Effectiveness of Sertraline in Depressed Patients With Advanced Chronic Kidney Disease
CAST was the largest trial to provide evidence about major depressive disorder treatment with a commonly used SSRI in patients with non-dialysis-dependent CKD.
Sertraline did not significantly improve depressive symptoms in patients with non-dialysis-dependent chronic kidney disease (CKD), according to the results of the CKD Antidepressant Sertraline Trial (CAST) published in JAMA.
In this 12-week randomized controlled trial, researchers randomly assigned patients with non-dialysis-dependent stage 3 through 5 CKD to receive sertraline 50 mg/d (n=102) or placebo (n=99) after a 1-week placebo run-in. Sertraline could be uptitrated to 200 mg/d based on tolerability and response. They evaluated depressive symptom severity at baseline and 12 weeks with the 16-item Quick Inventory of Depression Symptomatology-Clinician Rated (score range 0 to 27).
Mean baseline depressive symptoms were similar in both groups (14.0 vs 14.1). The median participation was 12 weeks, and the median dosage was 150 mg/d.
After 12 weeks of treatment, the change in depressive symptom severity from baseline was not significantly different in the sertraline group compared with placebo (-4.1 vs -4.2; between-group difference 0.1, 95% CI, -1.1 to 1.3; P =.8). In a similar fashion, no significant difference was reported for changes in patient-reported overall health (0 vs 0; between-group difference 0; 95% CI, -10.0 to 0; P =.61).
Nausea or vomiting and diarrhea occurred more frequently in the sertraline group than in the placebo group (P =.03 and P =.02, respectively).
The study investigators noted that this study was "the largest randomized, double-blind, placebo-controlled trial to provide evidence about [major depressive disorder] treatment with a commonly used [selective serotonin reuptake inhibitor] in patients with non-dialysis-dependent CKD, a chronically ill population that is not only at significantly increased risk for developing depression, but also its serious complications."
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 [published online November 3, 2017]. JAMA. doi:10.1001/jama.2017.17131