Stress-related disorders linked to kidney disease progression, AKI
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Swedish patients who had a stress-related disorder were more likely to experience chronic kidney disease progression and AKI compared with a population-matched control group.
“Stress-related disorders (SRDs) are a group of psychiatric disorders (namely acute stress reaction, post-traumatic stress disorder (PTSD) and adjustment disorders), that appear as a consequence of excessive or prolonged psychological stress, such as the death of a loved one, a diagnosis of life-threatening illness, natural disasters or violence,” Guobin Su, MD, PhD, of Guangdong Provincial Hospital of Chinese Medicine and Karolinska Institutet in Stockholm, and colleagues wrote. “SRDs differ from other common psychiatric disorders, such as depression or anxiety, in its attribution to a precise psychological trauma or a stressful life event.”
According to the researchers, previous research has linked these disorders to increased risk for cardiovascular disease, autoimmune diseases and infections. Coupled with the fact that cardiovascular disease and autoimmune diseases are “established risk factors for kidney function decline,” Su and colleagues suggested SRDs may contribute to CKD progression and AKI risk due to the relationship between psychological stressors and ischemia in the kidney, activated sympathetic nervous system activity, altered the hypothalamic-pituitary-adrenal axis and impaired immune function.
To investigate, researchers matched 30,998 patients who received an SRD diagnosis (median age, 45 years; 71% were women) to 116,677 patients without an SRD diagnosis. Matching was done by age, sex and eGFR.
“The primary outcome was CKD progression, defined as a sustained relative decline in eGFR of more than 40% or commencement of kidney replacement therapy,” they wrote. “The secondary outcome was AKI, defined by death or hospitalization attributed to AKI or rapid creatinine changes.”
During a medium follow-up of 3.2 years, researchers observed patients with an SRD diagnosis were at an increased risk of CKD progression (hazard ratio [HR] = 1.23) and AKI (HR = 1.22), though the association with AKI was only significant during the first year after SRD diagnosis.
Su and colleagues noted these associations were independent of a history of other psychiatric disorders, comorbidities and medications.
“The main limitation of our study is that we were unable to ascertain the precise cause, intensity and timing of the life stressor that led to the SRDs diagnosis,” the researchers wrote. “Some causes of SRDs (such as trauma after severe burning) may explain the subsequently observed kidney disease risks; SRDs may originate in anticipation of upcoming events (such as a risky heart operation) that may mediate the observed risks; finally, the response to the SRDs (such as prescription of [selective serotonin reuptake inhibitors] SSRI, family support or unhealthy coping behaviors like heavy drinking or drugs) may also explain the associations observed.”
Due to these gaps in knowledge, the researchers contended further studies are needed on the “plausible interplay between stress and kidney diseases.” Despite the need for further research, Su and colleagues recommend clinicians monitor kidney function after an SRD diagnosis.
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