Sertraline concentration in serum unaffected by hemodialysis: a case report

About 20% of patients receiving hemodialysis (HD) show clinical signs of major depressive disorder (MDD). However, end-stage renal disease (ESRD) or HD are often exclusion criteria for clinical studies. Due to that, publications regarding treatment efficacy and pharmacokinetics are rare for this population.

We report the case of a female inpatient with MDD and ESRD (GFR <10ml/min/1,73qm) receiving HD three times a week. We started sertraline and monitored response to therapy using Hamilton Depression Rating Scale (HAMD-21, 21-item-version) and Beck Depression Inventory (BDI). Additionally, we conducted therapeutic drug monitoring (TDM) before and after HD. We then genotyped CYP2C19 as the main metabolizing enzyme of sertraline.

Sertraline serum concentrations were within or slightly above the established range for patients without HD. Intermediate metabolizer genotype (IM-GT) was determined. Our patient responded well to the antidepressive therapy (HAMD 33 at admission HAMD 5 at discharge). Additionally, both blood pressure and need for further pain medication decreased.

Our case report suggests that HD has none or only limited effect on sertraline serum concentration. IM-GT status is likely to be the explanation for the slight elevation measured in serum concentration. Sertraline seems to be an effective treatment option in MDD patients undergoing HD. Additionally blood pressure and need for analgetics improved. Studies with higher numbers of patients are needed to prove effectiveness and acceptability of sertraline in MDD patients during HD.

Publication History

Article published online:
12 March 2024