Daniel Cukor

@hswapnil @NephJC @markunruh_01 @MRoumelioti @rajmehrotra1122 Prevalence was 45%, 15% participated #nephjc

@NephJC 126/923 ~ 15% That seems lower than the reported prevalence of insomnia Does that mean the actual prevalence is low, or the ISI index selects for severe insomnia? @markunruh_01 @MRoumelioti @rajmehrotra1122 @CukorDaniel #NephJC

T2a: #NephJC Over 42 months, 923/1068 pts completed the Insomnia Severity Index (ISI) 126 met the eligibility criteria-> randomly assigned to one of the following groups: 🧠Cognitive Behavioral Therapy for Insomnia (CBT-I): 43 pts 💊Trazodone: 42 pts 💊Placebo: 41 pts

Daniel Cukor here, psychologist from New York. Coi: one of the study authors #NephJC

@rogosin This work was inspired by all of the people that bravely face their kidney disease everyday and their healthcare teams who work to ease the burden. Thanks for the support!

@TeriBrowne Nothing gets reimbursed until evidence demonstrates the need. But agreed, a significant challenge.

@Renaltubules @rajmehrotra1122 The bdi is designed for 18+, but there is a beck youth inventory that measures depression. There is also a PHQ-A for adolescents

can we use BDI-II score to detect depressive symptoms in children? @rajmehrotra1122 @CukorDaniel

What could be manifestations of depression in children on dialysis? #NephJC

@SLeonMD @MarioFunesMD It was fun, thanks for the invitation

@CukorDaniel @MarioFunesMD thank you for making the #NephJC chat, I unfortunately could not make it. 👶🏾

The type of depression matters isn't it? More triggers better response to CBT. Less triggers better response to medication. Any psychiatrist in the house to confirm? #NephJC

@sarahkmels Thanks. Very similar CBT approach, but wanted to see how it would play out ina larger scale trial #nephjc

congrats on your great & important work, Dr. @CukorDaniel Also, I was interested in your psychosocial work via JASN 2014 - could you perhaps comment on that vs. pharmacological tx too?, ;) #NephJC

@TeriBrowne @NephJC Totally agree, unit social workers are the front line responders. Hopefully data, like ASCEND, will continue to put pressure on the providers to seriously commit to addressing depression. #nephjc

T0E: Do you think we recognise depression in our patients? What kind of access do your patients have to CBT? #NephJC

@hswapnil @NephJC I don't think it is a measurement issue, both used QIDS for primary outcome. #nephjc

@CukorDaniel @NephJC Thanks! Quite possible Or the phase 1 of ASCEND helped in selecting patients who might respond favourably? Presume BDI vs QIDS doesn’t matter #NephJC

T3B: Depression symptoms + some patient-reported outcomes improved with both CBT and sertraline, with modestly better 12-week scores for sertraline. #NephJC

@hswapnil @NephJC Might be something to do with patient populations. CAST had a higher percentage of veterans, who may have had more complex mental health issues and previous treatment histories. #nephjc

@CukorDaniel @NephJC Ah! Good point - thanks! Why would Sertraline not work in CAST but work in ASCEND? #NephJC

@hswapnil @NephJC Yes! look at the error bars, in ASCEND post treatment is an improvement from start in both groups. In CAST - no significant change. #nephjc

@hswapnil @NephJC Yes! look at the error bars, in ASCEND post treatment is an improvement from start in both groups. In CAST - no significant change

@NephroGuy This study was quite short (3 months) no mortality outcomes are examined. #nephjc

@NephJC We were quite surprised by this, it is probably because the 'control' condition still had significant contact with study staff. And the folks who didn't accept the diagnosis, dropped out of the screening process

T3A: The authors concluded that engagement interview had no effect on acceptance of depression treatment. #NephJC

@Renaltubules patients were randomized, but the CBT group did start with slightly more severe depression. In the end the difference in change was less than 1 point. #nephjc

Two questions 1. Does more BDI score means severe depression? 2. if so , that means CBT has more severe form of depression ( baseline score 22.2) , isnot it ? could that that has effect on results? #NephJC

@kidney_boy @jbda19 @NephJC They were no found to be clinically different, but both showed marked improvement. Success! #nephjc

@jbda19 @NephJC And in the end the difference between the two therapies was found to be clinically meaningless. Am I right? #NephJC

T2C: What do you think about the differences in depression scores between sertraline and CBT? Is this an important difference? #NephJC

@kidney_boy @NephJC We discussed it, but felt anyone diagnoses should be offered treatment

@NephJC Would it have been ethical to diagnose depression and then not treat one arm? #NephJC

T1D: In Phase 2, patients were randomised to individual CBT or sertraline. CBT included 10 session x 60 min over 12 weeks while on HD. Sertraline group started at 25 mg/d with titration 2 weekly to goal of 200 mg/d. What do you think about the two interventions? #NephJC

Most ESRD pts attribute their low mood to being part of dialysis treatment, not a separate 'depression' diagnosis