Prevalence of depression in chronic kidney disease: systematic review and meta-analysis of observational studies. Kidney Int. 2013;84:179-191. [PMID: 23486521 DOI: 10.1038/ki.2013.77]

Plasma brain-derived neurotrophic factor before hemodialysis reduces the risk of depression in patients with chronic renal failure

BACKGROUND

Neurotrophins are related with depressive disorders. Significant neurotrophins variations occur during renal replacement therapy, but whether peri-hemodialysis availability is associated with depression in patients with Chronic Kidney Disease (CKD) is yet unclear.

AIM

To determine dynamic concentrations of neurotrophins in the peri-hemodialysis range and their association with depressive symptoms in patients with CKD.

METHODS

Pre-, and post-hemodialysis plasma concentrations of brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF), as well as their plasma clearance rates, were determined (multiplexing) in patients with stage 5 CKD. Depressive symptoms, as assessed by the Beck Depression Inventory-II (BDI-II), were determined. Finally, the bioavailability of BDNF and NGF was related to the score of depressive symptoms.

RESULTS

Fifty-three patients were divided according to depressive symptoms. Pre-hemodialysis plasma BDNF was lower in patients with depressive disorder; whereas basal BDNF value >220 pg/mL independently reduced the risk for depressive disorder (Odds Ratio 0.23, p = 0.047) at uni- and multivariate analysis. Post-hemodialysis concentration and clearance rate of neurotrophins were not related with depressive symptoms.

CONCLUSION

Higher plasma BDNF before hemodialysis reduces the risk of mild depression in patients with CKD under renal replacement therapy.

Depression in chronic kidney disease: Particularities, specific mechanisms and therapeutic considerations, a narrative review

INTRODUCTION

Depression is highly prevalent during chronic kidney disease (CKD) with studies suggesting prevalence rates ranging from approximately one-quarter to half of CKD patients. CKD and depression have a bidirectional relationship, each disorder aggravating the other, leading to more complex and challenging patient management. Depression during CKD is multifactorial and is associated with increased risk of adverse events and hospitalization.

METHODS

We conducted a narrative review of experimental and observational studies in animals and humans, as well as meta-analyses, to explore specific mechanisms of depression in CKD and its treatment.

RESULTS

In depression the gut-brain axis is central. CKD leads to an accumulation of gut-derived uremic toxins. One key factor is the accumulation of tryptophan-derived uremic toxins like kynurenines or indoxyl sulfate, whose serum concentration increases progressively with the stage of CKD (up to 100-fold in stage 5), and which plays an important role in depression mechanisms, by activating aryl hydrocarbon receptor, decreasing brain concentrations of serotonin by approximately 40 %, increasing brain inflammation, via activation of microglia and astrocytes and release of TNFα, IL-6 and NO. Randomized controlled studies found limited or no benefits of antidepressants for depressive symptoms in CKD and hemodialysis patients.

CONCLUSION

Chronic inflammation, in relation to uremic toxin accumulation during CKD, seems to be a complex but important mechanism for treatment resistance in depression. Future research should consider inhibitors of uremic toxins inhibitors and anti-inflammatory molecules as potential therapeutic agents, to improve the prognosis of depression in CKD patients.

Development of a nomogram for predicting depression risk in patients with chronic kidney disease: an analysis of data from the US National Health and Nutrition Examination Survey, 2007-2014

OBJECTIVES

Depression frequently occurs among individuals suffering from chronic kidney disease (CKD), diminishing life quality considerably while accelerating the disease course. This study aims to create a predictive model to identify patients with CKD at high risk for depression.

DESIGN

Analysis of cross-sectional data.

SETTING

US National Health and Nutrition Examination Survey (2007-2014).

PARTICIPANTS

A total of 2303 patients with CKD (weighted=17 422 083) with complete data were included in the analysis.

OUTCOME MEASURES

We used the least absolute shrinkage and selection operator regression for variable selection and constructed a weighted logistic regression model through stepwise backward elimination based on minimisation of the Akaike information criterion, visualised with a nomogram. Internal validation was conducted using 1000 bootstrap resamples. Model discrimination was assessed using receiver operating characteristic curves, calibration was evaluated using the Hosmer-Lemeshow test and calibration curves, and net benefits and clinical impact were analysed using decision curve analysis and comparative impact chart curves.

RESULTS

The final model included 10 predictors: age, gender, poverty income ratio, body mass index, smoking, sleep time, sleep disorder, chest pain, diabetes and arthritis. The model achieved an area under the curve of 0.776 (95% CI 0.745 to 0.806) with good fit (Hosmer-Lemeshow p=0.805). Interventions within the 0.1-0.6 probability range showed significant benefits.

CONCLUSION

We have crafted a predictive model with good discriminative power that could potentially help clinicians identify patients with CKD at high risk for depression, thereby facilitating early intervention and improving the prognosis of these patients.

Psychobiotic Protection of Nutritional Supplements and Probiotics in Patients Undergoing Hemodialysis: A Randomized Trial

BACKGROUND/OBJECTIVES

The prevalence of depression and anxiety symptoms is remarkably high in malnourished individuals undergoing hemodialysis. The goal of this project was to evaluate the impact of administering an oral nutritional supplement combined with a probiotic blend on the microbiota, intestinal permeability, and depression symptoms in malnourished hemodialysis patients.

METHODS

With this aim, a randomized trial was conducted with three parallel groups: a control group with individualized diet, a supplement-placebo (SU-PL) group with oral nutritional supplementation (ONS), and a supplement-probiotic (SU-PR) group with ONS in conjunction with a probiotic blend. Blood and fecal samples were collected at basal time, and at 3 and 6 months. Several blood biomarkers, like zonulin, lipopolysaccharide-binding protein (LBP), lipopolysaccharide (LPS), and brain-derived neurotrophic factor (BDNF), were measured, and the fecal microbiome was sequenced with the Illumina platform. The Hospital Anxiety and Depression Scale (HADS) was used for the estimation of depression (HADS-D) and anxiety (HADS-A) symptoms, along with the standardized mental health index SF12-MH from the general health questionnaire SF-12.

RESULTS

The results showed that patients who consumed the probiotic blend maintained the LPS levels from their baseline readings and decreased their BDNF levels compared to the SU-PL or control groups. Moreover, a significant decrease in HADS-D scores (less depressive symptoms) and an increase in SF12-MH scores (higher quality of life) were found in that group in comparison to the other groups. The intervention produced an impact on the microbiome population, where the SU-PR group had reduced Akkermansia abundance with respect to the other groups, while their Acidaminococcus abundance decreased and their Barnesiella abundance increased with respect to the SU-PL group.

CONCLUSIONS

Overall, the results indicate that the probiotic with the nutritional supplement could reduce the intestinal permeability biomarkers and improve depressive symptoms and quality of life in malnourished hemodialysis patients.

Addressing the Human Experience of Chronic Kidney Disease: A Call to Transform Kidney Care

Chronic kidney disease (CKD), a long-term condition in which kidney function declines over time, is a growing global healthcare concern. CKD can have a major impact on the quality of life of patients and their caregivers. Recent research by the International Society of Nephrology highlights that current treatment strategies and policies do not fully address patients' needs. This commentary provides patient insights into the real-life concerns of those who are living with CKD, with main concerns focusing on relationships and support, work and finances, and awareness, prevention, and intervention. Strong support networks are essential for patients and caregivers, but the burden of CKD can make it difficult to maintain personal connections. Limiting disease progression and providing mental health support can help patients and caregivers to maintain their relationships. Work or education can be challenging to manage with CKD; however, employers and educational institutions can create supportive environments that meet the diverse needs of people with CKD. Although delaying disease progression can preserve patient quality of life, people are often unaware of their disease prior to diagnosis, the severity of their CKD, and the risk factors for progression. This presents an opportunity to involve patients in their care by improving education about the benefits of maintaining kidney health. Early identification and holistic intervention could slow disease progression and protect the well-being of patients with CKD and their caregivers. This commentary brings together the diverse perspectives of patients and patient advocacy groups, as well as primary care and specialist healthcare professionals, to advocate for a transformation of CKD management that encourages patient self-care and that prioritizes timely intervention.A patient perspective video and a graphical abstract are available with this article. Addressing the Human Experience of Chronic Kidney Disease: A Call to Transform Kidney Care. Watch Lweendo Hamusankwa discuss his experience of living with chronic kidney disease, from how it impacted his family life to the importance of support networks and patient-facing information. Lweendo advocates for patients to be educated on CKD progression, treatment options, and lifestyle interventions to encourage people to manage their own health and well-being.

Relationship between accelerometer-measured physical activity and depressive symptoms in hemodialysis patients with comorbid diabetes mellitus: a multicenter cross-sectional study

Objective

The objective of this study was to examine the association between accelerometer-derived moderate-to-vigorous physical activity (MVPA) and depressive symptoms in hemodialysis patients with and without type 2 diabetes mellitus (T2DM).

Methods

This cross-sectional study finally included 450 maintenance hemodialysis patients (male 281, average age 62 years) from seven dialysis centers in Shanghai, China. Physical activity (PA) was measured using the triaxial accelerometer (ActiGraph GT3X+, Pensacola, FL, United States). We measured depressive symptoms using the 9-item Patient Health Questionnaire (PHQ-9) (PHQ-9 ⩾ 10). We categorized physical activity into quartile groups (Q1 through Q4), with the first quartile defined as low engagement and the remaining quartiles defined as moderate to high engagement. We used logistic regression and trend test to analyze the relationship between quartile groups and depressive symptoms. The analyses in this study adjusted for a range of confounders.

