Abstract: SA-PO440

Treatment of Depression Symptoms Is Associated with Attenuated Risk of All-Cause Mortality among Patients with CKD

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 304 CKD: Epidemiology, Outcomes - Non-Cardiovascular

Authors

  • Tuot, Delphine S., University of California, San Francisco, San Francisco, California, United States
  • Norris, Keith C., UCLA, Marina Del Rey, California, United States
  • Gassman, Jennifer J., Cleveland Clinic, Cleveland, Ohio, United States
  • Ku, Elaine, University of California, San Francisco, San Francisco, California, United States
Background

Depression is common, under-recognized, and undertreated among patients with CKD, especially among racial/ethnic minorities. We examined whether the relationship between depressive affect and mortality differs by antidepressant use or race/ethnicity among patients with CKD.

Methods

We assessed the presence of depressive symptoms among Chronic Renal Insufficient Cohort (CRIC) participants, defined by a Beck Depression Inventory II (BDI) score of >14 at baseline enrollment. Cox regression was used to associate baseline depressive symptoms with risk of all-cause mortality (before or after ESRD) adjusted for socioeconomic factors, baseline CKD severity, time-updated comorbid conditions including ESRD status, and baseline anti-depressant use. We tested for the presence of interaction between race/ethnicity and depressive symptoms. Confirmatory analyses were performed using long-term follow-up data from the African American Study of Kidney Disease and Hypertension Cohort (AASK).

Results

Among 3725 CRIC participants, 23.3% had a baseline BDI of >14 with 17.0% prevalence of anti-depressant use. Crude mortality rate was 3.37/100-person years (PY) during 6.7 years of median follow-up. Baseline BDI >14 was associated with higher risk of all-cause mortality, attenuated by antidepressant use (Table). Differences in the relationship between BDI score and mortality were noted by race/ethnicity (Pinteraction= 0.04, Table). Results were consistent among 652 AASK study participants, among whom 30.3% had BDI >14 with a crude mortality rate of 6.8/100-PY. Baseline BDI >14 in AASK was not associated with greater risk of mortality during 5.1 years of median follow-up (aHR=0.84; 0.61-1.18).

Conclusion

Treatment of depressive symptoms was associated with attenuated risk of mortality among individuals with CKD. Further investigation is needed to better understand differences in mortality risk by depressive symptoms among racial/ethnic subgroups.

CRIC participantsBaseline BDI >= 14Baseline antidepressant useNumber of deathsCrude mortality rate (per 100 person years)Association between baseline BDI >=14 and all-cause mortality
unadjusted HRModel 1Model 2+ baseline antidepressant use
Overall23.3%17.0%7533.371.93 (1.66-2.24)1.41 (1.21-1.70)1.21 (1.01-1.45)1.17 (0.97-1.40)
Whites13.6%23.0%2862.781.61 (1.20-2.17)1.58 (1.15-2.16)1.52 (1.10-2.09)1.35 (0.97-1.88)
Blacks20.7%14.0%3873.881.34 (1.06-1.70)1.24 (0.98-1.59)1.06 (0.82-1.37)1.01 (0.78-1.31)
Overall cohort includes Whites, Blacks and Hispanics
Model 1 adjusted for age, gender, income, education, insurance, marital status and employment
Model 2 adjusted for model 1 + Body Mass Index, hypertension, coronary artery disease, congestive heart failure, cardiovascular disease, diabetes, cancer, tobacco use, alcohol use, baseline eGFR, baseline proteinuria, ESRD
BDI = Beck Depression Inventory

Funding

  • NIDDK Support