The association of post-traumatic stress disorder with glomerular filtration rate decline

Abstract

While major depression is known to be associated with glomerular filtration rate (GFR) decline, there is a lack of data on the association of other mental illnesses like posttraumatic stress disorder (PTSD) with kidney disease. In 640 adult participants of the Heart and Soul Study (mean baseline age of 66.2 years) with a high prevalence cardiovascular disease, hypertension and diabetes, we examined the association of PTSD with GFR decline over a 5-year follow-up. We observed a significantly greater estimated (e) GFR decline over time in those with PTSD compared to those without (2.97 vs. 2.11 ml/min/1.73 m² /year; p = .022). PTSD was associated with 91% (95% CI 12%-225%) higher odds of 'rapid' versus 'mild' (>3.0 vs. <3.0 ml/min/1.73 m² /per year) eGFR decline. These associations remained consistent despite controlling for demographics, medical comorbidities, other mental disorders and psychiatric medications. In conclusion, our study provides evidence that PTSD is independently associated with GFR decline in middle-aged adults with a high comorbidity burden. This association needs to be examined in larger cohorts with longer follow-ups.

Keywords: chronic kidney disease; epidemiology; glomerular filtration rate.

Figure 1:. Association of PTSD with the slope of eGFR Decline

Forest Plot to display to association between PTSD and slope/trajectory of eGFR decline unadjusted [Model 1]. In addition, after sequential adjustment for demographics (age, gender, race) [Model 2], medical comorbidities (BMI, HTN, DM, CHF, LVH, stroke and angina) [Model 3], psychiatric diagnoses (MDD and GAD) [Model 4], psychiatric medication use [Model 5], and finally alcohol abuse and smoking [Model 6]. Regression coefficient (β statistic) and 95% confidence interval (CI) is shown for each model. Abbreviations: BMI (body mass index), HTN (hypertension), DM (diabetes mellitus), CHF (congestive heart failure), LVH (left ventricular hypertrophy), MDD (major depressive disorder), GAD (generalized anxiety disorder).

Figure 2:. Association of PTSD with ‘rapid’ (> 3.0 ml/min/1.73m2 per year) versus ‘mild’ (< 3.0 ml/min/1.73m2 per year) eGFR decline

Forest Plot to display to association between PTSD with ‘rapid’ compared to ‘mild’ eGFR decline unadjusted [Model 1]. In addition, after sequential adjustment for demographics (age, gender, race) [Model 2], medical comorbidities (BMI, HTN, DM, CHF, LVH, stroke and angina) [Model 3], psychiatric diagnoses (MDD and GAD) [Model 4], psychiatric medication use [Model 5], and finally alcohol abuse and smoking [Model 6]. Odds Ratios (OR) and 95% confidence interval (CI) is shown for each model. Abbreviations: BMI (body mass index), HTN (hypertension), DM (diabetes mellitus), CHF (congestive heart failure), LVH (left ventricular hypertrophy), MDD (major depressive disorder), GAD (generalized anxiety disorder).