Results

The prevalence of depression was higher in patients with hemodialysis combined with T2DM (17.2%). In diabetic patients, MVPAQ4 was negatively associated with depression after adjusting for covariates [OR = 0.076; 95% confidence interval (CI) = 0.006-0.955, p = 0.046]. However, in non-diabetic hemodialysis patients, no significant association was found between MVPAQ1-Q4 and depression after adjusting for covariates (p > 0.05).

Conclusion

Moderate-to-vigorous physical activity was associated with depression in the diabetic hemodialysis group, but not in the non-diabetic group. Further studies are needed to investigate more causal relationships between MVPA and depressive symptoms in patients with T2DM.

Progress in the application of novel inflammatory indicators in chronic kidney disease

Chronic kidney disease has become a public health problem endangering the health of all humans because of its high prevalence, high mortality and high medical burden. The chronic micro-inflammatory state is recognized as a significant component of CKD, playing a key role in disease progression. Intervening in chronic inflammation during the disease course can enhance prognosis. Recent studies have demonstrated that novel inflammatory indices, such as the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and systemic immune-inflammatory index are closely associated with CKD, meanwhile may serve as prognostic monitors of all-cause death and poor renal prognosis for the disease. This article comprehensively reports on the mechanisms of micro-inflammation in CKD, the relationship between inflammatory indicators and CKD, and their impact on prognosis.

Association between vitamin D deficiency and major depression in patients with chronic kidney disease: a cohort study

Background

Patients with chronic kidney disease (CKD) have an elevated risk of both vitamin D deficiency (VDD) and depression. However, the relationship between VDD and the risk of depression in this population remains unclear.

Methods

Using the TriNetX network database (2010-2019), we conducted a propensity score-matched cohort study of CKD patients aged ≥50 years. Patients were categorized into VDD (≤20 ng/mL) and control (≥30 ng/mL) groups based on measurements within 3 months of CKD diagnosis. The primary outcome was the incidence of major depression within 1 year of follow-up.

Results

Among 17,955 matched pairs, VDD was associated with increased depression risk at 1 year (hazard ratio [HR]: 1.929; 95% confidence interval [CI]: 1.52-2.448; p < 0.0001). This association persisted through 3 years of follow-up. The relationship remained consistent across CKD stages, with similar risks in early (HR:1.977; 95% CI: 1.382-2.829) and CKD stage 3-5 (HR:1.981; 95% CI: 1.533-2.559). Males with VDD showed higher depression risk (HR: 2.264; 95% CI: 1.498-3.421) compared to females (HR:1.761; 95% CI: 1.307-2.374). Even vitamin D insufficiency (20-30 ng/mL) increased depression risk compared to normal levels (HR:1.667; 95% CI: 1.318-2.11). In patients with VDD, cerebrovascular disease, malnutrition, and ischemic heart disease are risk factors for depression.

Conclusion

VDD is independently associated with increased depression risk in patients with CKD, particularly in males. These findings suggest that maintaining adequate vitamin D levels might be important for mental health in patients with CKD, although randomized trials are needed to confirm whether supplementation can prevent depression in this population.

Causal relationship between IgA nephropathy and common neuropsychiatric disorders: A two-sample Mendelian randomization analysis

OBJECTIVE

Utilizing two-sample Mendelian randomization (TSMR), this study seeks to determine the causal relationship between IgA nephropathy and five prevalent neuropsychiatric disorders. By exploring the genetic associations between IgA nephropathy and neuropsychiatric disorders, this research aims to contribute to the prevention of neuropsychiatric disorders in patients with IgA nephropathy.

METHODS

Public genome-wide association study databases were searched, with IgA nephropathy as the exposure factor, including 15,587 patients with IgA nephropathy and 462,197 healthy controls. The outcome factors were five common neuropsychiatric disorders (bipolar disorder, depressive disorder, schizophrenia, anorexia nervosa, and Alzheimer's disease), with outcome data drawn from five datasets in the PGC and GWAScatalog databases. Inverse-variance weighting served as the primary method for causal effect estimation, supplemented by MR-Egger, weighted median, weighted mode, and simple mode methods. Heterogeneity was tested using Cochran's Q test, and sensitivity analysis was conducted using MR-Egger and MR-presso.

RESULTS

MR analysis indicated a positive causal relationship between IgA nephropathy and depressive disorder (OR = 1.010, 95%CI: 1.003-1.017, P = 3.27 × 10-3), and a potential positive causal relationship between IgA nephropathy and anorexia nervosa (OR = 1.165, 95%CI: 1.030-1.319, P = 0.015).

CONCLUSION

There is a positive causal relationship between IgA nephropathy and depressive disorder, and a potential positive causal relationship with anorexia nervosa. No causal relationship was found with schizophrenia, bipolar disorder, or Alzheimer's disease.

Global, regional, and national burden inequality of chronic kidney disease, 1990-2021: a systematic analysis for the global burden of disease study 2021

Background

Chronic kidney disease (CKD) is a significant global health issue, often linked to diabetes, hypertension, and glomerulonephritis. However, aggregated statistics can obscure heterogeneity across subtypes, age, gender, and regions. This study aimed to analyze global CKD trends from 1990 to 2021, focusing on age, gender, socio-demographic index (SDI), and regional variations.

Methods

Data were extracted from the Global Burden of Disease (GBD) 2021 database, covering prevalence, incidence, mortality, and disability-adjusted life years (DALYs). These were presented as counts per 100,000 population and age-standardized rates, with uncertainty intervals (UIs) to highlight variability. Joinpoint regression was used to assess trends over the 30-year period.

Results

In 2021, global CKD prevalence was 359 million, with 11.13 million new cases, 1.53 million deaths, and 44.45 million DALYs-up 92, 156, 176, and 114% since 1990. While prevalence slightly declined, incidence, mortality, and DALYs increased significantly. CKD burden varied by region and age, with notable gender disparities.

Conclusion

The study highlights a dramatic rise in CKD burden linked to population growth and aging, emphasizing the need for targeted treatment and effective global healthcare policies.

Patient-physician communication in advanced kidney disease: a narrative review

The increasing prevalence of kidney failure highlights the crucial need for effective patient-physician communication to improve health-related quality of life and ensure adherence to treatment plans. This narrative review evaluates communication practices in the context of advanced kidney disease, focusing on the frameworks of shared decision-making, advanced care planning, and communication skills training among nephrologists. The findings highlight the significant gaps in patient-physician communication, particularly in the domains of advanced care planning, shared decision-making, and dialysis withdrawal. When communication in such situations falls short, it affects patient satisfaction and outcomes. Effective communication is essential for managing advanced kidney disease, requiring a patient-centered approach that includes patients, families, and healthcare providers in care planning. This review advocates for a more integrated, empathic approach to healthcare interactions, emphasizing the importance of including patients, their families, and healthcare providers in a collaborative model based on goals of care. Moreover, it highlights the role of patient-reported outcome measures and patient experience of care in assessing the quality of care in dialysis settings. Here, we call for enhanced training programs regarding communication skills for physicians and emphasize the need for systemic changes to foster patient-centered communication.

Coping strategies and changes in type D personality were associated with depressive tendency at 9 months after percutaneous coronary intervention

Type D personality, characterized by negative affectivity and social inhibition, has been associated with both the psychophysiology of coronary artery disease (CAD) and depressive disorders. However, few reports have described the impact of coping strategies in these patients. This study aimed to analyze the characteristics of type D personality and the coping strategies adopted by patients with CAD and to explore the factors associated with depressive tendencies during follow-up. Among 84 patients with CAD (median age 66.5 years, nine women) who underwent percutaneous coronary intervention (PCI), we examined pre-discharge characteristics for personality and coping strategies. We prospectively evaluated associations with the persistence or improvement of depressive tendencies at 9 months. Our findings revealed that persistence of depressive tendencies at 9 months was inversely associated with the adoption of the "planning" coping strategy (odds ratio [OR]: 0.80). We observed worsening depressive tendencies in patients with type D personality who transitioned from non-type D during follow-up. Conversely, improvement in depressive tendencies was associated with the adoption of "planning" (OR: 1.47), "evasive thinking" (OR: 1.47), and "positive interpretation" (OR: 1.43) coping strategies, and inversely associated with the adoption of the "abandonment or resignation" strategy (OR: 0.71). The persistence or improvement of depressive tendencies at 9 months post-PCI was associated with the adoption of specific coping strategies. Changes in type D personality during follow-up were associated with the status of depressive tendency. Personality-oriented treatment incorporating specific coping strategies may provide new strategies to prevent depression and improve care for patients with CAD.

Depression and anxiety in people with kidney disease: understanding symptom variability, patient experience and preferences for mental health support

BACKGROUND

Depression and anxiety are commonly experienced by people with chronic kidney disease (CKD). This study aimed to evaluate person- and service-level factors associated with depression and anxiety symptoms. We sought to also understand utilisation of mental health treatments and preferences for future psychological support.

METHODS

An online survey recruited participants from six UK kidney services with varying levels of psychosocial provision. The survey was also advertised on social media. Participants completed screening questionnaires for depression and anxiety, alongside questions about mental health history, self-efficacy, treatment and support. The study included adults (18 years or older) living with CKD (stages 3b and above) or those receiving any form of Kidney Replacement Therapy (KRT), including individuals with a functioning kidney transplant. Eligible participants had to complete study measures and be proficient in reading and writing in either English or Welsh, as the survey was administered in these languages. This survey was developed with our Patient and Public Involvement group and was administered from January 2023 until 31st January, 2024 using Qualtrics and RedCap.

