Association of depression and antidepressant use with mortality in a large cohort of patients with nondialysis-dependent CKD

Abstract

Background and objectives: Depression is common and is associated with higher mortality in patients with ESRD or CKD (stage 5). Less information is available on earlier stages of CKD. This study aimed to determine the prevalence of depression and any association with all-cause mortality in patients with varying severity of nondialysis-dependent CKD.

Design, setting, participants, & measurements: This is a retrospective study of a national cohort of 598,153 US veterans with nondialysis-dependent CKD stages 1-5 followed for a median of 4.7 years in the US Department of Veterans Affairs Health System. Diagnosis of depression was established as a result of systematic screening and administration of antidepressants. Association of depression with all-cause mortality overall and stratified by CKD stages were examined with the Kaplan-Meier method and in Cox models.

Results: There were 179,441 patients (30%) with a diagnosis of depression. Over median follow-up of 4.7 years, depression was associated with significantly higher age-adjusted mortality overall (hazard ratio, 1.55; 95% confidence interval, 1.54-1.57; P<0.001). Sequential adjustments for sociodemographic characteristics and especially for comorbid conditions attenuated this association, which nevertheless remained significant (hazard ratio, 1.25; 95% confidence interval, 1.23-1.26).

Conclusions: In this large cohort of predominantly elderly male patients with CKD, prevalence of depression and antidepressant use is high (30%) and is associated with significantly higher all-cause mortality independent of comorbid conditions.

Figure 1.

Age-adjusted Kaplan–Meier survival curves in patients with and without a diagnosis of depression. Comparison was made by log-rank test for equality of survival function.

Figure 2.

Forest plot showing all-cause mortality hazard ratios (95% confidence intervals) associated with depression in several prespecified subgroups of patients. All models were adjusted for age, sex, race, marital and insurance status, geographic location, diabetes mellitus, hypertension, cardiovascular disease, congestive heart failure, cerebrovascular disease, liver disease, chronic lung disease, the Charlson comorbidity index, estimated GFR, serum sodium, albumin, calcium, bicarbonate, hemoglobin, and white blood cell count. 95% CI, 95% confidence interval; DM, diabetes mellitus; CVD, cerebrovascular disease; eGFR, estimated GFR.