Newswise — DALLAS – April 12, 2023 – Susan Hedayati, M.D., Director of Clinical and Population Health Research in Nephrology at UT Southwestern Medical Center, has spent a career investigating the links between kidney disease and depression, working to improve data gathering from electronic records, and developing methods to improve care from a patient-centric perspective for the 37 million people managing chronic kidney disease (CKD) in the U.S.
On Thursday, April 13, Dr. Hedayati will share her experience and insights during the Shaul G. Massry Distinguished Lecture at the National Kidney Foundation Clinical Research Conference in Austin.
“I’ve learned throughout my training and career that sometimes for patients, outcomes like quality of life, depression, sleep, fatigue, and how they feel day-to-day are as important as things like mortality, hospitalization, and dialysis initiation,” said Dr. Hedayati, Professor and Associate Vice Chair for Research of Internal Medicine who holds the Yin Quan-Yuen Distinguished Professorship in Nephrology. “I’m hoping to make an impact not just on the hard outcomes but on these patient-centered outcomes too. That’s where I’d like to be impactful.”
As Dr. Hedayati started the research phase of her nephrology fellowship at Duke University, she noted after gathering medical histories that many patients with advanced kidney disease would become tearful and often display symptoms of depression.
“They had kidney failure and were being initiated on dialysis. So, were they depressed? Or were their symptoms just a clinical consequence of uremia? When I looked in the literature, I saw that there were no validated ways of distinguishing between these two clinical phenomena,” said Dr. Hedayati, who interned in Dr. Anthony Fauci’s laboratory at the National Institutes of Health.
Dr. Hedayati has focused her career on nontraditional cardiovascular risk factors in patients with CKD, including depression. Her subsequent research has ranged from testing antidepressants in CKD patients to identifying inflammatory pathways that could be targets for treatment.
- Depression /CKD prevalence
Dr. Hedayati’s early research focused on defining the prevalence and correlates of depression in patients with CKD before and after starting dialysis. Her work validated the use of multiple self-report scales to diagnose depression in these patients, finding that about 20% of patients with CKD have major depressive disorder. In another study, Dr. Hedayati and colleagues showed that CKD patients with a depressive disorder had nearly twice the risk of death, hospitalization, or dialysis initiation compared to those without. This risk was independent of the severity of kidney disease and other medical comorbidities. Future studies supported by the National Institutes of Health will focus on identifying which inflammatory pathways are involved in developing depression in CKD patients and whether combining antidepressant medication with behavioral activation therapy (a subset of cognitive behavioral therapy) could effectively treat depression.
- CKD depression antidepressant effectiveness
In the first randomized, placebo-controlled trial in patients with CKD, evaluating the safety and efficacy of sertraline, Dr. Hedayati found that sertraline did not improve depressive symptoms over a placebo in CKD patients and increased the risk of gastrointestinal adverse events such as nausea and vomiting. In the first randomized controlled comparative efficacy study focusing only on CKD patients treated with chronic dialysis, Dr. Hedayati and colleagues found that sertraline improved depressive symptoms only modestly better than cognitive behavioral therapy.
- CKD biomarkers
Dr. Hedayati’s team linked depression in CKD patients to biomarkers of inflammation, such as lower albumin and higher interleukin-6, and found that baseline elevated plasma levels of high-sensitivity C-reactive protein could predict which individual patients responded to sertraline. In another study, Dr. Hedayati and colleagues identified several nontraditional biomarkers that can help predict cardiovascular risk in patients with early kidney disease.
Another paper described how her team used the UT Southwestern COVID-19 registry – created among 20 hospitals in Dallas-Fort Worth – to develop a predictive model for the incidence of hospital-acquired acute kidney injury (AKI) in patients with COVID-19. Dr. Hedayati also recently developed an AKI patient registry at UT Southwestern in collaboration with DuWayne Willett, M.D., and Christoph Lehmann, M.D. The registry will use information from patients’ electronic health records for early recognition of AKI both for research purposes and clinical care. Eventually, it will allow implementation of machine learning tools for following these patients long term for outcomes such as decline in kidney function and development of CKD.
“Dr. Hedayati’s research has taught us how to care for some of the most challenging problems faced by patients with kidney disease,” said Samir Parikh, M.D., Chief of UTSW’s Division of Nephrology, which is nationally rated high-performing in kidney failure treatment and has an excellent rating for survival by U.S. News & World Report. “This award from the National Kidney Foundation is richly deserved.”
Dr. Lehmann holds the Willis C. Maddrey, M.D. Distinguished Professorship in Clinical Science.
Dr. Parikh holds the Ruth W. and Milton P. Levy, Sr. Chair in Molecular Nephrology and the Robert Tucker Hayes Distinguished Chair in Nephrology, in Honor of Dr. Floyd C. Rector, Jr.
Dr. Willett holds the Haberecht Family Chair in Medical Informatics, in Honor of DuWayne Willett, M.D.
About UT Southwestern Medical Center
UT Southwestern, one of the nation’s premier academic medical centers, integrates pioneering biomedical research with exceptional clinical care and education. The institution’s faculty has received six Nobel Prizes, and includes 24 members of the National Academy of Sciences, 18 members of the National Academy of Medicine, and 14 Howard Hughes Medical Institute Investigators. The full-time faculty of more than 2,900 is responsible for groundbreaking medical advances and is committed to translating science-driven research quickly to new clinical treatments. UT Southwestern physicians provide care in more than 80 specialties to more than 100,000 hospitalized patients, more than 360,000 emergency room cases, and oversee nearly 4 million outpatient visits a year.