TY - JOUR
T1 - Associations between depressive symptoms and disease progression in older patients with chronic kidney disease
T2 - Results of the EQUAL study
AU - Eveleens Maarse, Boukje C.
AU - Chesnaye, Nicholas C.
AU - Schouten, Robbert
AU - Michels, Wieneke M.
AU - Bos, Willem Jan W.
AU - Szymczak, MacIej
AU - Krajewska, Magdalena
AU - Evans, Marie
AU - Heimburger, Olof
AU - Caskey, Fergus J.
AU - Wanner, Christoph
AU - Jager, Kitty J.
AU - Dekker, Friedo W.
AU - Meuleman, Yvette
AU - Schneider, Andreas
AU - Torp, Anke
AU - Iwig, Beate
AU - Perras, Boris
AU - Marx, Christian
AU - Drechsler, Christiane
AU - Blaser, Christof
AU - Emde, Claudia
AU - Krieter, Detlef
AU - Fuchs, Dunja
AU - Irmler, Ellen
AU - Platen, Eva
AU - Schmidt-Gürtler, Hans
AU - Schlee, Hendrik
AU - Naujoks, Holger
AU - Schlee, Ines
AU - Cäsar, Sabine
AU - Beige, Joachim
AU - Röthele, Jochen
AU - Mazur, Justyna
AU - Hahn, Kai
AU - Blouin, Katja
AU - Neumeier, Katrin
AU - Anding-Rost, Kirsten
AU - Schramm, Lothar
AU - Hopf, Monika
AU - Wuttke, Nadja
AU - Frischmuth, Nikolaus
AU - Ichtiaris, Pawlos
AU - Kirste, Petra
AU - Schulz, Petra
AU - Aign, Sabine
AU - Biribauer, Sandra
AU - Gaillard, Carlo
AU - Voskamp, Pauline
AU - Blankestijn, Peter
N1 - Funding Information:
Funding for the present study was received from the European Renal Association (ERA), Dutch Kidney Foundation (SB142), National Institute for Health Research (NIHR) in the UK, Swedish Medical Association (SLS), Njurfonden (Sweden), Stockholm County Council ALF, Italian Society of Nephrology (SIN-Reni) and a Young Investigators grant in Germany. The funders had no role in the study design (collection, analysis or interpretation of data), writing of the paper and the decision to submit this paper.
Publisher Copyright:
© 2021 The Author(s).
PY - 2022/4/1
Y1 - 2022/4/1
N2 - Background: Depressive symptoms are associated with adverse clinical outcomes in patients with end-stage kidney disease; however, 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; estimated glomerular filtration rate ≤20 mL/min/1.73 m2) were included from a European multicentre prospective cohort between 2012 and 2019. Depressive symptoms were measured by the five-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/1.73 m2/month. A total of 515 patients showed depressive symptoms. No significant association was found between depressive symptoms and kidney function over time (P = 0.08). Unlike women, men with depressive symptoms had an increased mortality rate compared with those without symptoms [adjusted hazard ratio 1.41 (95% confidence interval 1.03-1.93)]. Depressive symptoms were not significantly associated with a higher hazard of dialysis initiation, or 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.
AB - Background: Depressive symptoms are associated with adverse clinical outcomes in patients with end-stage kidney disease; however, 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; estimated glomerular filtration rate ≤20 mL/min/1.73 m2) were included from a European multicentre prospective cohort between 2012 and 2019. Depressive symptoms were measured by the five-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/1.73 m2/month. A total of 515 patients showed depressive symptoms. No significant association was found between depressive symptoms and kidney function over time (P = 0.08). Unlike women, men with depressive symptoms had an increased mortality rate compared with those without symptoms [adjusted hazard ratio 1.41 (95% confidence interval 1.03-1.93)]. Depressive symptoms were not significantly associated with a higher hazard of dialysis initiation, or 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.
KW - chronic kidney disease
KW - clinical outcome
KW - clinical trial
KW - depressive symptoms
KW - epidemiology
KW - joint model
KW - nephrology care
KW - prospective cohort study
KW - survival analysis
UR - http://www.scopus.com/inward/record.url?scp=85140732306&partnerID=8YFLogxK
U2 - 10.1093/ckj/sfab261
DO - 10.1093/ckj/sfab261
M3 - Article
AN - SCOPUS:85140732306
SN - 2048-8505
VL - 15
SP - 786
EP - 797
JO - Clinical Kidney Journal
JF - Clinical Kidney Journal
IS - 4
ER -