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. 2024 Feb 9;6(4):100790.
doi: 10.1016/j.xkme.2024.100790. eCollection 2024 Apr.

Depressive Symptoms, Antidepressants, and Clinical Outcomes in Chronic Kidney Disease: Findings from the CRIC Study

Rosalba Hernandez  1 , Dawei Xie  2 , Xue Wang  2 , Neil Jordan  3 , Ana C Ricardo  4 , Amanda H Anderson  5 , Clarissa J Diamantidis  6 , John W Kusek  2 , Kristine Yaffe  7 , James P Lash  4 , Michael J Fischer  4   8   9 ; CRIC Study Investigators
Collaborators, Affiliations

Depressive Symptoms, Antidepressants, and Clinical Outcomes in Chronic Kidney Disease: Findings from the CRIC Study

Rosalba Hernandez et al. Kidney Med. .

Abstract

Rationale & objective: The extent to which depression affects the progression of chronic kidney disease (CKD) and leads to adverse clinical outcomes remains inadequately understood. We examined the association of depressive symptoms (DS) and antidepressant medication use on clinical outcomes in 4,839 adults with nondialysis CKD.

Study design: Observational cohort study.

Setting and participants: Adults with mild to moderate CKD who participated in the multicenter Chronic Renal Insufficiency Cohort Study (CRIC).

Exposure: The Beck Depression Inventory (BDI) was used to quantify DS. Antidepressant use was identified from medication bottles and prescription lists. Individual effects of DS and antidepressants were examined along with categorization as follows: (1) BDI <11 and no antidepressant use, (2) BDI <11 with antidepressant use, (3) BDI ≥11 and no antidepressant use, and (4) BDI ≥11 with antidepressant use.

Outcomes: CKD progression, incident cardiovascular disease composite, all-cause hospitalizations, and mortality.

Analytic approach: Cox regression models were fitted for outcomes of CKD progression, incident cardiovascular disease, and all-cause mortality, whereas hospitalizations used Poisson regression.

Results: At baseline, 27.3% of participants had elevated DS, and 19.7% used antidepressants. Elevated DS at baseline were associated with significantly greater risk for an incident cardiovascular disease event, hospitalization, and all-cause mortality, but not CKD progression, adjusted for antidepressants. Antidepressant use was associated with higher risk for all-cause mortality and hospitalizations, after adjusting for DS. Compared to participants without elevated DS and not using antidepressants, the remaining groups (BDI <11 with antidepressants; BDI ≥11 and no antidepressants; BDI ≥11 with antidepressants) showed higher risks of hospitalization and all-cause mortality.

Limitations: Inability to infer causality among depressive symptoms, antidepressants, and outcomes. Additionally, the absence of nonpharmacological data, and required exploration of generalizability and alternative analytical approaches.

Conclusions: Elevated DS increased adverse outcome risk in nondialysis CKD, unattenuated by antidepressants. Additionally, investigation into the utilization and counterproductivity of antidepressants in this population is warranted.

Keywords: Antidepressant medication; chronic kidney disease progression; depressive symptoms; hospitalizations; mortality.

Plain language summary

We analyzed data from 4,839 nondialysis chronic kidney disease (CKD) patients in the Chronic Renal Insufficiency Cohort Study to explore how depression and antidepressants affect CKD-related outcomes. Using the Beck Depression Inventory (BDI), we assessed depressive symptoms (DS) and identified antidepressant use through medication records. Outcomes included CKD progression, cardiovascular events, hospitalizations, and mortality. Elevated DS at baseline raised the risk of cardiovascular events, hospitalizations, and mortality, regardless of antidepressant use. Antidepressant use alone was associated with higher mortality and hospitalization risks. In comparison to those without elevated DS and no antidepressant use, all other groups faced increased hospitalization and mortality risks. Elevated DS posed a significant risk to nondialysis CKD patients, and antidepressants did not mitigate this risk.

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References

    1. Fischer M.J., Kimmel P.L., Greene T., et al. Elevated depressive affect is associated with adverse cardiovascular outcomes among African Americans with chronic kidney disease. Kidney Int. 2011;80(6):670–678. - PMC - PubMed
    1. Hedayati S.S., Jiang W., O'Connor C.M., et al. The association between depression and chronic kidney disease and mortality among patients hospitalized with congestive heart failure. Am J Kidney Dis. 2004;44(2):207–215. - PubMed
    1. Fischer M.J., Kimmel P.L., Greene T., et al. Sociodemographic factors contribute to the depressive affect among African Americans with chronic kidney disease. Kidney Int. 2010;77(11):1010–1019. - PMC - PubMed
    1. Hedayati S.S., Minhajuddin A.T., Toto R.D., Morris D.W., Rush A.J. Prevalence of major depressive episode in CKD. Am J Kidney Dis. 2009;54(3):424–432. - PMC - PubMed
    1. Palmer S., Vecchio M., Craig J.C., et al. Prevalence of depression in chronic kidney disease: systematic review and meta-analysis of observational studies. Kidney Int. 2013;84(1):179–191. - PubMed

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