Clinical trial findings presented at American Society of Nephrology Kidney Week 2026 reveal that standard interventions for chronic kidney disease depression often fail short, prompting a renewed focus on shared decision-making, biomarker research, and strict limits on ineffective treatments.
Depression in chronic kidney disease patients demands a careful balance between offering relief and avoiding unnecessary medication burdens. Recent clinical evaluations, including findings highlighted at American Society of Nephrology Kidney Week 2026, point to a recurring challenge in nephrology: trials addressing depressive symptoms, sleep disturbances, and fatigue frequently yield negative outcomes or lack proper control arms.
🫘🔬 Day 2 of #KidneyWk 2026 is here!Follow our @UTSWNephrology team!🎤 Featuring Dr. Susan Hedayati presenting the CONCORD trial, and Dr. Ramesh Saxena moderating a session on home dialysis!💙 Another exciting day of UTSW representation in Denver! pic.twitter.com/Pvg7uv7pXI
Clinicians Weigh Short Trials
Dr. Susan Hedayati, tenured professor in nephrology and vice dean for research at the Stony Brook Renaissance School of Medicine, emphasizes that patient-centered discussions should guide whether to pursue pharmacological or talk-therapy options (Stony Brook Renaissance School of Medicine). When patients elect to try an intervention, clinicians should offer medications that were tried before such as sertraline, bupropion, or talk therapy.
I think we should use a shared decision making approach with the patient, and if they do want to try treatment, offer them one of these medications that we tried before, like sertraline or bupropion, or talk therapy.
Dr. Susan Hedayati, MD, MHSc, Vice Dean for Research at Stony Brook Renaissance School of Medicine, via Hcplive
However, clinicians must enforce strict timelines to protect patients from enduring fruitless therapies. Talk therapy alternatives include cognitive behavioral therapy or BAT, a shorter form requiring fewer sessions. Hedayati notes that the primary objective of a defined trial period is preventing patients from remaining on ineffective regimens.
But the thing to keep in mind is try it for a short duration period, like 4 to 6 weeks, and if the patient doesn’t respond, don’t continue it, because it’s just a treatment burden.
Dr. Susan Hedayati, MD, MHSc, Vice Dean for Research at Stony Brook Renaissance School of Medicine, via Hcplive
Sertraline Dosage Requires Careful Titration and Safety Monitoring
When prescribing selective serotonin reuptake inhibitors for patients with chronic kidney disease, careful dose titration and continuous safety monitoring are essential. Hedayati advises initiating sertraline at 50 mg daily, then gradually doubling the dose every two weeks up to a maximum of 200 mg daily, mirroring the flexible dosing approach utilized in the CAST randomized clinical trial.
Reassess the patient for tolerability and safety.
Dr. Susan Hedayati, MD, MHSc, Vice Dean for Research at Stony Brook Renaissance School of Medicine, via Hcplive
If the prescribed intervention fails to produce a clinical response within the four-to-six-week window, the guidance is direct.
And again, if it’s not working, stop the intervention.
Dr. Susan Hedayati, MD, MHSc, Vice Dean for Research at Stony Brook Renaissance School of Medicine, via Hcplive
Researchers Investigate Biomarkers
Hedayati’s research team is currently utilizing an NIH R01 supplement to CONCORD to analyze circulating serum and inflammatory biomarkers via whole genome profiling, RNA sequencing, and proteomics. The overarching goal is developing prediction models that can accurately identify which patient subgroups will respond positively to existing therapies before treatment begins.