Associations between depressive symptoms and disease progression in older patients with chronic kidney disease: results of the EQUAL study
Authors: Eveleens Maarse Boukje C , Chesnaye Nicholas C , Schouten Robbert , Michels Wieneke M , Bos Willem Jan W , Szymczak Maciej , Krajewska Magdalena , Evans Marie , Heimburger Olof , Caskey Fergus J , Wanner Christoph , Jager Kitty J , Dekker Friedo W , Meuleman Yvette ,   EQUAL Study Investigators, Schneider Andreas , Torp Anke , Iwig Beate , Perras Boris , Marx Christian , Drechsler Christiane , Blaser Christof , Wanner Christoph , Emde Claudia , Krieter Detlef , Fuchs Dunja , Irmler Ellen , Platen Eva , Schmidt-Gürtler Hans , Schlee Hendrik , Naujoks Holger , Schlee Ines , Cäsar Sabine , Beige Joachim , Röthele Jochen , Mazur Justyna , Hahn Kai , Blouin Katja , Neumeier Katrin , Anding-Rost Kirsten , Schramm Lothar , Hopf Monika , Wuttke Nadja , Frischmuth Nikolaus , Ichtiaris Pawlos , Kirste Petra , Schulz Petra , Aign Sabine , Biribauer Sandra , Manan Sherin , Röser Silke , Heidenreich Stefan , Palm Stephanie , Schwedler Susanne , Delrieux Sylke , Renker Sylvia , Schättel Sylvia , Stephan Theresa , Schmiedeke Thomas , Weinreich Thomas , Leimbach Til , Stövesand Torsten , Bahner Udo , Seeger Wolfgang , Cupisti Adamasco , Sagliocca Adelia , Ferraro Alberto , Mele Alessandra , Naticchia Alessandro , Còsaro Alex , Ranghino Andrea , Stucchi Andrea , Pignataro Angelo , De Blasio Antonella , Pani Antonello , Tsalouichos Aris , Antonio Bellasi , Raffaele Di Iorio Biagio , Alessandra Butti , Abaterusso Cataldo , Somma Chiara , D'alessandro Claudia , Torino Claudia , Zullo Claudia , Pozzi Claudio , Bergamo Daniela , Ciurlino Daniele , Motta Daria , Russo Domenico , Favaro Enrico , Vigotti Federica , Ansali Ferruccio , Conte Ferruccio , Cianciotta Francesca , Giacchino Francesca , Cappellaio Francesco , Pizzarelli Francesco , Greco Gaetano , Porto Gaetana , Bigatti Giada , Marinangeli Giancarlo , Cabiddu Gianfranca , Fumagalli Giordano , Caloro Giorgia , Piccoli Giorgina , Capasso Giovanbattista , Gambaro Giovanni , Tognarelli Giuliana , Bonforte Giuseppe , Conte Giuseppe , Toscano Giuseppe , Del Rosso Goffredo , Capizzi Irene , Baragetti Ivano , Oldrizzi Lamberto , Gesualdo Loreto , Biancone Luigi , Magnano Manuela , Ricardi Marco , Di Bari Maria , Laudato Maria , Luisa Sirico Maria , Ferraresi Martina , Postorino Maurizio , Provenzano Michele , Malaguti Moreno , Palmieri Nicola , Murrone Paola , Cirillo Pietro , Dattolo Pietro , Acampora Pina , Nigro Rita , Boero Roberto , Scarpioni Roberto , Sicoli Rosa , Malandra Rosella , Savoldi Silvana , Bertoli Silvio , Borrelli Silvio , Maxia Stefania , Maffei Stefano , Mangano Stefano , Cicchetti Teresa , Rappa Tiziana , Palazzo Valentina , De Simone Walter , Schrander Anita , van Dam Bastiaan , Siegert Carl , Gaillard Carlo , Beerenhout Charles , Verburgh Cornelis , Janmaat Cynthia , Hoogeveen Ellen , Hoorn Ewout , Dekker Friedo , Boots Johannes , Boom Henk , Eijgenraam Jan-Willem , Kooman Jeroen , Rotmans Joris , Jager Kitty , Vogt Liffert , Raasveld Maarten , Vervloet Marc , van Buren Marjolijn , van Diepen Merel , Chesnaye Nicholas , Leurs Paul , Voskamp Pauline , Blankestijn Peter , van Esch Sadie , Boorsma Siska , Berger Stefan , Konings Constantijn , Aydin Zeynep , Musiała Aleksandra , Szymczak Anna , Olczyk Ewelina , Augustyniak-Bartosik Hanna , Miśkowiec-Wiśniewska Ilona , Manitius Jacek , Pondel Joanna , Jędrzejak Kamila , Nowańska Katarzyna , Nowak Łukasz , Szymczak Maciej , Durlik Magdalena , Dorota Szyszkowska , Nieszporek Teresa , Heleniak Zbigniew , Jonsson Andreas , Blom Anna-Lena , Rogland Björn , Wallquist Carin , Vargas Denes , Dimény Emöke , Sundelin Fredrik , Uhlin Fredrik , Welander Gunilla , Bascaran Hernandez Isabel , Gröntoft Knut-Christian , Stendahl Maria , Svensson Maria , Evans Marie , Heimburger Olof , Kashioulis Pavlos , Melander Stefan , Almquist Tora , Jensen Ulrika , Woodman Alistair , McKeever Anna , Ullah Asad , McLaren Barbara , Harron Camille , Barrett Carla , O'Toole Charlotte , Summersgill Christina , Geddes Colin , Glowski Deborah , McGlynn Deborah , Sands Dympna , Caskey Fergus , Roy Geena , Hirst Gillian , King Hayley , McNally Helen , Masri-Senghor Houda , Murtagh Hugh , Rayner Hugh , Turner Jane , Wilcox Joanne , Berdeprado Jocelyn , Wong Jonathan , Banda Joyce , Jones Kirsteen , Haydock Lesley , Wilkinson Lily , Carmody Margaret , Weetman Maria , Joinson Martin , Dutton Mary , Matthews Michael , Morgan Neal , Bleakley Nina , Cockwell Paul , Roderick Paul , Mason Phil , Kalra Philip , Sajith Rincy , Chapman Sally , Navjee Santee , Crosbie Sarah , Brown Sharon , Tickle Sheila , Mathavakkannan Suresh , Kuan Ying 
Published: December 2021

