The prevalence of psychiatric disorders has been well documented in individuals with renal insufficiency. Although not robust, data exists to guide medication choices and dosing strategies in patients with renal insufficiency and those on dialysis.

Essential Questions and References

How should medications be dosed in patients with renal insufficiency or those on dialysis?

  1. Guide to Renal/Dialysis Considerations. JCPNP. 2002; 1(1). [Weblink]
  2. Nemecek BD, Hammon DA.. Demystifying Drug Dosing in Renal Dysfunction. 2019. American Society of Health-System Pharmacists. ISBN: 978-1585285518. [Weblink]
  3. Eyler RF, Unruh ML, Quinn DK, Vilay AM. Psychotherapeutic Agents in End-Stage Renal Disease. Semin Dial. 2015;28(4):417-26. DOI: 10.1111/sdi.12370. PubMed PMID: 25857865.
  4. Mathew RO, Bettinger JJ, Wegrzyn EL, Fudin J. Pharmacotherapeutic considerations for chronic pain in chronic kidney and end-stage renal disease. JPR. 2016;9:1191-1195. DOI: 10.2147/JPR.S125270. PubMed PMID: 27994481; PubMed Central PMCID: PMC5153274.
  5. Scherer JS, Combs SA, Brennan F. Sleep Disorders, Restless Legs Syndrome, and Uremic Pruritus: Diagnosis and Treatment of Common Symptoms in Dialysis Patients. Am J Kidney Dis. 2017;69(1):117-128. DOI: 10.1053/j.ajkd.2016.07.031. PubMed PMID: 27693261; PubMed Central PMCID: PMC5497466.
  6. Whittaker CF, Miklich MA, Patel RS, Fink JC. Medication Safety Principles and Practice in CKD. CJASN. 2018;13(11):1738-1746. DOI: 10.2215/CJN.00580118. PubMed PMID: 29915131; PubMed Central PMCID: PMC6237057.
  7. Bautovich A, Katz I, Smith M, Loo CK, Harvey SB. Depression and chronic kidney disease: A review for clinicians. Aust N Z J Psychiatry. 11th ed. 2014;48(6):530-41. DOI: 10.1177/0004867414528589. PubMed PMID: 24658294.
  8. Chen L, Greenberg WM, Brand-Schieber E, Wangsa J, Periclou A, Ghahramani P. Effect of renal impairment on the pharmacokinetics of levomilnacipran following a single oral dose of levomilnacipran extended-release capsule in humans. DDDT. 2015;9:3293-300. DOI: 10.2147/DDDT.S85418. PubMed PMID: 26150701; PubMed Central PMCID: PMC4485797.

In particular, should depression be managed differently in patients with renal disease?

  1. Shirazian S, Grant CD, Aina O, Mattana J, Khorassani F, Ricardo AC. Depression in Chronic Kidney Disease and End-Stage Renal Disease: Similarities and Differences in Diagnosis, Epidemiology, and Management. Kidney Int Reports. 2017;2(1):94-107. DOI: 10.1016/j.ekir.2016.09.005. PubMed PMID: 29318209; PubMed Central PMCID: PMC5720531.
  2. Nagler EV, Webster AC, Vanholder R, Zoccali C. Antidepressants for depression in stage 3-5 chronic kidney disease: a systematic review of pharmacokinetics, efficacy and safety with recommendations by European Renal Best Practice (ERBP). Nephrol Dial Transplant. 2012; 27(10): 3736-45. [PubMed]
  3. Hedayati SS, Gregg LP, Carmody T, Jain N, Toups M, Rush AJ, Toto RD, Trivedi MH. Effect of sertraline on depressive symptoms in patients with chronic kidney disease without dialysis dependence: the CAST randomized clinical trial. JAMA. 2017; 318(19): 1876-90. [PubMed]
  4. Assimon MM, Brookhart MA, Flythe JE. Comparative Cardiac Safety of Selective Serotonin Reuptake Inhibitors among Individuals Receiving Maintenance Hemodialysis. JASN. 2019;30(4):611-623. DOI: 10.1681/ASN.2018101032. PubMed PMID: 30885935; PubMed Central PMCID: PMC6442344.
  5. Mehrotra R, Cukor D, Unruh M, Rue T, Heagerty P, Cohen SD, et al. Comparative Efficacy of Therapies for Treatment of Depression for Patients Undergoing Maintenance Hemodialysis: A Randomized Clinical Trial. Ann Intern Med. 2019;170(6):369-379. DOI: 10.7326/M18-2229. PubMed PMID: 30802897.