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Depression worsens with nephropathy stage in diabetes
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The progression of kidney damage was associated with an increased risk for depression among patients with diabetes, researchers in Japan found.
However, depression improved with kidney transplantation, according to the researchers.
“Cohort studies have demonstrated that depression in patients with diabetes leads to increased risk of [end-stage kidney disease],” Keiko Takasaki, of the Tokyo Women’s Medical University School of Medicine in Shinjuku-ku, Japan, and colleagues wrote. “However, severity of depression has not been comprehensively examined among the stages of diabetic kidney disease.”
Researchers reviewed data from 2,212 patients with diabetes as part of the DIACET study (mean age, 60.9 years; 928 women; 1,838 with type 2 diabetes). Takasaki and colleagues grouped patients into five stages of nephropathy according to increasing severity, with stage 5 patients undergoing dialysis categorized as 5D and those receiving kidney transplantation as 5T. Patients received Patient Health Questionnaire-9 (PHQ-9) upon admission to gauge depression levels, if any. The researchers then used multivariate logistic regression analysis and analysis of covariance to evaluate the relationship between depression and nephropathy.
Mean scores indicating mild, moderate and severe depression all increased alongside nephropathy stage, but decreased upon kidney transplantation, Takasaki and colleagues wrote. Multivariate analysis showed that OR for depression increased with nephropathy stage compared with patients in stage 1, and that as with mean depression score, OR decreased at stage 5T. Albuminuria was significantly associated with higher depression scores after adjustment for clinical findings, but estimated glomerular filtration rate was not, the researchers reported.
Takasaki and colleagues wrote that it could be “easily inferred” that a successful kidney transplant could help with depression, but that “severe depression may decrease the patient’s motivation for receiving a kidney transplant, which may have yielded a selection bias associated with lower prevalence of depression in kidney-transplanted patients.” A longitudinal study covering the period before and after transplantation would be necessary to fully explore the benefits of transplantation for patients experiencing nephropathy and depression, they wrote.
“Future studies should examine this relationship using more accurate methods to diagnose depression, such as interviews with psychiatric specialists,” the researchers wrote. “Nevertheless, there has been no previous report of a detailed examination of this relationship based on nephropathy stage in more than 2,000 patients with diabetes.” – by Andy Polhamus
Disclosure: The researchers report no relevant financial disclosures.
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