Relationship of Depression With Incident Cardiovascular Disease in Individuals With Chronic Kidney Disease

Depression is common in patients with chronic kidney disease (CKD) and known to be associated with a greater risk of developing cardiovascular disease (CVD). However, it is uncertain whether, and to what extent, depression influences the incidence of CVD among individuals with CKD.

We analyzed 281,961 individuals with CKD defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m² or proteinuria (≥ +1) including 14,527 (5.2%) individuals with depression registered in the DeSC database from April 2014 to August 2023. The DeSC database is commercially available from DeSC Healthcare Inc. A Cox proportional hazards regression analysis was conducted to estimate the hazard ratio associated with the presence of depression. The median age was 68 years and 47.8% were men. During the follow-up period, 48,359 composite CVD events were recorded. Multivariable Cox regression analysis showed that CKD individuals with depression had a greater risk of composite CVD events than those without (hazard ratio 1.36; 95% confidence interval 1.31-1.42). Given the limitations of real-world data, we performed multiple sensitivity analyses, which confirmed the results of our primary analysis. Notably, we found that the association between depression and a subsequent risk of developing CVD was not modified by eGFR.

Depression is independently associated with an increased risk of CVD among individuals with CKD regardless of baseline kidney function.