The purpose of this application is for Daniel Cukor, Ph.D. to transition to an independent investigator in the field of psychosocial nephrology. Depression in hemodialysis patients has been associated with lower quality of life, poor compliance to dietary restrictions, and an overall increase in mortality. This proposal would help Dr. Cukor, a trained Clinical Health Psychologist, test a Cognitive Behavioral Therapy (CBT) Intervention that has been specifically designed for an ethnically diverse ESRD population to reduce their levels of depressive affect and improve their compliance with a hemodialysis-healthy lifestyle. This is the first attempt at treating depression in ESRD patients with a controlled psychosocial intervention. Under the mentorship of Jeremy Coplan, MD, Paul Kimmel, MD, and Rolf Peterson, Ph.D., a didactic experience has been devloped to help Dr. Cukor further his skills in the disciplines of nephrology, psychological theory and intervention, as well as research methodology. The actual intervention is based on traditional CBT treatment for depression with modifications for an ESRD population based on Dr. Cukor's previous clinical experience. Overall, this study provides a model to test the efficacy of this intervention on hemodialysis patients versus wait-list controls. Eighty subjects will be randomized to either the intervention first condition or the wait list and then they will receive the 10 session intervention. Psychological, Biological, and Medical information will be gathered before and after the intervention as well as at follow-up to provide data on the subjects'mood, quality of life, behavioral compliance, psychopathology and the general effects of their illness. This project stands to contribute to the health of the community at large, as it could demonstrate the efficacy of an intervention that is designed to target depression and compliance in an ethnically diverse dialysis population. This could lend support to the belief that the relationship between depression and ESRD is bidirectional, meaning that an effective psychosocial intervention will not only impact depressive affect, compliance, quality of life, and illness perceptions, but also laboratory dialysis values and even possibly overall health. If if it is proven to be benficial, this targeted and brief intervention could be incorporated into standard of care for all depressed dialysis patients.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Mentored Patient-Oriented Research Career Development Award (K23)
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Diabetes, Endocrinology and Metabolic Diseases B Subcommittee (DDK)
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Rankin, Tracy L
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Suny Downstate Medical Center
Schools of Medicine
United States
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Cukor, Daniel; Ver Halen, Nisha; Asher, Deborah Rosenthal et al. (2014) Psychosocial intervention improves depression, quality of life, and fluid adherence in hemodialysis. J Am Soc Nephrol 25:196-206
Cukor, Daniel; Ver Halen, Nisha; Rosenthal Asher, Deborah et al. (2013) A pilot investigation of cognitive improvement across a single hemodialysis treatment. J Nephrol 26:323-30
Rosenthal Asher, Deborah; Ver Halen, Nisha; Cukor, Daniel (2012) Depression and nonadherence predict mortality in hemodialysis treated end-stage renal disease patients. Hemodial Int 16:387-93
Cukor, Daniel; Rosenthal, Deborah S; Jindal, Rahul M et al. (2009) Depression is an important contributor to low medication adherence in hemodialyzed patients and transplant recipients. Kidney Int 75:1223-9
Cukor, Daniel; Coplan, Jeremy; Brown, Clinton et al. (2008) Anxiety disorders in adults treated by hemodialysis: a single-center study. Am J Kidney Dis 52:128-36
Cukor, Daniel; Coplan, Jeremy; Brown, Clinton et al. (2008) Course of depression and anxiety diagnosis in patients treated with hemodialysis: a 16-month follow-up. Clin J Am Soc Nephrol 3:1752-8