Associations between depressive symptoms and disease progression in older patients with chronic kidney disease: results of the EQUAL study

Abstract

Background Depressive symptoms are associated with adverse clinical outcomes in patients with end-stage kidney disease. Yet, few small studies have examined this association in patients with earlier phases of chronic kidney disease (CKD). We studied associations between baseline depressive symptoms and clinical outcomes in older patients with advanced CKD and examined whether these associations differed depending on sex. Methods CKD patients (≥65 years; eGFR ≤ 20 mL/min/1.73m2) were included from a European multicenter prospective cohort between 2012 and 2019. Depressive symptoms were measured by the 5-item Mental Health Inventory (cut-off ≤ 70;0–100 scale). Cox proportional hazard analysis was used to study associations between depressive symptoms and time to dialysis initiation, all-cause mortality, and these outcomes combined. A joint model was used to study the association between depressive symptoms and kidney function over time. Analyses were adjusted for potential baseline confounders. Results Overall kidney function decline in 1326 patients was -0.12 mL/min/1.73m2/month. 515 patients showed depressive symptoms. No significant association was found between depressive symptoms and kidney function over time (p = 0.08). Men with depressive symptoms had an increased mortality rate compared to those without symptoms (adjusted HR 1.41, 95%CI 1.03;1.93), women had not. Depressive symptoms were not significantly associated with a higher hazard of dialysis initiation, nor with the combined outcome (i.e. dialysis initiation and all-cause mortality). Conclusions There was no significant association between depressive symptoms at baseline and decline in kidney function over time in older patients with advanced CKD. Depressive symptoms at baseline were associated with a higher mortality rate in men.

Association between incident depression and clinical outcomes in patients with chronic kidney disease

“…Moreover, we observed that the associations of depression with hospitalization and mortality were more evident in men and in patients with eGFR ≥45 ml/min/1.73 m 2 . This sex difference has been previously reported [ 27 ], besides biological pathways, it may also be attributed to psychosocial aspects. For example, men are less likely to report mild depressive symptoms and have fewer help-seeking behaviors [ 43 ].…”

“…A few previous studies have demonstrated a positive association between depression and CKD progression [ 17 , 23–25 ], whereas others have not [ 22 , 27 ]. There is notable heterogeneity in the definition of CKD progression across studies, where dialysis initiation was the most often used kidney endpoint, with a HR estimate ranging from 1.1 to 3.5.…”

“…In addition, Tsai et al. found that participants with higher depressive symptoms experienced more rapid kidney function decline [ 23 ], which yet was not supported by another study in older patients with advanced CKD [ 27 ]. Our study yielded significant estimates for three single kidney outcomes that manifest different degrees of disease progression, with a 38% increased rate for >40% decline in eGFR, 32% for initiation of KRT, and 84% for death due to CKD.…”

Depression and clinical outcomes in CKD: do anti-depressants play a role? (EQUAL study)

“…We read with interest the impressive study ‘Associations between depressive symptoms and disease progression in older patients with chronic kidney disease: results of the EQUAL study’ by Eveleens Maarse [ 1 ]. This study examined the associations between depression symptoms and clinical outcomes in older people (≥65 years of age) with chronic kidney disease (CKD) (eGFR ≤20 mL/min/1.73 m 2 ) and considered sex differences.…”