Pre-existing anxiety and mood disorders and multisystem outcomes in young adults with chronic kidney disease

Anxiety and mood disorders (AMD) are common in young adults and may amplify medical risk in chronic kidney disease (CKD). However, their prognostic impact in young adults with moderate-severe CKD remains poorly defined. We investigated whether pre-existing AMD identify a subgroup of young CKD patients at increased risk of adverse clinical outcomes.

Using the TriNetX Global Collaborative Network, we identified young adults aged 18-30 years with stage 3-4 CKD documented in the Electronic Health Records. Patients with documented AMD prior to CKD identification were compared with those without AMD. Cohorts were balanced using 1:1 propensity score matching. Time-to-event outcomes were analyzed using Kaplan-Meier methods and Cox proportional hazards models. Prespecified sensitivity analyses included restriction to patients with documented body mass index and a landmark analysis with delayed outcome assessment to address surveillance bias and follow-up heterogeneity.

Among 3876 eligible patients, 1356 had pre-existing AMD. After matching, 734 patients remained in each cohort. Over follow-up, AMD was associated with higher risks of cardiovascular outcomes (ischemic heart disease, arrhythmias, stroke, hypotension), renal outcomes (acute kidney injury, progression to dialysis), pneumonia, neurocognitive complications (acute confusional state, encephalopathy), and sleep disorders. In the primary matched analysis, all-cause mortality did not differ between groups [hazard ratio (HR) 1.00, 95% confidence interval (CI) 0.72-1.39]. In prespecified sensitivity analyses restricted to patients with sustained follow-up and delayed outcome assessment, AMD was associated with higher mortality risk (HR 1.92, 95% CI 1.21-3.03).

In young adults with stage 3-4 CKD, pre-existing AMD identify a phenotype associated with increased multisystem morbidity. Although no difference in mortality was observed in the primary analysis, sensitivity analyses suggest a potential association with excess mortality among patients with sustained follow-up. These findings support integrating mental health assessment into CKD risk stratification and highlight the need for prospective studies on the long-term survival.