Depression Symptoms Do Not Worsen Over Time in a Cohort of CKD Patients: The BRINK Study

Christopher D Knapp; Kayla Horak; Nicholas S Roetker; Abigail Fink; Allan Gao; Kirsten L Johansen; Anne Murray; Allyson Hart

doi:10.34067/KID.0000000670

Depression Symptoms Do Not Worsen Over Time in a Cohort of CKD Patients: The BRINK Study

Kidney360. 2024 Dec 3. doi: 10.34067/KID.0000000670. Online ahead of print.

Authors

Christopher D Knapp^{1

2

3}, Kayla Horak⁴, Nicholas S Roetker⁴, Abigail Fink⁵, Allan Gao², Kirsten L Johansen^{1

2

4}, Anne Murray^{3

5

6}, Allyson Hart^{1

2

4}

Affiliations

¹ Hennepin Healthcare System, Department of Medicine, Division of Nephrology, Minneapolis, MN.
² University of Minnesota Medical School, Department of Medicine, Minneapolis, MN.
³ Hennepin Healthcare Research Institute, Minneapolis, MN.
⁴ Chronic Disease Research Group, Minneapolis, MN.
⁵ Berman Center for Research and Clinical Outcomes, Minneapolis, MN.
⁶ Hennepin Healthcare System, Department of Medicine, Division of Geriatrics and Palliative Care, Minneapolis, MN.

PMID: 39625788
DOI: 10.34067/KID.0000000670

Abstract

Background: The prevalence of depression is high in the chronic kidney disease (CKD) (20-40%) and dialysis (30-50%) populations. Less is known about how depressive symptoms change over time in patients with CKD.

Methods: Participants in the Brain in Kidney Disease (BRINK) cohort study completed a depressive symptom questionnaire (PHQ-9) and serum creatinine testing annually. We used linear mixed effects models to examine changes in PHQ-9 scores over time and compared rates of change between participants with different ranges of eGFR impairment and those with normal eGFR.

Results: At baseline, 147 participants had normal eGFR, 424 had impaired eGFR without dialysis dependence, and 31% reported a diagnosis of depression, with a mean baseline PHQ-9 score of 4.3. Participants were followed for up to 5 years. After adjustment for factors associated with depression, mean PHQ-9 scores decreased (improved) by 0.25 points per year (95% confidence interval [CI] 0.07, 0.42) among participants with normal eGFR (>60 ml/min/1.73m2) and by 0.35 points (95% CI 0.14, 0.56), 0.30 points (95% CI 0.13,0.46) and 0.42 points (95% CI 0.06, 0.77) among participants with eGFR of 45 to 59 ml/min/1.73m2, 30 to 44 ml/min/1.73m2, and participants who developed dialysis dependence, respectively. PHQ-9 scores among participants with eGFR <30 ml/min/1.73m2 did not change significantly. We did not observe any statistically significant differences in mean change in PHQ-9 score between participants with any degree of eGFR impairment and those with normal eGFR, nor between participants with dialysis-dependence and those with eGFR of ≤15 ml/min/1.73m2. Participants with a PHQ-9 score ≥5 had 80% greater odds of immediate study attrition than participants with a PHQ-9 score of 0-4."

Conclusions: The mean PHQ-9 scores of participants were largely stable over time, and we observed no differences in the change in PHQ-9 scores between those with impaired eGFR and those with normal eGFR.