Depression affects 20% of patients with chronic kidney disease (CKD) and is associated with dialysis initiation, hospitalization, and death.1-3 In the Chronic Kidney Disease Antidepressant Sertraline Trial (CAST), treatment with sertraline vs placebo did not improve depressive symptoms in patients with CKD not requiring kidney replacement therapy and major depressive disorder (MDD).4 Patients with CKD have enhanced systemic inflammation, which has been proposed as a mediator of depression in chronic medical illnesses.