ABSTRACT

Background
Depressive symptoms are associated with adverse clinical outcomes in patients with end-stage kidney disease; however, few small studies have examined this association in patients with earlier phases of chronic kidney disease (CKD). We studied associations between baseline depressive symptoms and clinical outcomes in older patients with advanced CKD and examined whether these associations differed depending on sex.

Methods
CKD patients (≥65 years; estimated glomerular filtration rate ≤20 mL/min/1.73 m2) were included from a European multicentre prospective cohort between 2012 and 2019. Depressive symptoms were measured by the five-item Mental Health Inventory (cut-off ≤70; 0–100 scale). Cox proportional hazard analysis was used to study associations between depressive symptoms and time to dialysis initiation, all-cause mortality and these outcomes combined. A joint model was used to study the association between depressive symptoms and kidney function over time. Analyses were adjusted for potential baseline confounders.

Results
Overall kidney function decline in 1326 patients was –0.12 mL/min/1.73 m2/month. A total of 515 patients showed depressive symptoms. No significant association was found between depressive symptoms and kidney function over time (P = 0.08). Unlike women, men with depressive symptoms had an increased mortality rate compared with those without symptoms [adjusted hazard ratio 1.41 (95% confidence interval 1.03–1.93)]. Depressive symptoms were not significantly associated with a higher hazard of dialysis initiation, or with the combined outcome (i.e. dialysis initiation and all-cause mortality).

Conclusions
There was no significant association between depressive symptoms at baseline and decline in kidney function over time in older patients with advanced CKD. Depressive symptoms at baseline were associated with a higher mortality rate in men.