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Association of symptoms of depression with progression of CKD.
Am J Kidney Dis. 2012 Jul; 60(1):54-61.AJ

Abstract

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.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Tsai YC
Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Taiwan.
Chiu YW
No affiliation info available
Hung CC
No affiliation info available
Hwang SJ
No affiliation info available
Tsai JC
No affiliation info available
Wang SL
No affiliation info available
Lin MY
No affiliation info available
Chen HC
No affiliation info available

MeSH

AdultAgedComorbidityDepressionDisease ProgressionFemaleGlomerular Filtration RateHospitalizationHumansKaplan-Meier EstimateMaleMiddle AgedPrognosisProspective StudiesRenal DialysisRenal Insufficiency, Chronic

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22495469

Citation

Tsai, Yi-Chun, et al. "Association of Symptoms of Depression With Progression of CKD." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 60, no. 1, 2012, pp. 54-61.
Tsai YC, Chiu YW, Hung CC, et al. Association of symptoms of depression with progression of CKD. Am J Kidney Dis. 2012;60(1):54-61.
Tsai, Y. C., Chiu, Y. W., Hung, C. C., Hwang, S. J., Tsai, J. C., Wang, S. L., Lin, M. Y., & Chen, H. C. (2012). Association of symptoms of depression with progression of CKD. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 60(1), 54-61. https://doi.org/10.1053/j.ajkd.2012.02.325
Tsai YC, et al. Association of Symptoms of Depression With Progression of CKD. Am J Kidney Dis. 2012;60(1):54-61. PubMed PMID: 22495469.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of symptoms of depression with progression of CKD. AU - Tsai,Yi-Chun, AU - Chiu,Yi-Wen, AU - Hung,Chi-Chih, AU - Hwang,Shang-Jyh, AU - Tsai,Jer-Chia, AU - Wang,Shu-Li, AU - Lin,Ming-Yen, AU - Chen,Hung-Chun, Y1 - 2012/04/10/ PY - 2011/09/18/received PY - 2012/02/11/accepted PY - 2012/4/13/entrez PY - 2012/4/13/pubmed PY - 2012/8/24/medline SP - 54 EP - 61 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 60 IS - 1 N2 - 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. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/22495469/Association_of_symptoms_of_depression_with_progression_of_CKD_ DB - PRIME DP - Unbound Medicine ER -