Journal Article Annotations
2017, 2nd Quarter

Psychonephrology

Annotations by Paula Zimbrean, MD, FAPM and Marta Novak, MD, PHD
July 2017

Ethnic background is a potential barrier to living donor kidney transplantation in Canada: a single-center retrospective cohort study
Prevalence, incidence, indication, and choice of antidepressants in patients with and without chronic kidney disease: a matched cohort study in UK Clinical Practice Research Datalink

PUBLICATION #1 — Psychonephrology

Ethnic background is a potential barrier to living donor kidney transplantation in Canada: a single-center retrospective cohort study

Mucsi I, Bansal A, Famure O, et al

Transplantation 2017; 101(4):e142-e151

BACKGROUND: We examined if African or Asian ethnicity was associated with lower access to kidney transplantation (KT) in a Canadian setting.

METHODS: Patients referred for KT to the Toronto General Hospital from January 1, 2003, to December 31, 2012, who completed social work assessment, were included (n = 1769). The association between ethnicity and the time from referral to completion of KT evaluation or receipt of a KT were examined using Cox proportional hazards models.

RESULTS: About 54% of the sample was white, 13% African, 11% East Asian, and 11% South Asian; 7% had “other” (n = 121) ethnic background. African Canadians (hazard ratio [HR], 0.75; 95% CI: 0.62-0.92]) and patients with “other” ethnicity (HR, 0.71; 95% CI, 0.55-0.92) were less likely to complete the KT evaluation compared with white Canadians, and this association remained statistically significant in multivariable adjusted models. Access to KT was significantly reduced for all ethnic groups assessed compared with white Canadians, and this was primarily driven by differences in access to living donor KT. The adjusted HRs for living donor KT were 0.35 (95% CI, 0.24-0.51), 0.27 (95% CI, 0.17-0.41), 0.43 (95% CI, 0.30-0.61), and 0.34 (95% CI, 0.20-0.56) for African, East or South Asian Canadians and for patients with “other” ethnic background, respectively.

CONCLUSIONS: Similar to other jurisdictions, nonwhite patients face barriers to accessing KT in Canada. This inequity is very substantial for living donor KT. Further research is needed to identify if these inequities are due to potentially modifiable barriers.

On PubMed: Transplantation 2017; 101(4):e142-e151

Annotation

The finding: Patients with end-stage kidney disease who were not white had less access to the kidney transplantation compared to white Canadians. This access was primarily driven by differences in availability of living donor.

Strength and weaknesses: This was a retrospective study of over 2000 patients who were evaluated at Toronto General Hospital over a 10-year period. The strengths of the study come from the long duration of follow-up, a high number of patients, and the standardized evaluation and data collection. The limitations are due to its retrospective character and to the fact that it was based on one single center, which questions its generalizability.

Relevance: This study underlines the differences in access to kidney transplantation between white and non-white populations. It supports the need for further study to evaluate what are no barriers to care and what interventions could be implemented to address this health disparity.

PUBLICATION #2 — Psychonephrology

Prevalence, incidence, indication, and choice of antidepressants in patients with and without chronic kidney disease: a matched cohort study in UK Clinical Practice Research Datalink

Iwagami M, Tomlinson LA, Mansfield KE, McDonald HI, Smeeth L, Nitsch D

Pharmacoepidemiol Drug Saf 2017; 26(7):792-801

PURPOSE: People with chronic kidney disease (CKD) have an increased prevalence of depression, anxiety, and neuropathic pain. We examined prevalence, incidence, indication for, and choice of antidepressants among patients with and without CKD.

METHODS: Using the UK Clinical Practice Research Datalink, we identified patients with CKD (two measurements of estimated glomerular filtration rate < 60 mL/min/1.73m2 for ≥3 months) between April 2004 and March 2014. We compared those with CKD to a general population cohort without CKD (matched on age, sex, general practice, and calendar time [index date]). We identified any antidepressant prescribing in the six months prior to index date (prevalence), the first prescription after index date among non-prevalent users (incidence), and recorded diagnoses (indication). We compared antidepressant choice between patients with and without CKD among patients with a diagnosis of depression.

RESULTS: There were 242 349 matched patients (median age 76 [interquartile range 70-82], male 39.3%) with and without CKD. Prevalence of antidepressant prescribing was 16.3 and 11.9%, and incidence was 57.2 and 42.4/1000 person-years, in patients with and without CKD, respectively. After adjusting for confounders, CKD remained associated with higher prevalence and incidence of antidepressant prescription. Regardless of CKD status, selective serotonin reuptake inhibitors were predominantly prescribed for depression or anxiety, while tricyclic antidepressants were prescribed for neuropathic pain or other reasons. Antidepressant choice was similar in depressed patients with and without CKD.

CONCLUSIONS: The rate of antidepressant prescribing was nearly one and a half times higher among people with CKD than in the general population.

On PubMed: Pharmacoepidemiol Drug Saf 2017; 26(7):792-801

Annotation

The finding: This study shows that patients with chronic kidney disease are more likely to be prescribed antidepressant medications compared to the general population. Selective serotonin reuptake inhibitors were the most common antidepressant prescribed.

Strength and weaknesses: This is an analysis of over 200,000 patients with and without chronic kidney disease treated over a 10 -year period, based on the UK Clinical Practice Research Datalink (CPRD). CPRD is a governmental, not-for-profit research service, jointly funded by the NHS National Institute for Health Research (NIHR) and the Medicines and Healthcare products Regulatory Agency (MHRA), a part of the UK Department of Health. It provides anonymized primary care records for public health research.

Relevance: This is likely the biggest study today looking at the use of antidepressants in chronic kidney disease. It was interesting to note that antidepressants are widely prescribed, despite the lack of studies informing of their efficacy and safety in this population. This study supports the need for additional research regarding the use of antidepressants in patients with chronic kidney disease.