All-Cause Mortality and Bleeding Risks Associated With Serotonin Reuptake Inhibitors in Patients With End-Stage Kidney Disease and Depression: A Nationwide Cohort Study

Objective The prevalence of depression is high among patients with end stage kidney disease (ESKD). To date, there has been limited investigation into the comparative effects of antidepressant in patients with ESKD. This study aims to explore the association between type of antidepressant, incidence of all-cause death, and hospitalization for major bleeding in patients with ESKD and depression. Methods This study utilized data obtained from the Korean National Health Insurance Service Database. Patients with ESKD were divided into two groups: those prescribed strong serotonin reuptake inhibitors (SRIs) and those prescribed weak or intermediate SRIs. Results Over a mean follow-up of 2.46 years, the strong SRI group had a lower risk of all-cause death (hazard ratio [HR] 0.87, 95% confidence interval [CI] 0.81–0.93) and hospitalization for major bleeding (HR 0.84, 95% CI 0.79–0.90) with no increased risk of bleeding-related death (HR 1.05, 95% CI 0.80–1.37) compared to the weak or intermediate SRI group. The protective effects of strong SRI use for all-cause death and hospitalization for major bleeding remained consistent in those prescribed SSRIs for less than 120 days (death: HR 0.85, 95% CI 0.80–0.92; hospitalization for major bleeding: HR 0.84, 95% CI 0.78–0.90), and in patients aged below 75 years (death: HR 0.83, 95% CI 0.76–0.90; hospitalization for major bleeding: HR 0.81, 95% CI 0.75–0.87). Conclusion In patients with ESKD and depression, the use of strong SRIs was associated with a reduced risk of all-cause death and major bleeding hospitalization compared to the use of weak or intermediate SRIs.