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Published on: April 26, 2024
Association of symptoms of depression with progression of CKD
Yi-Chun Tsai1, Yi-Wen Chiu, Chi-Chih Hung
1Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Taiwan.
Insights
Depression in chronic kidney disease (CKD) patients not on dialysis predicts worse outcomes. Early evaluation and treatment of depressive symptoms are crucial for better clinical results in CKD management.
Area of Science:
- Nephrology
- Psychiatry
- Clinical Research
Background:
- Depression is linked to poor outcomes in dialysis patients.
- Its impact on earlier stages of chronic kidney disease (CKD) is not well understood.
- This study examines depressive symptoms in non-dialysis CKD patients.
Purpose of the Study:
- To investigate the association between depressive symptoms and clinical outcomes in patients with CKD not requiring dialysis.
- To determine if depression predicts progression to end-stage renal disease (ESRD), mortality, or hospitalization.
- To assess the effect of depressive symptoms on the rate of kidney function decline.
Main Methods:
- Prospective observational cohort study involving 568 participants with CKD.
- Depressive symptoms assessed using the Beck Depression Inventory.
- Estimated glomerular filtration rate (eGFR) calculated using the MDRD equation over a 4-year follow-up.
Main Results:
- 37% of participants reported depressive symptoms.
- Depressive symptoms were associated with a higher risk of progression to ESRD or death (HR=1.66) and hospitalization (HR=1.59).
- Patients with depression experienced faster eGFR decline and initiated dialysis at higher eGFR levels.
Conclusions:
- Depressive symptoms are independent predictors of adverse outcomes in CKD patients.
- These outcomes include faster kidney function decline, increased risk of dialysis initiation, mortality, and hospitalization.
- Early screening and treatment for depression are recommended for patients with CKD.
Background:
Depression is related to morbidity and mortality in patients with kidney failure treated by dialysis, but its influence on patients with earlier stages of chronic kidney disease (CKD) is uncertain. This study investigates the association of depressive symptoms with clinical outcomes in patients with CKD not requiring dialysis.
Study Design:
Prospective observational cohort study.
Setting & Participants:
568 participants with CKD not requiring maintenance dialysis were recruited consecutively at a tertiary hospital in Southern Taiwan and followed up for 4 years.
Predictors:
Baseline status of depressive symptoms.
Outcomes:
The primary outcome is a composite of progression to end-stage renal disease (ESRD), defined as requiring maintenance dialysis treatment, or all-cause mortality; and secondary outcome was first hospitalization.
Measurements:
Depressive symptoms were assessed by Beck Depression Inventory. Estimated glomerular filtration rate (eGFR) was computed using the 4-variable MDRD (Modification of Diet in Renal Disease) Study equation.
Results:
428 participants completed the questionnaires and 160 (37%) had depressive symptoms. During a mean follow-up of 25.2 ± 11.9 months, 136 participants (32%) reached the primary outcome (119 reached ESRD and 17 died) and 110 participants (26%) were hospitalized. High depressive symptoms increased the risk of progression to ESRD or death (HR, 1.66; 95% CI, 1.14-2.44) and first hospitalization (HR, 1.59; 95% CI, 1.03-2.47). Participants with high depressive symptoms had more rapid GFR decrease (eGFR slopes of -2.3 [25th-75th percentile, -5.3 to -0.4] vs -1.2 [25th-75th percentile, -3.5 to 0.3] mL/min/1.73 m(2) per year; P = 0.001) and initial dialysis treatment at a higher eGFR (OR for initiation of dialysis at eGFR >5 mL/min/1.73 m(2), 4.45; 95% CI, 1.44-13.78).
Limitations:
A single-center study of Taiwanese, Beck Depression Inventory evaluates only depressive symptom burden.
Conclusions:
Depressive symptoms in CKD are independent predictors of adverse clinical outcomes, including faster eGFR decrease, dialysis therapy initiation, death, or hospitalization. Depression should be evaluated early and treated in patients with CKD.
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