Depressive Symptoms at Kidney Transplant Evaluation and Access to the Kidney Transplant Waitlist

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Introduction: Depressive symptoms, even without a clinical diagnosis of depression, are common in kidney failure patients and may be a barrier to completing the complex process of kidney transplant (KT) evaluation. We assessed depressive symptom burden and association between depressive symptoms and access to KT waitlist by age. Methods: In a prospective cohort of 3728 KT patients (aged 18–88 years), the Center for Epidemiologic Studies—Depression (CES-D) scale was used to measure depressive symptoms at evaluation. Depressive symptom severity was defined as follows: none: 0; minimal: 1 to 15; mild: 16 to 20; moderate: 21 to 25; severe: 26 to 60. Hazard ratios (HRs) of active listing within 1 year after evaluation were estimated using Cox proportional hazards models, adjusted for clinical and social factors. Results: At evaluation, 85.8% of the patients reported at least minimal depressive symptoms; the proportion was lower among older patients: 18 to 29 years = 92.0%; 30 to 39 years = 88.3%; 40 to 49 years = 87.2%; 50 to 59 years = 87.0%; 60 to 69 years = 83.4%; and ≥70 years = 82.0%. Chance of active listing decreased with more severe depressive symptoms (log-rank, P < 0.001). After adjustment, every 5-point higher CES-D score (more depressive symptoms) was associated with a 13% lower chance of listing (HR = 0.87, 95% CI: 0.85–0.90); the strongest association was found among patients aged ≥70 years (adjusted HR [aHR] = 0.73, 95% CI: 0.62–0.86). Furthermore, minimal (HR = 0.69, 95% CI: 0.60–0.79), mild (HR = 0.57, 95% CI: 0.44–0.72), moderate (HR = 0.53, 95% CI: 0.39–0.71), and severe (HR = 0.44, 95% CI: 0.34–0.57) depressive symptoms were all associated with a lower chance of listing. Conclusion: Older candidates were less likely to report depressive symptoms at KT evaluation. Regardless of age, candidates who did report depressive symptoms, and even minimal symptoms, had a lower chance of listing. Transplant centers should routinely screen patients for depressive symptoms and refer the affected patients to mental health services to improve access to KT.

Original languageEnglish (US)
Pages (from-to)1306-1317
Number of pages12
JournalKidney International Reports
Issue number6
StatePublished - Jun 2022


  • age
  • depressive symptoms
  • end-stage kidney disease
  • kidney transplantation
  • waitlisting

ASJC Scopus subject areas

  • Nephrology


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