Background: Kidney transplantation (KT) improves not only physically but also psychologically in patients with kidney failure. However, there are few studies comparing the psychiatric effects of renal replacement therapy (dialysis versus KT).
Methods: By using National Health Insurance Service database, we extracted 21,809 kidney failure patients who had no history of depression and insomnia before receiving renal replacement therapy between January 2002 and December 2018.
Results: 17,649 patients received dialysis (15,537 patients hemodialysis, 2,112 patients peritoneal dialysis), and 4,160 patients received KT. Dialysis patients more suffer from insomnia than KT recipients (7,949; 45.04% vs. 1,070; 25.72%, P<0.001). Compared to KT recipients, dialysis patients were more prescribed antidepressant medication (4,019; 22.77% vs. 358, 8.61%, P<0.001). Compared to KT recipients, dialysis patients were more completely suicided (33; 0.19% vs. 5; 0.12%, P=0.047). In multivariate-adjusted analysis, the hazard ratio (HR) of depression was 1.82 (95% confidence intervals [CI], 1.62–2.04). In subgroup analysis, insomnia patients (HR, 2.15; 95% CI, 1.86–2.47), living in rural areas (HR, 2.04; 95% CI, 1.70–2.36), male patients (HR, 1.85; 95% CI, 1.61–2.13), aged under 65 years old patients (HR, 1.90; 95% CI, 1.68–2.14) were more prescribed anti-depressant medication.
Conclusions: Compared to dialysis, KT reduced complete suicide rate. In addition, KT is effective in reducing the prevalence of depression in patients with kidney failure in Korea, especially for insomnia patients, patients living in rural areas, male patients, and those aged under 65 years old.