Researchers examined data on 4,763 adults 45 years and older with normal kidney function at baseline who participated in three waves of the China Health and Retirement Longitudinal Study, in 2011, 2013, and 2015. All had a mean estimated glomerular filtration rate (eGFR) of at least 60 mL/min/1.73m2 at baseline and had eGFR assessed at baseline and study exit.
Baseline depressive symptoms were assessed with the 10-item Center for Epidemiology Studies Depression (CES-D) scale, which asked patients to rate how often they experienced depression symptoms in the past week (score range 0-30 with higher scores indicating worse symptoms). Researchers set a cutoff score of 10 to classify participants as having depressive symptoms, and also examined subgroups with "moderate" (scores of 10-20) or "higher" (scores of 21 or more) depressive symptoms.
Compared to participants without depressive symptoms at baseline, those who did have depressive symptoms were significantly more likely to have a rapid decline in kidney function, defined as annualized decline in eGFR of at least 5 mL/min/1.73m2, over a median follow-up of four years.
Each 5-point increase in CES-D scores was associated with a significantly increased risk of rapid decline in kidney function (adjusted odds ratio 1.15).
The risk increase for rapid kidney function decline was greatest among participants with the highest depressive symptom scores (aOR 1.39), researchers report in CJASN.
These findings are consistent with earlier research linking depressive symptoms to declining kidney function, and offer fresh evidence that this association persists even among relatively healthy individuals, said Willem Kop, a professor at the Center of Research on Psychology in Somatic diseases at Tilburg University in the Netherlands.
"The new study also finds a dose-response relationship between depression and kidney function decline, meaning that more severe depression is associated with an increasing likelihood of rapid kidney function decline," Kop, who wasn't involved in the study, said by email.
"It is very important to demonstrate the predictive value of psychological factors for medical outcomes in diverse populations, as it may help identify individuals at high risk of chronic kidney disease," Kop added.
When the study team looked at each of the 10 CES-D items separately, four in particular were significantly associated with rapid decline in kidney function. Participants who felt "bothered by things" (aOR 1.16), who "had trouble concentrating" (aOR 1.17), who "felt everything was an effort" (aOR 1.18), and who "felt lonely" (aOR 1.16) were all significantly more likely to experience a rapid decline in kidney function.
One limitation of the study is that kidney function wasn't assessed during interim follow-up visits, which would have given a more accurate picture of changes over time, the authors note. The researchers also lacked data on urine protein and urine albumin, eliminating the ability to assess how proteinuria might influence the association between depressive symptoms and kidney function changes.
Senior study author Dr. Xianhui Qin of Nanfang Hospital and Southern Medical University in Guangzhou, China, didn't respond to requests for comment.
The results suggest that clinicians should be on the lookout for depressive symptoms and treat them promptly, said Dr. Ana Cristina Simões e Silva, a professor of pediatrics at the Federal University of Minas Gerais in Brazil.
"Psychiatric conditions are sometimes neglected in patients with other clinical conditions as chronic kidney disease," Dr. Simões e Silva, who wasn't involved in the study, said by email. "However, the presence of depressive symptoms can aggravate chronic kidney disease."
SOURCE: https://bit.ly/34DN6zB CJASN, online May 29, 2021.
By Lisa Rapaport
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