Results Summary

What was the research about?

In patients with kidney disease, the kidneys don’t work well to remove waste from the blood. Some people with kidney disease have kidney failure and have lost most of their kidney function. These patients often receive dialysis, a treatment with a machine that cleans the blood. Patients usually go to a dialysis center for this treatment, about three times each week. Depression is common in people with kidney failure who receive dialysis.

In this study, the research team compared how likely patients were to start treatment for depression after talking with a therapist during a dialysis visit versus getting dialysis as usual. For patients who did start treatment, the team compared two treatments for depression in patients getting dialysis:

  • Cognitive behavioral therapy, or CBT, a type of talk therapy. In CBT, patients learn to change patterns in their thinking to improve how they feel.
  • Sertraline, a medicine used to treat depression.

What were the results?

Patients who didn’t talk with a therapist were just as likely to start treatment for depression as those who talked with a therapist.

After 12 weeks of treatment, both sertraline and CBT reduced symptoms of depression. The two treatments worked about the same.

Compared with patients who had CBT, patients treated with sertraline scored better on surveys that asked about their quality of life, including how much energy they had and how well they slept.

Attendance at dialysis sessions was similar for patients getting either treatment for depression.

Who was in the study?

The study included 184 patients with kidney failure getting dialysis at centers in three large cities in New Mexico, Texas, and Washington State. Of these patients, 120 wanted to receive treatment for depression. Forty-three percent of these patients were white, 28 percent were black, and 21 percent were another race; 28 percent were Hispanic. The average age was 51, and 57 percent were men.

What did the research team do?

The research team assigned patients by chance to one of two groups. In one group, patients met with a therapist during one of their dialysis sessions. The therapist asked them about their symptoms of depression and concerns about treatment. In the other group, patients received dialysis but did not meet with a therapist.

The research team then assigned patients who wanted to start treatment for depression by chance to one of two groups. In one group, patients took sertraline for 12 weeks. Patients could fill their prescriptions at the dialysis center. In the second group, the team scheduled patients for 10 one-on-one CBT sessions with a trained therapist. The sessions took place over 12 weeks during dialysis.

Patients completed surveys about symptoms of depression and quality of life before treatment started and again 6 and 12 weeks later.

Patients with kidney disease, doctors, nurses, social workers, and managers of dialysis centers helped design the study.

What were the limits of the study?

The study didn’t look at how well the treatments worked compared with no treatment. As a result, the research team can’t say for sure that changes were because of either treatment. The research team didn’t look at the effects of treatment beyond 12 weeks.

Future research could study whether combining sertraline and CBT is more effective than either treatment alone.

How can people use the results?

Patients on dialysis and their doctors can use the results when considering treatments for depression.

Final Research Report

View this project's final research report.


Journal Citations

Article Highlight: Patients undergoing long-term treatment for kidney failure often also experience depression. In this PCORI-funded study, more patients reported modest improvements in their depressive symptoms with the drug sertraline than patients who received cognitive behavioral therapy, the study’s researchers report in the Annals of Internal Medicine. However, patients who opted for the daily medication experienced more adverse events, such as nausea and dizziness.

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments. 

Peer reviewers commented, and the researchers made changes or provided responses. The comments and responses included the following:

  • Some reviewers felt that the lack of a placebo arm was a serious limitation. The researchers edited the background section to note that six previous trials have compared cognitive behavioral therapy (CBT) and drug therapy in treating depression in patients undergoing dialysis, so the researchers felt the more important knowledge gap in this population was in the comparative effectiveness of CBT versus antidepressant drug therapy. The researchers acknowledged as a limitation that their study design did not allow them to demonstrate that either treatment was superior to placebo or to no treatment.
  • Reviewers commented that 12 weeks is a very short duration of follow-up. The researchers agreed and acknowledged this as a limitation of the study. But they noted that patients who do not respond to antidepressant medication within 12 weeks are unlikely to do so, and they added that previous trials of CBT and antidepressant drug therapy in dialysis patients have also followed patients for 12 weeks and sometimes less.
  • Reviewers noted that a very low proportion of patients initially included in the study used the tools presented and wondered whether that reflected the acceptability of the tools. The researchers clarified that while they approached more than 2500 dialysis patients, the large majority did not have depressive symptoms. Therefore, they were appropriately excluded from the clinical trial. Many patients with depressive symptoms were also appropriately excluded because they were already receiving treatment for depression or did not have symptoms of sufficient severity to qualify. Ultimately, the researchers said, the proportion of patients included in this clinical trial was similar to that of other similar, successful trials.

Conflict of Interest Disclosures

Project Information

Rajnish Mehrotra, MD, MS
University of Washington
Treatment Options for Depression in Patients Undergoing Hemodialysis -- The ASCEND Study

Key Dates

July 2014
June 2019

Study Registration Information


Has Results
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Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
Populations Populations PCORI is interested in research that seeks to better understand how different clinical and health system options work for different people. These populations are frequently studied in our portfolio or identified as being of interest by our stakeholders. View Glossary
Intervention Strategy Intervention Strategies PCORI funds comparative clinical effectiveness research (CER) studies that compare two or more options or approaches to health care, or that compare different ways of delivering or receiving care. View Glossary
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Last updated: April 10, 2024