Depressive Symptoms Associate With Race and All-Cause Mortality in Patients With CKD

Delphine S Tuot; Feng Lin; Keith Norris; Jennifer Gassman; Miroslaw Smogorzewski; Elaine Ku

doi:10.1016/j.ekir.2018.10.001

Depressive Symptoms Associate With Race and All-Cause Mortality in Patients With CKD

Kidney Int Rep. 2018 Oct 9;4(2):222-230. doi: 10.1016/j.ekir.2018.10.001. eCollection 2019 Feb.

Authors

Delphine S Tuot^{1

2

3}, Feng Lin⁴, Keith Norris⁵, Jennifer Gassman⁶, Miroslaw Smogorzewski⁷, Elaine Ku^{1

3}

Affiliations

¹ Division of Nephrology, University of California, San Francisco; San Francisco, California, USA.
² Center for Vulnerable Populations at Priscilla Chan and Mark Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA.
³ Kidney Health Research Institute, University of California, San Francisco, San Francisco, California, USA.
⁴ Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA.
⁵ University of California, Los Angeles, Los Angeles, California, USA.
⁶ Cleveland Clinic Foundation, Cleveland, Ohio, USA.
⁷ University of Southern California, Los Angeles, Los Angeles, California, USA.

Abstract

Introduction: Depression is common but underrecognized in patients with chronic kidney disease (CKD), especially among racial/ethnic minorities. We examined the association between depressive symptoms and all-cause mortality (including deaths before and after end-stage renal disease [ESRD]) and whether antidepressant use impacts this association, overall, and by race/ethnicity.

Methods: We ascertained whether the presence of depressive symptoms, defined by a Beck Depression Inventory II (BDI) score of >14 at cohort enrollment, was associated with all-cause mortality (before or after ESRD) among study participants of the Chronic Renal Insufficient Cohort (CRIC) overall and by race/ethnicity. Models were adjusted for socioeconomic factors, baseline CKD severity, time-updated comorbid conditions, and time-updated antidepressant use. Confirmatory analyses were performed among African American Study of Kidney Disease and Hypertension (AASK) participants.

Results: Among 3739 CRIC participants, 16.3% had a baseline BDI of >14; 18.2% reported antidepressant use. Crude mortality rate was 3.16 per 100 person-years during 6.8 years of median follow-up. Baseline BDI >14 was independently associated with higher risk of all-cause mortality (adjusted hazard ratio [aHR]: 1.27; 95% confidence interval: 1.07-1.52) without attenuation by antidepressant use. Differences among white and black individuals were noted (P_interaction= 0.02) but not among white versus Hispanic individuals (P_interaction = 0.43) or black versus Hispanic individuals (P_interaction = 0.22). Depressive symptoms were associated with higher mortality among white individuals (aHR: 1.66; 1.21-2.28), but not Hispanic individuals (aHR: 1.47; 0.95-2.28) or black individuals (aHR: 1.06; 0.82-1.37). Similar results were noted among 611 AASK participants (aHR: 0.99; 0.69-1.42).

Conclusions: The presence of depressive symptoms is a risk factor for all-cause mortality among patients with mild-moderate CKD, particularly among white individuals. Further studies are needed to understand the heterogeneity in the response to the presence of depressive symptoms by race.

Keywords: AASK; CKD; CRIC; chronic kidney disease; depression; mortality.

Abstract

Grants and funding