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. 2021 Jun;16(6):889-897.
doi: 10.2215/CJN.18441120. Epub 2021 May 29.

Association of Depressive Symptoms with Rapid Kidney Function Decline in Adults with Normal Kidney Function

Zhuxian Zhang  1 , Panpan He  1 , Mengyi Liu  1 , Chun Zhou  1 , Chengzhang Liu  1   2 , Huan Li  1 , Yuanyuan Zhang  1 , Qinqin Li  2 , Ziliang Ye  1 , Qimeng Wu  1 , Guobao Wang  1 , Min Liang  1 , Xianhui Qin  1
Affiliations

Association of Depressive Symptoms with Rapid Kidney Function Decline in Adults with Normal Kidney Function

Zhuxian Zhang et al. Clin J Am Soc Nephrol. 2021 Jun.

Abstract

Background and objectives: The relationship of depressive symptoms with kidney function remains poorly investigated. We aimed to evaluate the prospective association between depressive symptoms and rapid decline in kidney function in Chinese adults with normal kidney function.

Design, setting, participants, & measurements: A total of 4763 participants with eGFR≥60 ml/min per 1.73 m2 at baseline were enrolled from the China Health and Retirement Longitudinal Study. Baseline depressive symptoms were determined using a ten-item Center for Epidemiologic Studies Depression scale with a cutoff score of greater than or equal to ten to define high depressive symptoms. The GFR was estimated by a combination of serum creatinine and cystatin C. The primary outcome was rapid decline in kidney function, defined as an annualized decline in eGFR of ≥5 ml/min per 1.73 m2. Secondary outcome was defined as an annualized decline in eGFR of ≥5 ml/min per 1.73 m2 and to a level of <60 ml/min per 1.73 m2 at the exit visit.

Results: During a median follow-up of 4 years (interquartile range, 3.92-4.00), 260 (6%) participants developed rapid decline in kidney function. Overall, there was a significant positive association between baseline depressive symptoms and rapid decline in kidney function (per five-scores increment; adjusted odds ratio, 1.15; 95% confidence interval, 1.03 to 1.28) after adjustments for major demographic, clinical, or psychosocial covariates. Consistently, compared with participants with low depressive symptoms (total Center for Epidemiologic Studies Depression scale score less than ten), a significantly higher risk of rapid decline in kidney function was found among those with high depressive symptoms (total Center for Epidemiologic Studies Depression scale score greater than or equal to ten; adjusted odds ratio, 1.39; 95% confidence interval, 1.03 to 1.88). Similar results were found for the secondary outcome (per five-scores increment; adjusted odds ratio, 1.26; 95% confidence interval, 1.06 to 1.51).

Conclusions: High depressive symptoms were significantly associated with a higher risk of rapid kidney function decline among Chinese adults with normal kidney function.

Keywords: CHARLS; chronic kidney disease; depression; depressive symptom; kidney function decline.

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Figures

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Graphical abstract
Figure 1.
Figure 1.
Positive relation of  depressive symptoms with rapid decline in kidney function  and progression to CKD . (A) Log-OR for rapid kidney function decline; (B) Log-OR for progression to CKD. *Adjusted for age, sex, body mass index, smoking status, living residence, systolic BP, diastolic BP, glucose, total cholesterol, triglycerides, HDL cholesterol, eGFR, uric acid, and self-reported heart disease. Log-OR, log odds ratio.
Figure 2.
Figure 2.
Stratified analyses for the association between depressive symptoms (high versus low) and rapid decline in kidney function. *Adjusted, if not stratified, for age, sex, body mass index, smoking status, living residence, systolic BP, diastolic BP, glucose, total cholesterol, triglycerides, HDL cholesterol, eGFR, uric acid, and self-reported heart disease. 95% CI, 95% confidence interval; CRP, C-reactive protein; OR, odds ratio.
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