Kidney Week

Abstract: TH-PO1113

Inflammatory Biomarkers Improve Prediction of Sertraline Treatment Response in CKD

Session Information

• CKD: Clinical, Outcomes, Trials - I
  October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 1902 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Gregg, L Parker, University of Texas Southwestern, Dallas, Texas, United States

L Parker Gregg,

• Carmody, Thomas, University of Texas Southwestern, Dallas, Texas, United States

Thomas Carmody,

• Le, Dustin, University of Texas Southwestern, Dallas, Texas, United States

Dustin Le,

• Trivedi, Madhukar, University of Texas Southwestern, Dallas, Texas, United States

Madhukar Trivedi,

• Hedayati, Susan, University of Texas Southwestern, Dallas, Texas, United States

Susan Hedayati,

Background

Inflammation may mediate depression, and CKD is associated with elevated inflammatory markers and depression prevalence. We studied whether baseline inflammation predicts treatment response to sertraline in individuals with CKD and depression.

Methods

In 193 participants with stage 3-5 CKD and depression randomized to sertraline or placebo in the double-blind Chronic Kidney Disease Antidepressant Sertraline Trial (CAST), we measured baseline albumin, pre-albumin, interleukin-6 (IL-6), and high sensitivity C-reactive protein (hsCRP). Outcomes were a ≥3-point decrease (improvement) and ≥50% decrease (response) in depressive symptoms, assessed by the Clinician-Rated 16-Item Quick Inventory of Depression Symptomatology (QIDS). Logistic regression measured associations of inflammatory markers with outcomes after covariate adjustment. Inflammatory marker x treatment interaction P<.1 was considered significant. The areas under the curve (AUC) for nested models predicting response were compared using non-parametric tests.

Results

Mean age was 58±13 years, 58% were Black, 42% White, and 18% Hispanic. HsCRP correlated with baseline QIDS score (r=.19, P<.05). In the sertraline group, hsCRP was higher in those who did vs. did not achieve improvement, median (IQR): 5.0 (1.7-8.6) mg/L vs. 1.4 (0.6-3.7), P=.005, and response, 5.0 (2.0-14.6) vs. 2.7 (0.8-6.0), P=.03. A 1 log-unit increase of hsCRP independently predicted a differential degree of improvement and response to sertraline vs. placebo (Table). Baseline QIDS, eGFR, age, diabetes, site, and hsCRP (highest tertile) predicted sertraline response, AUC (95% CI) .71 (.58, .85). Addition of albumin and pre-albumin (lowest tertile) and IL-6 (highest tertile) improved the AUC to .82 (.72, .92), P=.02 (Figure).

Conclusion

Higher baseline hsCRP was independently associated with depressive symptom improvement and response to sertraline. Inflammatory biomarkers may identify CKD patients more likely to benefit from sertraline.

Funding

• NIDDK Support