RESULTS

Four hundred fifty-eight people completed the survey. Moderate-severe symptoms of depression and anxiety were 37.7% and 26.5%, respectively. Over 50% reported a history of diagnosed depression. In addition to depression, sleep problems and fatigue were identified as future support needs, with over a third indicating a preference for in-centre provision. In case-mix adjusted analysis, there was no variability in depression and anxiety symptoms across centres. Centre location and size were unrelated to symptoms. Age, female gender, current mental health treatments, self-efficacy and perceptions regarding opportunity for support, were associated with symptoms of depression and anxiety. In sub-analysis, there was a negative association between psychosocial staffing levels and depression symptoms.

CONCLUSION

Patient-related factors and behavioural characteristics were related to variation of these symptoms. There was little evidence of symptom variability across centres, although in a small sub-analysis, psychosocial provision showed a weak negative correlation with depression symptoms. Our findings highlight preferences of future needs which could be helpful for designing future research and service provision.

The Impact of Dialysis Duration on Multidimensional Health Outcomes: A Cross-Sectional Study

Background: Dialysis patients face multidimensional challenges that affect their quality of life. This study aimed to evaluate the association between dialysis duration and various physical, cognitive, and psychosocial parameters, including fatigue, pain, sexual satisfaction, bowel control, vision, cognitive deficits, mental health, social support, quality of life, and life satisfaction, while incorporating sociodemographic data for greater context. Methods: A cross-sectional study was conducted using validated instruments such as the Modified Fatigue Impact Scale (MFIS), Pain Effect Scale (PES), Sexual Satisfaction Scale (SSS), Bowel Control Scale (BWCS), Impact of Visual Impairment Scale (IVIS), Perceived Deficits Questionnaire (PDQ), Mental Health Inventory (MHI), Modified Social Support Survey (MSSS), WHOQOL-BREF, and Cantril Ladder. Associations between dialysis duration and these parameters were analyzed. Correlations between current and future life satisfaction were also examined. Results: Dialysis duration significantly affected sexual satisfaction, with scores worsening over time (p = 0.029). Cognitive deficits in planning and organization exhibited a near-significant trend (p = 0.072). Patients with low current life satisfaction anticipated significant future declines (p = 0.001). However, no significant associations were observed between dialysis duration and fatigue, pain, bowel control, vision, mental health, social support, overall quality of life, or life satisfaction. Conclusions: Prolonged dialysis negatively influences sexual satisfaction and may impact specific cognitive domains. The relationship between current and expected life satisfaction highlights the importance of addressing psychological health in this population. While other parameters remained unaffected, individualized care strategies focusing on sexual, cognitive, and psychological support could improve outcomes. Future research should focus on exploring these relationships further and developing targeted interventions to address vulnerable areas, such as sexual, cognitive, and psychological health.

The utility of brief instruments for depression screening in dialysis patients

Background

Depression is a frequent but often underdiagnosed comorbid disorder in dialysis patients. The Beck Depression Inventory-Second Edition (BDI-II) is a reliable and valid instrument for depression screening but is relatively long for repeated use in clinical practice. The aim of this study was to compare the BDI-II with the shorter questionnaires Beck Depression Inventory-FastScreen (BDI-FS), the depression subscale of the Hospital Anxiety Depression Scale (HADS-D), the Mental Health (MH) scale of the 36-item Short Form Health Survey (SF-36) and two items of the MH ('So down in the dumps that nothing could cheer you up' and 'Downhearted and blue') to determine the most efficient instruments for screening depressive symptoms in dialysis patients.

Methods

A cross-sectional study was conducted involving patients from 14 health centres undergoing in-centre haemodialysis or peritoneal dialysis. All patients completed the BDI-II, HADS-D and MH scale. The sensitivity, specificity and positive and negative predictive values for each brief instrument were assessed relative to BDI-II ≥16.

Results

Of the 145 patients included in the study (mean age 62 years; 66% male), 24.8% had depressive symptoms (BDI ≥16). The cut-off points with the highest sensitivity and negative predictive value for BDI-FS were ≥3 (91.7% and 96.1%, respectively) and ≥4 (80.6% and 92.4%, respectively) and for the HADS-D these were ≥4 (91.7% and 95.8%, respectively) and ≥5 (83.3% and 92.6%, respectively). The cut-off points for the total MH and the two items (considered separately or together) resulted in lower sensitivity (<80%) and lower negative predictive values (<90%).

Conclusions

Both the BDI-FS and HADS-D are adequate screening tools for depression in the dialysis population. As the BDI-FS is easier to complete and score and enables identification of patients at risk of suicide, it may be the best alternative to the BDI-II for depression screening in dialysis patients in clinical settings.

Dose-dependent association between estimated glomerular filtration rate and the subsequent risk of depression: An analysis of a nationwide epidemiological dataset

BACKGROUND

Although the risk of depression is well-known in the patients with kidney dysfunction, especially at the late stages, little is known about the exact point at which the decline in estimated glomerular filtration rate (eGFR) begins to significantly increase the risk of depression. In the present study, we analysed a nationwide epidemiological dataset to investigate the dose-dependent association between baseline eGFR and a future risk of developing depression in a general population.

METHODS

We retrospectively analysed 1,518,885 individuals (male: 46.3%) without a history of depression identified between April 2014 and November 2022 within a nationwide epidemiological database, provided by DeSC Healthcare (Tokyo, Japan). We investigated the association of eGFR with the incidence of depression using Cox regression analyses and also conducted cubic spline analysis to investigate the dose-dependent association between eGFR and depression.

RESULTS

In the mean follow-up of 1218 ± 693 days, 45,878 cases (3.0% for total participants, 2.6% for men and 3.3% for women) of depression were recorded. The risk of depression increased with the eGFR decline as well as the presence of proteinuria. Multivariable Cox regression analysis showed the hazard ratio (95% CI) of depression in each kidney function category (eGFR ≥90, 60-89, 45-59, 30-44, 15-29, and < 15 mL/min/1.73 m2) was 1.14 (1.11-1.17), 1 (reference), 1.11 (1.08-1.14), 1.51 (1.43-1.59), 1.77 (1.57-1.99) and 1.77 (1.26-2.50), respectively. In the cubic spline analysis, the risk of depression continued to increase monotonically as the eGFR declined when the eGFR fell below approximately 65 mL/min/1.73 m2.

CONCLUSIONS

Our analysis using a large-scale epidemiological dataset presented the dose-dependent association between eGFR decline and the risk of depression, which highlights the importance of incorporating mental health assessments into the routine care of patients with kidney dysfunction, regardless of the stage of their disease.

Health outcomes in chronic kidney disease patients with cognitive impairment or dementia: a global collaborative analysis

Background and hypothesis

Mild cognitive impairment and dementia (CI) are common in patients with CKD. We aim to clarify whether and how CKD and CI coexistence increases adverse health outcomes.

Methods

This retrospective observational cohort study was conducted on CKD patients (stages 3-5) from the TriNetX platform. CKD patients with and without pre-existing CI were included from 115 healthcare organizations, and their outcomes were compared. The two cohorts were propensity score matched (PSM) for age, sex, ethnicity, comorbidities, BMI, blood parameters, and medications. The proportional hazard assumption was tested with a 95% confidence interval. Kaplan-Meier analysis was used to calculate survival probability. Outcomes were included from 1 day after the CKD diagnosis until 10 years afterwards.

Results

We identified 533 772 CKD patients, and 8184 had co-existent CI. Two cohorts of 8170 PSM patients each were generated. The mean age was 60.5 ± 7.0 years and the eGFR was 52.1±19 mL/min. Mean follow-up was 23.2 months. CKD patients with CI had higher all-cause mortality (18.5% vs 12.6%), higher risk of cerebrovascular disease (11.3% vs 6.9%), transient cerebral ischemic attacks (2.7% vs 1.6%), hypotension (16.5%-12.5%), malnutrition (6.7% vs 4.0%), pneumonia (10.7% vs 7.9%), urinary infections (13.2% vs 9.3%), encephalopathy (9.9% vs 5.0%), mood disorders (13.6% vs 9.7%), psychosis (9.8% vs 4.6%), and epilepsy (4.3% vs 1.5%). Higher use of antidepressants (26.3% vs 16.3%), anticonvulsants (19.5% vs 15.1%), antipsychotics (18.6% vs 9.1%), anticholinesterase (5.6% vs 0.1%), and benzodiazepines (30.6% vs 26.6%) was noted in those with CI. All these findings were statistically significant.

Conclusion

Despite the limitations of a retrospective study, real-world data demonstrate that concomitant CI is a decisive risk factor for higher mortality and increased adverse outcomes in patients with CKD. These results highlight the need for routine comprehensive cognitive assessments in patients at any stage of CKD.

Relieving Depressive Symptoms Through Chinese Relational Culture Among Older Adults with Multimorbidity: Evidence from CHARLS

Background

Depressive symptoms and multimorbidity are global public health concerns, the relationship between the two variables remains unclear. This study was an intervention attempt through the lens of regional relational culture to identify and reduce adverse consequences of this relationship. We aimed to explore the prevalence of multimorbidity and depressive symptoms among older Chinese adults, the association between the two variables, and the underlying moderating mechanism.

Methods

This study extracted data from the China Health Retirement Longitudinal Study (CHARLS) of 8356 older adults aged 60 years and older and analyzed the correlation between multimorbidity and depressive symptoms in this population using Stata 16.0. Moreover, the correlation between multimorbidity and depressive symptoms was verified using logistic regression analysis, and a hierarchical multiple regression analysis was used to test the existence of moderating effects between the two variables.

Results

The prevalence of multimorbidity and depressive symptoms among seniors aged 60 years and older was 66.16 and 36.85%, respectively. Multimorbidity was positively associated with depressive symptoms (p<0.001), and relationship satisfaction, social activity, and information isolation moderated this association (p < 0.05).

