GLOBAL PREVALENCE OF DEPRESSION IN CHRONIC KIDNEY DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS

ABSTRACT Background Chronic kidney disease (CKD) is commonly associated with psychosocial problems, especially depression, contributing to poor overall outcomes in CKD patients. Depression has not been given adequate priority in the management of CKD despite its significant adverse impact. Objectives This systematic review and meta-analysis determined the pooled prevalence of clinical depression in the global CKD population and sub-populations. Design A systematic search of PubMed, African Journals Online (AJOL), and EMBASE was undertaken to identify published articles with relevant data between 1989 and 2022. The pooled prevalence of clinical depression in the global CKD population was determined using random effects meta-analytic techniques. Participants Global adult and paediatric CKD population Results Eligible Sixty-one articles were included in this review, comprising 79,691 CKD patients from 26 countries. The participants’ mean age ranged from 11.0 to 76.3 years. Most (68.9%) of the studies had medium methodological quality. The overall pooled prevalence of depression was 27.6% (95% CI: 23.9–31.5%). Studies using Diagnostic Statistical Manual (DSM), International Classification of Disease, Mini-International Neuropsychiatric Interview and Structured Clinical Interview for DSM disorder returned a pooled prevalence of 31.7%, 39.6%, 23.3%, 25.1%, respectively; p=0.09. There was significant difference in the pooled prevalence of CKD across the various continents; p=0.01.The prevalence of depression was higher among patients on chronic haemodialysis compared to those in pre-dialysis (31.1% versus 18.9%; p=0.02), and among those on hemodialysis compared to peritoneal dialysis (31.9% versus 20.4%; p=0.03). There was no significant difference between adults and children (28.0% versus 15.9%, p=0.17). Conclusion Depression is a common disorder in patients with CKD. The findings of this study have brought to the fore the need for clinicians to make deliberate efforts to evaluate CKD patients for depression, especially those with advanced stages of the disease. The study protocol was registered with PROSPERO (CRD42022382708) Strengths and Limitations The pooled prevalence of depression in this study correctly represents the magnitude of the depression in the CKD population because it included only studies where depression was diagnosed clinically. This review involved the global population of both adult and paediatric patients with pre-dialysis and dialytic kidney disease. Only a few studies in this review determined the prevalence of depression in the early stages of CKD. Studies reporting depression prevalence among kidney transplant patients were not included in this review, and the number of studies in the paediatric population was limited.