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Kidney Week

Abstract: PO0547

Inflammation Mediates the Association of Depression Severity with Selective Serotonin Reuptake Inhibitor Treatment Response in Patients with CKD

Session Information

Category: CKD (Non-Dialysis)

  • 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Torres Rodriguez, Stephanie, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, United States
  • Gregg, L Parker, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, United States
  • Carmody, Thomas, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, United States
  • Trivedi, Madhukar, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, United States
  • Hedayati, Susan, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, United States
Background

Patients with chronic kidney disease (CKD) are at high risk for depression, which is associated with inflammation in patients with chronic diseases. We investigated whether depression severity is associated with response to treatment with sertraline and whether inflammation mediates this relationship in CKD patients with major depression (MDD).

Methods

We conducted the CKD Antidepressant Sertraline Trial (CAST), a randomized double-blind trial of 193 participants with stage 3-5 CKD and MDD randomized to sertraline or placebo for 12 weeks. Depressive symptoms were assessed using the Quick Inventory of Depressive Symptomatology (QIDS). High sensitivity C-reactive protein (hsCRP) was measured at baseline. Logistic regression determined associations of QIDS and hsCRP with treatment response (≥50% decrease) or improvement (≥3-point decrease) in QIDS. Interaction P<0.10 was considered significant.

Results

Fifty-five (28.5%) participants achieved treatment response. Baseline depression severity by QIDS correlated positively with hsCRP, rho=0.162, P<0.05. Median (IQR) hsCRP was 5.0 (2.0, 14.6) mg/L in sertraline responders and 2.7 (0.8, 6.0) mg/L in non-responders, P=0.03. Higher baseline QIDS was associated with increased odds of response in the sertraline group, OR (95% CI) per 1-point increase 1.26 (1.04-1.53), but lower odds in the placebo group, 0.77 (0.61-0.97), interaction P=0.002 (Figure). Higher baseline hsCRP was associated with higher odds of response, OR per log-unit increase 1.52 (1.06-2.19), and improvement, 1.66 (1.11-2.48), in the sertraline group, but not in the placebo group, interaction P=0.08 for response and 0.03 for improvement, even after controlling for baseline depression severity by QIDS score (Figure).

Conclusion

Higher depression severity was associated with improvement in depressive symptoms and response to treatment with sertraline in CKD patients. This may be explained by elevated baseline inflammation. Future studies should test whether sertraline is more effective than placebo in CKD individuals with higher plasma hsCRP.

Funding

  • NIDDK Support