Conclusion

Older adults with multimorbidity are more likely to develop depressive symptoms, and regional relational culture can play a moderating role between them. The government, as well as aging-related sectors, can reduce the risk of depressive symptoms by improving relationship satisfaction, increasing social activity, and decreasing information isolation among older adults.

Factors Influencing Presenteeism in Middle-aged and Older Workers with Chronic Kidney Disease: A Single-center Cross-sectional Study

Objectives

Managing presenteeism among patients with chronic kidney disease (CKD) is important for balancing disease management and employment. This study aimed to investigate presenteeism, exercise self-efficacy (SE), and physical function indices in workers with CKD and to examine the factors that influence presenteeism in this patient group.

Methods

This cross-sectional study included 36 workers with stage 3-5 pre-dialysis CKD. Presenteeism was quantified using the Work Functioning Impairment Scale (WFun). Other factors to be evaluated included exercise SE, physical function, anemia, and renal function. Exercise SE was assessed using Oka's scale. Physical function was measured through grip strength, the 10-m walk test, the short physical performance battery, the 6-min walk test, and skeletal muscle mass index. The χ2 and independent t-tests were used to compare patient characteristics between those with and without presenteeism. The WFun score was used as the dependent variable in the multiple regression analysis.

Results

Fourteen (38.9%) patients exhibited presenteeism. Comparisons between the two groups demonstrated significant differences in creatinine (Cr), exercise SE, and WFun and in the prevalences of CKD stage 3 and CKD stage 5 (P < 0.05). The WFun score was significantly correlated with Cr (r = 0.36) and exercise SE (r = -0.41) in a single correlation analysis. Multiple regression analysis showed that WFun was significantly related only to exercise SE (β = -0.34).

Conclusions

Presenteeism was significantly correlated with exercise SE in working patients with predialysis CKD. Our findings provide evidence to support the development of interventions for the prevention of presenteeism in predialysis CKD patients.

Global prevalence of depression in chronic kidney disease: a systematic review and meta-analysis

BACKGROUND

Chronic kidney disease (CKD) is commonly associated with psychosocial problems, especially depression, contributing to poor overall outcomes. Depression has not been given adequate priority in the management of CKD patients despite its significant adverse impact on all major outcomes. This systematic review and meta-analysis determined the pooled prevalence of clinical depression in the global CKD population and sub-populations.

METHODS

PubMed, African Journals Online (AJOL), and EMBASE were systematically searched to identify published articles with relevant data. The pooled prevalence of clinical depression in the global CKD population was determined using random effects meta-analytic techniques. The study protocol was registered with PROSPERO (CRD42022382708).

RESULTS

Sixty-five articles were included in this review, comprising 80,932 individuals with CKD from 27 countries. The participants' mean age ranged from 11.0 to 76.3 years. Most (70.4%) of the studies had medium methodological quality. The overall pooled prevalence of depression was 26.5% (95% CI 23.1-30.1%). Studies using the Diagnostic Statistical Manual for Mental Diseases (DSM) and International Classification of Disease (ICD) returned a pooled prevalence of 25.5% and 39.6%, respectively, p = 0.03. There was a significant difference in the pooled prevalence across regions; p = 0.002.The prevalence of depression was higher among individuals on chronic hemodialysis compared to pre-dialysis patients (29.9% versus 18.5%; p = 0.01) and among those on hemodialysis compared to peritoneal dialysis (30.6% versus 20.4%; p = 0.04). There was no significant difference between adults and children (26.8% versus 15.9%, p = 0.21). There was an increasing temporal trend in depression prevalence, though this did not achieve statistical significance (p = 0.16).

CONCLUSION

Depression is common in patients with CKD. The findings of this study highlight the need for clinicians to make efforts to evaluate individuals with CKD for depression, especially those with advanced stages of the disease.

Exercise and depression symptoms in chronic kidney disease patients: an updated systematic review and meta-analysis

OBJECTIVES

To investigate whether exercise intervention is associated with reducing depressive symptoms in chronic kidney disease (CKD) patients.

METHODS

Medline (PubMed), Web of Science, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to February 28, 2024. Randomized controlled trials comparing exercise intervention with usual care or stretching sessions for depression symptoms. Independent data extraction was conducted, and the quality of studies was assessed. A meta-analysis was carried out by using random effects models to calculate standardized mean difference (SMD) with a 95% confidence interval (95% CI) between groups.

RESULTS

23 trials with 1561 CKD patients were identified. Exercise interventions are associated with a significant reduction in depression symptoms among CKD patients, with a moderate average SMD of -0.726 (95% CI: -1.056, -0.396; t=-4.57; p < 0.001). Significant heterogeneity was observed (tau2 = 0.408 [95%CI: 0.227, 1.179], I2 = 79.9% [95% CI: 70.5%, 86.3%]). The funnel plot shows potential publication bias. Subgroup analyses showed that the beneficial effects of exercise on depression remained constant across all subgroups. The evidence is deemed as 'very low' certainty.

CONCLUSIONS

Our systematic review and meta-analysis showed that exercise intervention was associated with significantly alleviating depression symptoms (certainty of evidence: very low). While the very low certainty of the evidence highlights a need for further research.

PROSPERO REGISTRATION NUMBER

CRD42021248450.

Mineralocorticoid Receptor and Sleep Quality in Chronic Kidney Disease

The classical function of the mineralocorticoid receptor (MR) is to maintain electrolytic homeostasis and control extracellular volume and blood pressure. The MR is expressed in the central nervous system (CNS) and is involved in the regulation of the hypothalamic-pituitary-adrenal (HPA) axis as well as sleep physiology, playing a role in the non-rapid eye movement (NREM) phase of sleep. Some patients with psychiatric disorders have very poor sleep quality, and a relationship between MR dysregulation and this disorder has been found in them. In addition, the MR is involved in the regulation of the renal peripheral clock. One of the most common comorbidities observed in patients with chronic kidney disease (CKD) is poor sleep quality. Patients with CKD experience sleep disturbances, including reduced sleep duration, sleep fragmentation, and insomnia. To date, no studies have specifically investigated the relationship between MR activation and CKD-associated sleep disturbances. However, in this review, we analyzed the environment that occurs in CKD and proposed two MR-related mechanisms that may be responsible for these sleep disturbances: the circadian clock disruption and the high levels of MR agonist observed in CKD.

Depression in Cardiac Patients Is a Major Cardiovascular Event Risk Factor: A 12-Month Observational Study

Background: Depression is a known factor in poor cardiovascular outcomes but is often underassessed in cardiac units. This study evaluates the impact of depression on cardiovascular outcomes in patients undergoing cardiac interventions. Methods: The study included 133 patients who underwent uncomplicated procedures for degenerative aortic valve stenosis (n = 40), acute coronary syndrome (n = 29), or chronic coronary artery disease (n = 64). Depression was assessed using the Beck Depression Inventory (BDI) and Hamilton Depression Rating Scale (HAM-D). The primary endpoint was a major adverse cardiac and cerebrovascular event (MACCE). Patients were followed up for 12 months. Cox proportional hazards analysis was used to identify MACCE risk factors. Results: Depression was more frequently screened by HAM-D than BDI (42.9% vs. 30.8%, p < 0.001). During follow-up, 26 (19.5%) MACCEs occurred. In univariate analysis, risk factors included BDI score ≥ 11, HAM-D score ≥ 8, diabetes on insulin, anticoagulant use, atrial fibrillation, and serum creatinine level ≥ 130 µmol/L. Depression in the BDI increased the risk of the MACCE 3.6-fold (95%CI: 1.64-8.0, p = 0.001), whereas in the HAM-D, it increased the risk 4.9-fold (95%CI: 1.97-12.24, p < 0.001). Multivariate analysis showed HAM-D score ≥ 8 as the strongest predictor of MACCE (HR: 3.08, 95%CI: 1.18-8.08). Conclusions: Depression is a common finding in cardiovascular patients, and it is a strong risk factor for one-year cardiovascular mortality and adverse event risk. Therefore, we believe that common guidelines should be elaborated between relevant psychiatry and cardiology scientific societies.

Ketamine attenuates kidney damage and depression-like behaviors in mice with cisplatin-induced acute kidney injury

Acute kidney injury (AKI) is a serious condition characterized by decreased urine output, often accompanied by psychiatric symptoms like depression. However, there are limited pharmacological treatments available for AKI and its associated depressive symptoms. In this study, we investigated whether cisplatin-induced AKI in mice leads to depression-like behaviors and whether ketamine could alleviate both the kidney injury and these behaviors. Mice with cisplatin-induced AKI exhibited elevated levels of creatinine and urea, kidney damage, increased kidney injury molecule-1 protein, and pathological changes in the liver, colon, and spleen. They also showed depression-like behaviors and reduced expression of synaptic proteins in the prefrontal cortex. Remarkably, a single dose of ketamine significantly reduced these symptoms and pathological changes. Interestingly, the beneficial effects of ketamine on the kidneys, other organs, and depression-like behaviors, were reversed by the tropomyosin receptor kinase B (TrkB) inhibitor ANA-12. Western blot analysis revealed the involvement of the TrkB and ERK (extracellular signal-regulated kinase)-CREB (cAMP response element binding protein) signaling pathway. Additionally, metabolomics analysis indicated that blood metabolites, such as C16-ceramide, may contribute to the effects of ketamine in this model. These findings suggest that cisplatin-induced nephrotoxicity in AKI mice contributes to depression-like behaviors, and ketamine can alleviate both kidney damage and depression-like symptoms by modulating the TrkB and ERK-CREB signaling pathways, as well as altering blood metabolites. However, the role of the kidney-brain axis in these depression-like behaviors remains unclear. Furthermore, ketamine may have therapeutic potential for treating kidney diseases such as AKI, along with associated depressive symptoms.

