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Kidney Week

Abstract: TH-PO443

A Diagnosis of Depression/Anxiety Is Associated with More Rapid eGFR Decline in Autosomal Dominant Polycystic Kidney Disease

Session Information

Category: Genetic Diseases of the Kidneys

  • 1201 Genetic Diseases of the Kidneys: Cystic

Authors

  • Simmons, Kathryn E., Yale School of Medicine, New Haven, Connecticut, United States
  • Ullman, Lawrence S., Yale School of Medicine, New Haven, Connecticut, United States
  • Dahl, Neera K., Mayo Clinic Department of Internal Medicine, Rochester, Minnesota, United States
Background

Autosomal Dominant Polycystic Kidney Disease (ADPKD) is the leading genetic cause of kidney failure. 22-60% of patients with ADPKD are diagnosed with depression, which is associated with worse physical health and decreased dietary compliance with ADPKD guidelines. Depression in chronic kidney disease patients is associated with increased all-cause mortality, but the impact of mental health on ADPKD progression has not been assessed.

Methods

We identified ADPKD patients seen at Yale Nephrology from 2016 to 2021 and retrospectively collected demographic, medical history, and clinical data through automated query and manual chart review. Patients were separated into two groups, those diagnosed with depression and/or anxiety (DA), and those without a diagnosis of depression and/or anxiety (NDA). Estimated glomerular filtration rate (eGFR) was calculated using the 2021 CKD EPI Creatinine equation. Differences between groups were assessed through chi-squared and Student’s T-test, and the impact of DA on kidney function decline, represented by average change in eGFR, was assessed through simple and multiple linear regression.

Results

There were 49 (26%) patients with DA, and 140 (74%) patients without. DA patients were more likely to be female (p=0.0044), younger (p=0.044), have higher body mass index (BMI) (p=0.021), and be diagnosed with obstructive sleep apnea (p=0.046). There were no differences between Mayo Imaging Classification (MIC) or genotype between the groups, though tolvaptan use was more common in the NDA group (p=0.021). DA diagnosis was not linked to more rapid eGFR decline (p=0.672) with simple linear regression. However, DA was a significant predictor for rapid eGFR decline (p=0.019) on multivariable regression when controlling for factors linked to disease progression, including ADPKD genotype, MIC, kidney stones, hypertension, and diabetes, as well as age, sex, and BMI.

Conclusion

DA is significantly correlated with rapid eGFR decline in ADPKD patients in addition to traditional risk factors such as genotype, age and MIC. Future investigations may help determine if the impact of DA on eGFR decline is through a clinical, psychological, and/or behavioral mechanism.

Funding

  • Clinical Revenue Support