracyclic antidepressants.