Association between cardiorenal syndrome and depressive symptoms among the US population: a mediation analysis via lipid indices

BACKGROUND

Cardiovascular diseases (CVD), chronic kidney disease (CKD), and lipids are positively correlated with the presence of depressive symptoms. However, investigation into the complex link that exists between cardiorenal syndrome (CRS) and lipid indices and depression remains scarce.

METHODS

This study analyzed data from 11, 729 adults in the National Health and Nutritional Examination Surveys from 2005 to 2018. Weighted regression analysis was employed to examine the relationships between CRS and depression, CRS and the Patient Health Questionnaire-9 score, and lipid indices with depression. The restricted cubic spline analysis was used to determine whether there is a linear association between lipid indices and depression. Smooth curve fitting was employed to illustrate the relationship between lipids, depression, and cardiorenal diseases. Subgroup and sensitivity analyses were also conducted to enhance the stability of the results. Finally, we applied mediation analysis to explore whether the Atherogenic Index of Plasma (AIP), triglyceride glucose (TyG) index, and remnant cholesterol (RC) mediate the association between CRS and depression.

RESULTS

After applying propensity score matching (PSM), 1,509 adults remained in the study. After PSM, more remarkable results were rendered that CRS was associated with depression compared with non-CRS (OR: 1. 240, 95% CI: 1. 237 ~ 1. 243), only-CVD (OR: 0. 646, 95% CI: 0. 644 ~ 0. 649), and only-CKD (OR: 1.432, 95% CI: 1.428 ~ 1.437) in a fully corrected model. Smooth curve fitting shows that the intersection point of the lines of CRS and non-CRS occurs at a higher value on the horizontal axis than the intersection point of the lines representing CVD and non-CVD. In the fully corrected model, AIP, TyG, and RC did not independently mediate the association between CRS and depression.

CONCLUSION

There was a significant association between CRS and depression and a linear relationship between AIP, TyG, and RC and depression. However, the above lipid indicators did not mediate the association between CRS and depression.

Association Between Serum Magnesium Levels and Depression in Patients Undergoing Peritoneal Dialysis: A Study Conducted at Handan First Hospital, China

Background

Depression exhibits notable prevalence among patients affected by chronic kidney disease(CKD) and end-stage renal disease (ESRD). Emerging reports suggest a potential association between magnesium (Mg) levels and depressive symptoms, there has been a surge of interest in exploring Mg supplementation as a complementary measure in depression treatment.

Objective

In this study our aim is to investigate the correlation between depressive symptoms and serum Mg level in patients undergoing peritoneal dialysis (PD) at Handan First Hospital, China. Additionally, we assessed the diagnostic significance of this relationship and identified pertinent influencing factors.

Methods

This study comprises a cohort of 140 individuals undergoing PD for a minimum duration of 3 months at the PD center of the Handan First Hospital. The Hamilton Depression Scale (HAMD) served as the assessment tool to evaluate the psychological status of the patients. Serum Mg levels, hemoglobin (Hb), and various demographic and clinical data were collected. Logistic regression and ROC analysis were performed to identify significant predictors of depression.

Results

The prevalence of depression was higher in patients with hypomagnesemia (60%) compared to those with normal or elevated Mg levels. Notably, a correlation emerged between abnormal serum Mg levels and the presence of depressive symptoms among individuals undergoing PD. Furthermore, binary logistic regression analysis revealed that serum Mg levels, hemoglobin (Hb) concentration, and unemployment significantly influenced the likelihood of occurrence of depression in patients undergoing PD (P< 0.05).

Conclusion

In addition, serum Mg levels demonstrate significant predictive value in anticipating onset of depression, indicating that rectifying low serum Mg levels among patients undergoing PD may serve as a preventive measure against depression. Further research is recommended to explore the therapeutic potential of Mg supplementation in this population.

Independent and joint influence of depression and advanced lung cancer inflammation index on mortality among individuals with chronic kidney disease

Background

The combined effect of depression and nutritional-inflammatory status on mortality in the chronic kidney disease (CKD) population is unclear.

Methods

We prospectively analyzed 3,934 (weighted population: 22,611,423) CKD participants from the National Health and Nutrition Examination Survey (2007-2018). Depression and nutritional-inflammatory status were assessed with Patient Health Questionnaire 9 (PHQ-9) and Advanced Lung Cancer Inflammation Index (ALI), respectively. Weighted multivariate COX regression models, restricted cubic splines (RCS) models, and stratified analyses were used to investigate the association of PHQ-9 scores and ALI with all-cause mortality.

Results

During a median follow-up of 5.8 years (interquartile range 3.4-8.6 years), a total of 985 patients died (25.0%). Each point increase in a patient's PHQ-9 score increased the risk of all-cause mortality by 4% (HR, 1.04; 95% CI, 1.02-1.06; p < 0.001), in the full adjusted model. However, an increase in ALI levels was associated with a decreased risk. HRs (95% CI) of 0.76 (0.65-0.90), 0.70 (0.57-0.86), and 0.51 (0.41-0.64) in the Q2, Q3, and Q4 of ALI compared with the Q1 of ALI, respectively. In addition, the joint analysis showed that CKD patients without depression and with higher ALI were associated with a reduced risk of all-cause mortality. Namely, patients in the highest ALI group (Q4) without depression had the lowest risk (HR, 0.32; 95% CI, 0.21-0.48). Furthermore, this combined effect was consistent across all subgroups, and no significant interaction was found (p > 0.05 for interaction).

Conclusion

In a nationally representative sample of US patients with CKD, coexisting depression and poorer nutrition-inflammation were associated with a significantly increased risk of all-cause mortality.

The association of micro and macro worries with psychological distress in people living with chronic kidney disease during the COVID-19 pandemic

BACKGROUND

Psychological distress can be exacerbated by micro (personal) and macro (societal) worries, especially during challenging times. Exploration of this relationship in people with chronic kidney disease is limited.

OBJECTIVES

(1) To identify the types and levels of worries concerning people with chronic kidney disease in the context of the COVID-19 pandemic; (2) to explore the association of worries with psychological distress including depression, stress, anxiety, and health anxiety.

DESIGN AND PARTICIPANTS

A cross-sectional online survey collected data at two time points (Autumn 2020, n = 528; Spring 2021, n = 241). Participants included kidney transplant recipients and people with non-dialysis dependent chronic kidney disease.

MEASUREMENTS

The survey included questions about worry taken from the World Health Organisation COVID-19 Survey, the Depression, Anxiety and Stress Scale, and the Short Health Anxiety Index. Data were analysed using descriptive statistics and multiple regression.

RESULTS

Worries about loved ones' health, the healthcare system becoming overloaded, losing a loved one, economic recession, and physical health were the highest rated concerns. Worrying about mental health was associated with higher depression, stress, anxiety, and health anxiety. Worrying about physical health was associated with anxiety and health anxiety. Worrying about losing a loved one was associated with health anxiety, and worrying about not being able to pay bills was associated with stress.

CONCLUSIONS

People with kidney disease reported micro and macro worries associated with psychological distress during the COVID-19 pandemic. This study highlights factors that should be considered to improve the mental health and well-being of people with kidney disease.

Association between dietary fatty acids and depressive symptoms in Chinese haemodialysis patients: a cross-sectional study

Depression is highly prevalent in haemodialysis patients, and diet might play an important role. Therefore, we conducted this cross-sectional study to determine the association between dietary fatty acids (FA) consumption and the prevalence of depression in maintenance haemodialysis (MHD) patients. Dietary intake was assessed using a validated FFQ between December 2021 and January 2022. The daily intake of dietary FA was categorised into three groups, and the lowest tertile was used as the reference category. Depression was assessed using the Patient Health Questionnaire-9. Logistic regression and restricted cubic spline (RCS) models were applied to assess the relationship between dietary FA intake and the prevalence of depression. As a result, after adjustment for potential confounders, a higher intake of total FA [odds ratio (OR)T3 vs. T1 = 1·59, 95 % confidence interval (CI) = 1·04, 2·46] and saturated fatty acids (SFA) (ORT3 vs. T1 = 1·83, 95 % CI = 1·19, 2·84) was associated with a higher prevalence of depressive symptoms. Significant positive linear trends were also observed (P < 0·05) except for SFA intake. Similarly, the prevalence of depression in MHD patients increased by 20% (OR = 1.20, 95% CI = 1.01-1.43) for each standard deviation increment in SFA intake. RCS analysis indicated an inverse U-shaped correlation between SFA and depression (P nonlinear > 0·05). Additionally, the sensitivity analysis produced similar results. Furthermore, no statistically significant association was observed in the subgroup analysis with significant interaction. In conclusion, higher total dietary FA and SFA were positively associated with depressive symptoms among MHD patients. These findings inform future research exploring potential mechanism underlying the association between dietary FA and depressive symptoms in MHD patients.

Dapagliflozin cardiovascular effects on end-stage kidney disease (DARE-ESKD-2) trial: rationale and design

BACKGROUND

Dapagliflozin prevents myocardial dysfunction in chronic kidney disease patients regardless of residual kidney function. We hypothesized that this effect is extensible also to patients on dialysis.

RESEARCH DESIGN AND METHODS

The DARE-ESKD-2 is an ongoing, single-center, open-label randomized clinical trial designed to determine the effects of adding dapagliflozin to standard treatment on myocardial function and structure. Eligible patients were adults on a regular dialysis scheme for more than 3 months. Pregnancy, liver failure, allergy to the investigational drug, and prior use of SGLT2i were exclusion criteria. Participants were randomized in a 1:1 ratio to dapagliflozin or standard treatment groups for 24-weeks. The primary goal is to compare the change in NT-proBNP levels between study arms, and secondary goals include comparing the between-group difference in left ventricle global longitudinal strain, indexed mass, ejection fraction, and E/e` ratio, and on symptoms scale and 6-minute walk test distance. An exploratory analysis will evaluate changes in body composition and bone densitometry.

