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Major depression increased ESRD risk among patients with diabetes
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In a study of adults with diabetes in the state of Washington, researchers discovered that major depression may increase patients’ risk for developing kidney failure.
“This is the first study to show that major depressive symptoms are associated with a higher risk of kidney failure in patients with diabetes,” said Margaret K. Yu, MD, MS, a nephrology fellow at the University of Washington. “Additional studies are needed to determine whether treatment of depression can reduce the risk of kidney failure.”
The researchers from the VA Puget Sound Health Care System and University of Washington evaluated 3,866 adults recruited into the observational, prospective cohort from primary care clinics of a large health maintenance organization. Of them, 448 had major depressive symptoms and 327 had minor depressive symptoms.
To evaluate the association between the depressive symptoms and risk for incident end-stage renal disease in a cohort of patients with diabetes, researchers collected demographics, laboratory data, depressive symptoms (based on a patient health questionnaire) and patterns of diabetes self-care.
Participant depression was measured by symptoms — at least five major depressive symptoms or two to four minor depressive symptoms — including depressed mood or anhedonia more than 50% of the time for at least 2 weeks, and a Patient Health Questionnaire-9 (PHQ-9) score of ≥10 for major and ≥5 for minor depressive symptoms. Their incident ESRD risk was estimated using Cox proportional hazards regressions with pre-dialysis death as a competing risk.
When follow-up was conducted at 8.8 years, 87 patients had developed ESRD. Major depressive symptoms were associated with a higher risk for incident ESRD (HR=1.85; 95% CI, 1.02-3.33), whereas minor symptoms were not significantly associated (HR=1.08; 95% CI, 0.52-2.25).
Adjustments were made for age, sex, race/ethnicity, marital status, education, smoking, BMI, diabetes duration, HbA1c, baseline kidney function, microalbuminuria, hypertension, renin-angiotensin system blockers and adherence to diabetes self-care.
Disclosure: One of the researchers reported board membership with Eli Lilly and Wyeth and honoraria for lectures from Eli Lilly and Wyeth, Pfizer, and Forest.
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