Screening for depression: only one piece of the puzzle.

In this issue of NDT, van den Beukel et al. from the Netherlands suggest that a 5-item survey questionnaire might be used to replace the Beck Depression Index to screen patients with chronic kidney disease (CKD) for depression. The nephrology community is at a tipping point in terms of the assessment of outcomes, especially among patients on dialysis. Indeed, the entire healthcare community has begun to shift its focus to patient-reported outcomes (PROs), including quality of life, patient satisfaction and the psychosocial determinants of health. Beyond depression, there are a myriad of aspects of psychological distress that include anxiety, worrying, fear of progression of kidney disease and the fear of the future in general, death and dying, hopelessness, questions around the meaning of life and the experience of recurrent psychological and physical trauma through the CKD trajectory. We encourage the community and its researchers to embrace and research PROs, with the aim to create a holistic, patient-centered model of care for patients at all stages of CKD, including those on chronic dialysis and after transplantation, keeping the whole person-and their families-in mind.