RESULTS

The trial has finished the enrollment of 80 patients, who are currently being followed-up.

CONCLUSIONS

This trial will provide novel data on myocardial effects of SGLT2i in dialysis recipients. Results from this study may provide evidence to support SGLT2i use in ESKD.

Increased Blood-Brain Barrier Permeability and Cognitive Impairment in Patients With ESKD

Introduction

Chronic kidney disease (CKD) is associated with an increased risk of cognitive impairment. This cognitive impairment is associated with an increased permeability of blood-brain barrier (BBB) in rodents with CKD, linked to activation of aryl hydrocarbon receptor (AhR) by indoxyl sulphate (IS). The objective of the BREIN study was to confirm the increased BBB permeability in humans with CKD.

Method

The BREIN comparative study (NCT04328415) prospectively included patients with end-stage kidney disease (ESKD) and controls healthy volunteers matched in age, sex, and level of education to a patient. In all participants, BBB permeability was quantified by brain 99mTc-DTPA SPECT/CT as a percentage of injected activity (% IA). A battery of neurocognitive tests was performed, and serum uremic toxins accumulation and AhR activation were assessed.

Results

Fifteen patients with ESKD and 14 healthy volunteers were analyzed. Patients with ESKD had higher BBB permeability compared to controls: 0.29 ± 0.07 versus 0.14 ± 0.06 %IA, P = 0.002. Patients with ESKD displayed lower Montreal Cognitive Assessment test (MoCA) score: 22.0 ± 5.0 versus 27.3 ± 2.8, P = 0.008; impaired short-term memory (doors test): 12.5 ± 3.4 versus 16.5 ± 3.4, P = 0.005; higher Beck depression score 8.1 ± 9.1 versus 2.7 ± 3.4, P = 0.046; and slightly more daily cognitive complaints: 42.5 ± 29.3 versus 29.8 ± 14.0 P = 0.060. Patients with ESKD displayed higher IS levels (86.1 ± 48.4 vs. 3.2 ± 1.7 μmol/l, P = 0.001) and AhR activating potential (37.7 ± 17.8% vs. 24.7 ± 10.4%, P = 0.027). BBB permeability was inversely correlated with MoCA score (r = -0.60, 95% confidence interval [-0.772 to -0.339], P = 0.001) in the overall population.

Conclusion

Patients with ESKD display an increased BBB permeability compared to matched healthy volunteers. Association with uremic toxins and cognitive impairment needs to be assessed in larger cohorts of patients.

Quality of life and sleep, depression, family functioning, and marital adjustment in patients on hemodialysis and peritoneal dialysis

INTRODUCTION

End-stage renal disease is different from other chronic diseases that the treatment method is as difficult. Our aim in this study was to compare marital adjustment, sexual functions and family functioning between hemodialysis (HD) and peritoneal dialysis (PD) patient.

METHOD

A total of 21 HD and 27 PD patients were included. Beck Depression Inventory (BDI), Short Form-36 (SF-36), Pittsburgh Sleep Quality Index (PSQI), Arizona Sexual Experiences Scale (ASEX), Golombok-Rust Inventory for Sexual Satisfaction (GRISS), Marital Adjustment Test (MAT) and Family Assessment Device (FAD) were applied.

RESULTS

BDI scores were significantly higher in HD patients (p < 0.001). According to FAD problem solving (p < 0.001), communication (p = 0.00) and general functioning scores (p = 0.04) were higher in PD. The rate of poor sleep quality was 44.4% in the PD group, and 66.7% in HD group (p = 0.12). General health (p = 0.04), vitality (p < 0.001), mental health (p = 0.00) and social functioning (p = 0.00) scores were lower in HD patients.

CONCLUSION

HD patients are at high risk for psychiatric disorders due to the treatment modality. These patients should be monitored carefully and consultation-liaison services should be increased.

Mirtazapine: A One-Drug Intervention for the Physical and Psychological Symptoms of End-Stage Renal Disease (ESRD)

Patients with end-stage renal disease (ESRD), especially those on dialysis, experience myriad medical and psychological symptoms that impact theirquality of life. These symptoms range from nausea, emesis, and insomnia to pruritus, anxiety, depression, and loss of appetite. These symptoms often require multiple medications (e.g., anticholinergics, antihistamines, tricyclics, benzodiazepines, and Z-drugs), which can lead to polypharmacy, medication non-adherence, and potentially harmful drug-drug interactions, especially in older ESRD patients, a population with an age-related decline in drug metabolism, multimorbidity, and polypharmacy. The current perspective article will discuss evidence from extant literature supporting mirtazapine (a noradrenergic antagonist and selective serotonin antagonist, NASSA) as a potentially useful one-stop pharmacologic agent to alleviate multiple symptoms that ESRD patients face. A one-stop strategy has the potential to decrease polypharmacy, reduce adverse drug-drug and drug-disease interactions, reduce healthcare costs, and improve the quality of life in ESRD patients. Mirtazapine use in an ESRD setting merits a large randomized pragmatic double-blinded controlled trial to evaluate its efficacy as a potential pharmacotherapeutic agent for the management of multiple disabling gastrointestinal and other neuropsychological symptoms in older adults living with ESRD.

Relationship between the triglyceride-glucose index and depression in individuals with chronic kidney disease: A cross-sectional study from National Health and Nutrition Examination Survey 2005-2020

Accumulating evidence indicates that individuals with chronic kidney disease (CKD) are at an increased risk of experiencing depressive disorders, which may accelerate its progression. However, the relationship between the triglyceride-glucose (TyG) index and depression in CKD individuals remains unclear. Therefore, this cross-sectional study aimed to assess whether such a relationship exists. To this end, the CKD cohort of the National Health and Nutrition Examination Survey from 2005 to 2020 was analyzed using multivariable logistic regression analyses and a generalized additive approach. A recursive algorithm was employed to pinpoint the turning point, constructing a dual-segment linear regression model. The study included 10,563 participants. After controlling for all variables, the odds ratios and 95% confidence intervals indicated a 1.24 (range, 1.09-1.42) relationship between the TyG index and depression in the CKD cohort. The findings underscored an asymmetrical association, with a pivotal value at a TyG index 9.29. Above this threshold, the adjusted odds ratio (95% confidence interval) was 1.10 (range, 0.93-1.31). This relationship was significant among the obese subgroups. The study results highlight the complex relationship between the TyG index and depression among American adults with CKD.

Sleep quality in middle-aged and elderly hemodialysis patients: Impact of a structured nursing intervention program

BACKGROUND

Poor sleep quality is common among hemodialysis patients and can significantly impact their well-being. This study aimed to evaluate the effectiveness of a structured nursing intervention program in improving sleep quality in middle-aged and elderly hemodialysis patients.

AIM

To evaluate the impact of nursing intervention on sleep quality in hemodialysis patients.

METHODS

This cross-sectional study was conducted in a tertiary hospital, the First Affiliated Hospital of Nanchang University, in 2023. This study included 105 middle-aged and elderly hemodialysis patients aged ≥ 45 years who underwent maintenance hemodialysis for at least 3 mo, utilizing the Pittsburgh Sleep Quality Index (PSQI) to identify poor sleepers. Those identified underwent a 12-wk nursing intervention program focusing on education, relaxation techniques, and counseling. Post-intervention, sleep quality was reassessed using the PSQI.

RESULTS

The study found that 68.6% of hemodialysis patients were poor sleepers. Following the 12-wk nursing intervention program, there was a significant decrease in the mean global PSQI score from 8.9 ± 3.2 to 5.1 ± 2.7 (P < 0.001), indicating improved sleep quality. This demonstrated the effectiveness of the structured nursing intervention in enhancing sleep quality for middle-aged and elderly hemodialysis patients.

CONCLUSION

The structured nursing intervention program focusing on sleep hygiene education, relaxation techniques, and counseling effectively improved sleep quality among middle-aged and elderly hemodialysis patients. The significant decrease in the mean global PSQI score post-intervention indicates the positive impact of tailored nursing interventions in addressing poor sleep quality in this patient population. These findings emphasize the importance of implementing targeted nursing interventions to enhance the quality of life for hemodialysis patients by addressing the prevalent issue of poor sleep quality.

The impact of depression on platelet activation, cardiocerebral vascular events and arteriovenous fistula dysfunction in patients undergoing haemodialysis

Depression is a common psychiatric disorder among patients undergoing maintenance haemodialysis (MHD). Depression may reportedly contribute to poor prognosis in several ways, including its effects on platelet function. We hypothesised that depression contributes to the occurrence of cardiocerebral vascular events (CCVE) and dysfunction of arteriovenous fistula (DAVF) in patients undergoing MHD through its effects on platelets. In this prospective cohort study, patients undergoing MHD were recruited and divided into depression and non-depression groups according to their Hamilton Depression Scale (HAMD) scores. The 286 enrolled patients had 103 occurrences of depressive symptoms (prevalence = 36.01%). Compared with the non-depression group, depression group had a significantly higher cumulative prevalence of CCVE and DAVF during follow-up. Cox regression analysis indicated that higher HAMD scores and lower plasma platelet distribution width (PDW) were common risk factors for CCVE and DAVF. Furthermore, HAMD scores were significantly negatively correlated with plasma PDW and was the main variable affecting changes in PDW, as indicated by multiple linear regression analysis. Depression may increase the risk of CCVE and DAVF in patients undergoing MHD by activating platelets. Plasma PDW may be a convenient indicator of platelet activation status and may predict the risk of CCVE and DAVF.

