Sertraline not effective for depression in NDD-CKD

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  • Sertraline (Zoloft) does not significantly improve symptoms of major depressive disorder (MDD) in patients with non-dialysis-dependent chronic kidney disease (NDD-CKD).

Why this matters

  • Depression is 4-fold more common in CKD than the general population.
  • Patients with CKD are typically excluded from clinical trials.

Study design

  • Double-blind, randomized multicenter CAST trial of 201 patients (mean age, 58.2 y; 27% female) with stage IIIA (11%), IIIB (36%), IV (36%), or V (17%), NDD-CKD, and MDD.
  • Patients received sertraline or placebo for 12 wk.
  • Primary endpoint was change in 16-item Quick Inventory of Depression Symptomatology-Clinician Rated (QIDS-C16).
  • Funding: National Institute of Diabetes and Digestive and Kidney Diseases, Department of Veterans Affairs, University of Texas Southwestern Medical Center, NIH, National Institute of Mental Health.

Key results

  • Mean baseline QIDS-C16 score was similar between groups (14.0±2.4 and 14.1±2.4).
  • In primary analysis (n=193), sertraline and placebo achieved similar changes in QIDS-C16 (–4.1 vs –4.2; Δ=0.1; 95% CI, –1.1 to 1.3; P=.82).
  • Changes in patient-reported overall health on the Kidney Disease Quality of Life Survey were likewise similar (median, 0 for both; P=.61).
  • Sertraline was tied to a higher incidence of nausea/vomiting (22.7% vs 10.4%; P=.03) and diarrhea (13.4% vs 3.1%; P=.02).


  • Lack of long-term data.