A related commentary discusses this research. As multimorbidity becomes the rule rather than the exception in much of clinical practice, trials targeting specific subpopulations, pragmatic trials, and personalized trials (including n-of-1 trials) are necessary to help determine whether prescribing a certain medication is more likely to help or to harm. Large, highly-selected and standardized efficacy trials, excluding those with chronic kidney disease (CKD) or other comorbidities, may have little relevance to the care of patients with complex multimorbidities. Patients with CKD constitute an especially important subpopulation, given its size and pathophysiological differences, and accumulating evidence that interventions that had been shown to be efficacious in populations mostly free from advanced CKD may not be effective in patients with chronically reduced kidney function.
It calls on the nephrology and psychiatry communities to conduct further trials that use rigorous criteria for identifying depression, include more severely depressed patients, and evaluate other SSRIs to further probe for effective and safe treatments for depression in patients with CKD.