Development and Validation of a Nomogram Model for Accurately Predicting Depression in Maintenance Hemodialysis Patients: A Multicenter Cross-Sectional Study in China

Purpose

Depression is a major concern in maintenance hemodialysis. However, given the elusive nature of its risk factors and the redundant nature of existing assessment forms for judging depression, further research is necessary. Therefore, this study was devoted to exploring the risk factors for depression in maintenance hemodialysis patients and to developing and validating a predictive model for assessing depression in maintenance hemodialysis patients.

Patients and Methods

This cross-sectional study was conducted from May 2022 to December 2022, and we recruited maintenance hemodialysis patients from a multicentre hemodialysis centre. Risk factors were identified by Lasso regression analysis and a Nomogram model was developed to predict depressed patients on maintenance hemodialysis. The predictive accuracy of the model was assessed by ROC curves, area under the ROC (AUC), consistency index (C-index), and calibration curves, and its applicability in clinical practice was evaluated using decision curves (DCA).

Results

A total of 175 maintenance hemodialysis patients were included in this study, and cases were randomised into a training set of 148 and a validation set of 27 (split ratio 8.5:1.5), with a depression prevalence of 29.1%. Based on age, employment, albumin, and blood uric acid, a predictive map of depression was created, and in the training set, the nomogram had an AUC of 0.7918, a sensitivity of 61.9%, and a specificity of 89.2%. In the validation set, the nomogram had an AUC of 0.810, a sensitivity of 100%, and a specificity of 61.1%. The bootstrap-based internal validation showed a c-index of 0.792, while the calibration curve showed a strong correlation between actual and predicted depression risk. Decision curve analysis (DCA) results indicated that the predictive model was clinically useful.

Conclusion

The nomogram constructed in this study can be used to identify depression conditions in vulnerable groups quickly, practically and reliably.

The effect of a scenario-based cognitive behavioral therapy mobile app on end-stage kidney disease patients on dialysis

It has been reported that a scenario-based cognitive behavioral therapy mobile app including Todac Todac was effective in improving depression in the general public. However, no study has been conducted on whether Todac Todac is effective in dialysis patients. Therefore, this study was intended to determine whether the use of this app was effective in improving depression in dialysis patients. Sixty-five end-stage kidney disease patients receiving dialysis at Soonchunhyang University Cheonan Hospital were randomly assigned to the Todac Todac app program (experimental group) or an E-moods daily mood chart app program (control group) for 3 weeks. The degree of depression was measured before and after using the app.After the end of the 3-week program, a small but significant improvement was observed in the Trait anxiety (p < 0.05) and Beck depression index (p < 0.05) in E-moods group and DAS-K scores (p < 0.05) in Todac Todac group. However, no differences were seen in any parameters between the two groups. In addition, Todac Todac was not statistically more effective than the control intervention in the subgroup analysis. The Todac Todac, a scenario-based cognitive behavioral therapy mobile app, seemed to have a limited effect on improving depression in dialysis patients. Therefore, it is necessary to develop new tools to improve depression in dialysis patients.

The impact of quality of life on the survival of elderly patients with end-stage renal disease: a prospective multicenter cohort study in Korea

Background

Quality of life (QOL) is associated with mortality in dialysis patients. However, the impact of QOL index or score on elderly patients undergoing maintenance dialysis is unclear. We analyzed the relationship between QOL domains and survival in elderly end-stage renal disease (ESRD) patients on dialysis.

Methods

We included 492 incident ESRD patients aged ≥65 years from a Korean nationwide prospective cohort study who were assessed for QOL with a follow-up duration of 67.3 ± 34.6 months after dialysis initiation. Their QOL was evaluated using the Kidney Disease Quality of Life (KDQOL) instrument, and the effect of each QOL domain on mortality was analyzed. Multivariable Cox regression analysis was performed to identify independent risk factors for death after adjusting for confounding factors.

Results

Low physical component summary (PCS) and Short Form-36 score were significantly associated with low survival rate (P < .001 and P = .017, respectively), whereas the mental component summary and ESRD-targeted item scores were not correlated with survival rate. Multivariable Cox regression analysis confirmed that only a high PCS score was associated with better survival (hazard ratio 0.71; 95% confidence interval 0.52-0.97; P = .031). Linear regression analysis revealed that age, sex, modified Charlson comorbidity index, albumin and intact parathyroid hormone were associated with PCS. Among the PCS items, only the physical functioning score was significantly associated with mortality (P = .017).

Conclusion

PCS was an independent risk factor for death in elderly ESRD patients. A higher physical functioning score was associated with a better outcome, suggesting the importance of physical condition in elderly dialysis patients.

The identification and management of depression in UK Kidney Care: Results from the Mood Maps Study

BACKGROUND

Depression is common in people with chronic kidney disease, yet little is known about how depression is identified and managed as part of routine kidney care.

OBJECTIVES

The primary objective was to survey all UK adult kidney centres to understand how depression is identified and managed. A secondary objective was to broadly describe the variability in psychosocial care.

DESIGN

Online survey.

METHODS

The survey comprised of three sections: (1) general kidney care, (2) psychological provision and (3) social work provision.

RESULTS

48/68 (71%) of centres responded to the general survey with 20 and 13 responses from psychological and social work module respectively. Only 31.4% reported having both in centre psychological and social work practitioners. Three centres reported no access to psychosocial provision. Of the 25 centres who reported on pathways, 36.0% reported having internal pathways for the identification and management of depression. Within services with psychological provision, screening for depression varied across modality/group (e.g., 7.1% in mild/moderate chronic kidney disease vs. 62.5% in kidney donors). Cognitive Behavioural Therapy and Acceptance and Commitment Therapy were the most common interventions offered. Most psychosocial services were aware of the National Institute for Health and Care Excellence guidelines for managing depression in long-term conditions (n = 18, 94.7%) yet few fully utilised (n = 6, 33.3%). Limited workforce capacity was evident.

CONCLUSIONS

There is considerable variability in approaches taken to identify and treat depression across UK kidney services, with few services having specific pathways designed to detect and manage depression. Workforce capacity remains a significant issue.

Mindfulness-based cognitive therapy for adherence of immunosuppressive treatment in liver transplant recipients: A randomized controlled trial

OBJECTIVE

The aim of this study was to analyze the effects of mindfulness-based cognitive therapy on the adherence of liver transplant recipients to immunosuppressive therapy with a randomized controlled design.

METHOD

This randomized controlled trial was performed with 120 liver transplant recipients hospitalized at the liver transplant department of a research and practice hospital (n = 120). While we administered no intervention to the patients in the control group (n = 60), we provided Mindfulness-Based Cognitive Therapy to those in the experimental group (n = 60). We used the Mindful Attention Awareness Scale and the Immunosuppressant Therapy Adherence Scale to collect data. We utilized descriptive statistics, paired-samples t-tests, independent-samples t-tests, one-way analysis of variance, and chi-squared tests to analyze the data.

RESULTS

After the intervention, the immunosuppressive therapy adherence levels of the experimental group increased significantly (p < 0.01). On the other hand, the control group had significantly higher adherence to immunosuppressive therapy and significantly higher levels of mindfulness in the pretest phase than it did in the posttest phase (p < 0.01).

CONCLUSIONS

Complete adherence to immunosuppressive therapy is imperative for the prevention of graft rejection in liver transplant recipients. In our study, the experimental group equipped with enhanced mindfulness had higher adherence to immunosuppressive therapy. Therefore, the use of Mindfulness-Based Cognitive Therapy in the promotion of adherence to immunosuppressive therapy is recommended.

A Prospective Study of Depression and Quality of Life after Kidney Transplantation

Key Points

Depression and health-related quality of life improve with kidney transplantation and is sustained beyond the immediate post-transplant period. The improvement in health-related quality of life, especially the physical component, differs by age and is higher in younger patients. Depression improves in all kidney transplantation recipients, irrespective of their age.

Background

Depression and diminished health-related quality of life (HRQOL) are common in kidney failure. In this study, we investigate whether kidney transplantation (KT), the treatment of choice for kidney failure, improves depression and HRQOL across lifespan and whether this effect is sustained.

Methods

In this longitudinal observational cohort study, we assessed depression and HRQOL in patients on the KT waitlist and again at 3 months and 1 year after KT. We measured depression using the Beck Depression Inventory-II (BDI-II) and HRQOL using the Kidney Disease Quality of Life Short Form Version 1.3 physical health composite score (PCS) and mental health composite score (MCS). We used linear mixed-effects models with random intercepts for patients to evaluate the effect of time, age, and KT status on BDI-II score, PCS, and MCS. For models with significant age interactions, we estimated this effect for baseline age groups.

Results

We analyzed 239 longitudinal BDI-II assessments completed by 99 patients and 143 Kidney Disease Quality of Life Short Form Version 1.3 assessments completed by 59 patients (16% Black, 79% White). The BDI-II scores improved pre- to post-KT (10 pre-KT versus five post-KT, P < 0.001). PCS improved pre- to post-KT in younger patients, but the magnitude of change was lower with older age (P for interaction=0.01). In the subgroup analysis by age, there was improvement in PCS post-KT in patients younger than 60 years (P = 0.003 for 30–39, P = 0.007 for 40–49, P = 0.03 for 50–59). The MCS also improved from 47 pre-KT to 51 post-KT (P < 0.001), and the magnitude of improvement was again lower with older age (P for interaction=0.03).

