Depression has been shown to be an important predictor of survival in hemodialysis patients. It is not known whether depression is an independent risk factor, or has its effect through medical factors such as nutrition, immunologic competence, and compliance with the medical regimen. Depression measured by questionnaire tools consists of a cognitive component (e.g. feeling of guilt, worthlessness) and a somatic component (e. g. fatigue, somnolence). The cognitive aspects of depression appear to have better relationship to a psychiatric diagnosis of depression, and to survival than the somatic aspects. We propose to prospectively examine, in a multicenter controlled cohort study, the relationship of depression to survival, controlling for traditional risk factors in the ESRD hemodialysis population, such as age, comorbid medical illnesses, race, and gender, simultaneously assessing nutrition, immunologic function, and compliance with the dialysis prescription. Attempts will be made to deliver a standard dialysis treatment, but the amount of dialysis will be controlled in data analysis. This study will provide information on the relationship of depression to survival in ESRD patients, and information necessary to plan an intervention trial in the future. It will also provide specific information on the relationship of depression to survival in black hemodialysis patients.
