Hedayati said the pattern extends beyond depression. Trials of interventions for other CKD symptoms, including sleep problems and fatigue, have generally been negative or lacked a control arm or a clinically meaningful difference. Depression trials in heart failure, asthma, and coronary artery disease have also come up negative.<\/p>\n
Shared Decision Making and a 4 to 6 Week Treatment Trial<\/p>\n
\u201cI think we should use a shared decision making approach with the patient, and if they do want to try treatment, offer them one of these medications that we tried before, like sertraline or bupropion, or talk therapy,\u201d Hedayati said. \u201cBut the thing to keep in mind is try it for a short duration period, like 4 to 6 weeks, and if the patient doesn\u2019t respond, don\u2019t continue it, because it\u2019s just a treatment burden.\u201d<\/p>\n
Talk therapy options include cognitive behavioral therapy or BAT, a shorter form that requires fewer sessions. Hedayati emphasized that the goal of a defined trial period is to avoid keeping patients on a therapy that isn\u2019t helping them.<\/p>\n
Starting Sertraline at a Low Dose in Patients With CKD<\/p>\n
\u201cReassess the patient for tolerability and safety,\u201d Hedayati said. \u201cAnd again, if it\u2019s not working, stop the intervention.\u201d<\/p>\n
For SSRIs, she advised starting sertraline at 50 mg daily and increasing gradually, which she described as doubling the dose every 2 weeks, up to a maximum of 200 mg daily. That range mirrors the flexible dosing used in CAST, which started at 50 mg daily and escalated to a maximum of 200 mg daily based on tolerability and response.\u00b3<\/p>\n
Biomarkers May Identify Who Responds to Depression Treatment in CKD<\/p>\n
Hedayati believes the next step is understanding what drives depressive symptoms in CKD, and whether a prediction model can identify subgroups of patients likely to respond to existing treatments. With an NIH R01 supplement to CONCORD, her team is studying circulating serum and inflammatory biomarkers using whole genome profiling, RNA sequencing, and proteomics. The goal is to determine which patients will and will not respond to treatment.<\/p>\n
Editors\u2019 Note: Hedayati reports no relevant disclosures with industry.<\/p>\n
ReferencesHedayati S, Zhang X, Tuttle KR, et al. CONCORD: a randomized controlled trial of novel therapies for depression in patients with CKD. Abstract FR-OR110. Presented at: American Society of Nephrology Kidney Week 2026; October 21-25, 2026; Denver, CO.Palmer S, Vecchio M, Craig JC, et al. Prevalence of depression in chronic kidney disease: systematic review and meta-analysis of observational studies. Kidney Int. 2013;84(1):179-191.Hedayati SS, Gregg LP, Carmody T, et al. Effect of sertraline on depressive symptoms in patients with chronic kidney disease without dialysis dependence: the CAST randomized clinical trial. JAMA. 2017;318(19):1876-1890. doi:10.1001\/jama.2017.17131 <\/p>\n","protected":false},"excerpt":{"rendered":"Hedayati said the pattern extends beyond depression. Trials of interventions for other CKD symptoms, including sleep problems and…\n","protected":false},"author":2,"featured_media":659724,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[10],"tags":[163,85,46],"class_list":["post-659723","post","type-post","status-publish","format-standard","has-post-thumbnail","category-health","tag-health","tag-il","tag-israel"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/posts\/659723","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/comments?post=659723"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/posts\/659723\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/media\/659724"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/media?parent=659723"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/categories?post=659723"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/tags?post=659723"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}