Conclusions

Depression and HRQOL improve with KT. While depression improves in all ages, the improvement in HRQOL, especially PCS, is more evident in younger patients. This improvement in depression and HRQOL is sustained until at least 1 year post-KT. These data help frame expectations for patients and transplant teams.

Podcast

This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/K360/2024_09_26_KID0000000000000538.mp3

A Rare Case: Is It Hemodialysis Encephalopathy, Dialysis Anxiety, or Both?

We present a case of a 59-year-old female who presented with progressively worsening altered mental status, seizures, and neuropsychiatric symptoms. Over the course of her emergency visit and admission to the hospital, laboratory tests failed to find an offending agent to her presentation. Her clinical presentations supported the diagnosis of encephalopathy, but the actual underlying cause was not found. After careful exclusion of bacterial, viral, and other types of encephalopathy, hemodialysis encephalopathy was a possible diagnosis. The presentation and symptoms of our patient led to a wide range of differentials, and a high index of suspicion was needed throughout her admission in order to obtain the appropriate tests. Computed tomography head (CTH) and electroencephalogram (EEG) were performed and showed results that supported our diagnosis of hemodialysis encephalopathy. Despite the supportive testing results of the brain, there are still some neuropsychiatric symptoms of our patient that remain unexplained. This led us to account for the physical exam, clinical judgment, and the process of elimination to diagnose our patient with anxiety due to dialysis concurrent with hemodialysis encephalopathy. Despite little evidence in the literature supporting the presence of anxiety disorders in patients receiving dialysis, our patient showed alleviated clinical presentation after being prescribed an anti-anxious medication, making this presentation uncommon. In this rare case, we present a patient with possible comorbidity of both hemodialysis encephalopathy and dialysis anxiety that the result from EEG and other tests failed to explain all the symptoms our patient experienced.

Effect of RANKL on Lower Depressive Symptoms In Hemodialysis Patients

Depression and osteoporosis are common diseases in dialysis patients. In addition, patients with osteoporosis are more susceptible to depression. Contrary to previous anti-osteoporosis agents, denosumab and romosozumab could be used in dialysis patients and have similar action mechanisms for blocking RANKL. RANKL causes bone resorption after binding RANKL, but binding with OPG leads to suppress of bone resorption. In recent mice study, inhibition of RANKL with denosumab improved depressive-like phenotype. Besides, it was found that OPG was associated with depression. Therefore, this study aimed to investigate the association of depressive symptoms with RANKL and OPG in hemodialysis patients. We conducted a cross-sectional study with a total of 172 hemodialysis patients. The participants were measured for plasma RANKL, OPG, MMP-2, and MMP-9 levels. Logistic regression analysis was performed to evaluate the effect of RANKL and OPG on the presence of depressive symptoms. The depressive symptoms were observed in 90 (52.3%) subjects. RANKL tertile 3 had negative association with BDI score (β - 4.527, 95% CI - 8.310 to - 0.743) in univariate analysis, and this association persisted even after multivariate adjustments (β - 5.603, 95% CI - 9.715 to -1.491) in linear regression. In logistic regression between RANKL tertiles and depressive symptoms, RANKL tertile 3 had significantly lower unadjusted OR (0.40, 95% CI 0.19-0.86), and multivariate-adjusted OR (0.31, 95% CI 0.12-0.82) for depressive symptoms. OPG was not significantly associated with depressive symptoms. Higher plasma RANKL concentrations were significantly associated with lower depressive symptoms in HD patients.Trial registration WHO registry, No. KCT0003281, date: January 12, 2017.

Clinical Factors and Biomarkers Associated with Depressive Disorders in Older Patients Affected by Chronic Kidney Disease (CKD): Does the Advanced Glycation End Products (AGEs)/RAGE (Receptor for AGEs) System Play Any Role?

Depressive disorders are highly prevalent among subjects suffering from chronic kidney disease (CKD). The aim of the present study is to evaluate clinical and biochemical factors associated with depressive disorders in a sample of older CKD patients, with a focus on advanced glycation end products (AGEs) and their soluble receptors (sRAGEs). A total of 115 older subjects affected by CKD (stages 3 to 5, not in dialysis) were selected for this study. These patients were divided into two groups according to the presence of depressive disorders defined by a score ≥ 10 on the 30-item Geriatric Depression Scale (GDS). The two groups were compared by independent sample t tests for continuous variables and χ2 tests for qualitative ones. Significant variables at univariate analyses were then inserted as predictors of a binary logistic regression model, with the presence or absence of depressive disorders as a dependent variable. The binary logistic regression model showed that patients with concomitant depressive disorders were more frequently of female gender (p < 0.01) and had lower MCP1 (p < 0.01) and AGE circulating levels (p < 0.01) than their counterparts. Depressive disorders in older CKD patients are more prevalent in women and seem to be inversely associated with systemic inflammation and circulating AGEs.

Urea Level and Depression in Patients with Chronic Kidney Disease

Depression is common in patients with chronic kidney disease (CKD). Experimental studies suggest the role of urea toxicity in depression. We assessed both the incidence of antidepressant prescriptions and depressive symptoms (measured by CESD (Center for Epidemiologic Depression) scale) in 2505 patients with CKD (Stage 3-4) followed up over 5 years in the Chronic Kidney Disease Renal Epidemiology and Information Network (CKD-REIN) cohort. We used a joint model to assess the association between the serum urea level and incident antidepressant prescriptions, and mixed models for the association between the baseline serum urea level and CESD score over the 5-year follow-up. Among the 2505 patients, 2331 were not taking antidepressants at baseline. Of the latter, 87 started taking one during a median follow-up of 4.6 years. After adjustment for confounding factors, the hazard ratio for incident antidepressant prescription associated with the serum urea level (1.28 [95%CI, 0.94,1.73] per 5 mmol/L increment) was not significant. After adjustment, the serum urea level was associated with the mean change in the CESD score (β = 0.26, [95%CI, 0.11,0.41] per 5 mmol/L increment). Depressive symptoms burden was associated with serum urea level unlike depression events. Further studies are needed to draw firm conclusions and better understand the mechanisms of depression in CKD.

Psychotropic Medication Usage in Pediatric CKD: Reporting from the CKD in Children Cohort

Key Points

Psychotropic medication use is prevalent in the pediatric CKD population. Central nervous system stimulant usage was more common in male patients, and antidepressant usage was more frequently reported at follow-up visits during teenage years.

Background

Mental health disorders within the pediatric CKD population are prevalent. The frequency is unknown with which psychotropic medications that commonly treat these conditions are used in this population.

Methods

Data from the CKD in Children (CKiD) cohort study were used to describe the use of psychotropic medications and patient-related characteristics of use. Medications were classified into three groups: antidepressants, central nervous system (CNS) stimulants, and antipsychotic/mood stabilizing medications. Participant age, sex, CKD severity, and duration of medication use were ascertained. Medication use was evaluated in parallel with CKD disease type, presence of urological comorbidity, and hypertension. Chi-square tests compared subgroup medication use.

Results

Among 1074 CKiD participants (median baseline age 9.8 years), 6% (n =60) used psychotropic medications at study entry with 11% reporting incident use of any medication category (n =120). CNS stimulants were most common at baseline. Antidepressants were more frequent among incident users at 7%. Use of two or more medications was rare (3%). Median eGFR at medication initiation was 45 ml/min per 1.73 m2. CNS stimulants were reported at a higher rate in male compared with female participants (P < 0.05).

Conclusions

Eleven percent of CKiD patients report incident use of any psychotropic medication, with 7% reporting incident use of antidepressants. Future work is warranted to better ascertain the frequency, safety, and efficacy of psychotropic medication usage in relationship to formal mental health disorder diagnoses in the pediatric CKD population.

Mental health and addiction service utilization among people living with chronic kidney disease

BACKGROUND

Mental health problems, particularly anxiety and depression, are common in patients with chronic kidney disease (CKD) and negatively impact quality of life, treatment adherence and mortality. However, the degree to which mental health and addiction services are utilized by those with CKD is unknown. We examined the history of mental health and addiction service use of individuals across levels of kidney function.

METHODS

We performed a population-based cross-sectional study using linked healthcare databases from Ontario, Canada from 2009 to 2017. We abstracted the prevalence of individuals with mental health and addiction service use within the previous 3 years across levels of kidney function [estimated glomerular filtration rate (eGFR) ≥60, 45 to <60, 30 to <45, 15 to <30, <15 ml/min/1.73 m2 and maintenance dialysis]. We calculated prevalence ratios (PRs) to compare prevalence across kidney function strata, while adjusting for age, sex, year of cohort entry, urban versus rural location, area-level marginalization and Charlson comorbidity index.

RESULTS

Of 5 956 589 adults, 9% (n = 534 605) had an eGFR <60 ml/min/1.73 m2 or were receiving maintenance dialysis. Fewer individuals with an eGFR <60 ml/min/1.73 m2 had a history of any mental health and addiction service utilization (crude prevalence range 28-31%) compared with individuals with an eGFR ≥60 ml/min/1.73 m2 (35%). Compared with an eGFR ≥60 ml/min/1.73 m2, the lowest prevalence of individuals with any mental health and addiction service utilization was among those with an eGFR of 15 to <30 ml/min/1.73 m2 {adjusted PR 0.86 [95% confidence interval (CI) 0.85 to 0.88]}, an eGFR <15 ml/min/1.73 m2 [adjusted PR 0.81 (95% CI 0.76-0.86)] and those receiving maintenance dialysis [adjusted PR 0.83 (95% CI 0.81-0.84)]. Less use of outpatient services accounted for differences in service utilization.

CONCLUSIONS

Mental health and addiction service utilization is common but less so in individuals with advanced CKD in Ontario, Canada.