Sertraline for the treatment of Depressive Symptoms in Chronic Kidney Disease compared to placebo: A Limited Systematic Review


Background: Depressive symptoms have been associated with chronic kidney disease and has been linked with morbidity, treatment adherence, hospitalizations and mortality. Sertraline, a type of Selective Serotonin Reuptake Inhibitor has been used widely in the general population as treatment of depression. However, evidence of its effectiveness in chronic kidney disease patients with depressive symptoms is still lacking.


Aim: To examine the effectiveness of Sertraline compared to placebo in treating depressive symptoms in adult patients with chronic kidney disease.


Methods: A limited systematic review was performed using five databases; PsychoINFO, Medline, Embase, SCOPUS, PUBMED, until September 2019. Citation tracking and hand searching were also performed.


Results: The literature search yielded 687 publications; of which 3 randomized controlled trials were included in the analysis. A total of 142 (n=15 to 102) patients were randomized to receive treatment with Sertraline. Trial durations were 8, 12 weeks and 6 months. There were no differences for non-dialysis population; score changed by -4.1 in the sertraline group and -4.2 in the placebo group (p=0.82). Two studies involving hemodialysis patients showed improvement in scores; from 24.5+4.1 to 10.3+5.8 (p<0.001) and 23+11 to 22.5+9; a reduction of 0.5+5 (p<0.001). However, both were of low quality as one had inadequate sample size and the other had less than half of the participants recorded reduction in scores despite overall improvement. Non-uniformity of validated assessment tools used for measurements precluded metanalysis.


Conclusion: Available evidence do not demonstrate the effectiveness of sertraline as treatment for depressive symptoms in chronic kidney disease patients.