Association of Depressive Symptoms with Rapid Kidney Function Decline in Adults with Normal Kidney Function

Association between change in serum uric acid and rapid decline in kidney function in China

While the elevation of serum uric acid (SUA) is acknowledged as a risk factor for chronic kidney disease, the independent extent to which variations in SUA levels are correlated with temporal changes in estimated glomerular filtration rate (eGFR) remains uncertain. In light of this uncertainty, our research endeavored to elucidate the temporal associations between change in SUA and rapid eGFR decline in China. In this longitudinal study of China's middle-aged and elderly between 2011 and 2015, we analyzed 5421 individuals with complete SUA and eGFR data. Logistic regression was applied to evaluate the risk factors associated with a rapid eGFR decline (defined by a 5 mL/min/1.73 m2 decrease or falling to less than 15 mL/min/1.73 m2 by 2015), adjusted for age, gender, marital, residence, income, BMI, hypertension, diabetes, dyslipidemia, CRP, Hba1c, baseline eGFR and baseline SUA. Linear regression was used to evaluate the relationship between variations in SUA and changes in eGFR. After multivariable adjustments, the risk factors of a rapid eGFR decline included aging (OR per 1-year increase: 1.1, 95% CI 1.08-1.12, P < 0.001), being female, being single, having hypertension, a higher baseline eGFR, a higher baseline SUA (OR per-1 mg/dL increase: 1.68, 95% CI 1.48-1.90, P < 0.001), and increase in change in SUA (OR per-1 mg/ dL increase: 1.92,95% CI 1.71-2.16, P < 0.001). Pearson's analysis showed a significant inverse correlation between SUA changes and eGFR decline, particularly pronounced in females, with correlation coefficients of - 0.349 for females and - 0.306 for males (95% CI - 0.347 to - 0.299, P < 0.001). A significant correlation was found between the change in SUA and the rapid decline in eGFR, with this association being particularly pronounced in females.

Association of depressive symptoms and incident chronic kidney disease in middle-aged and older adults

BACKGROUND

Emerging evidence suggests that depressive symptoms may be a risk factor for the development of Chronic kidney disease (CKD). This study aimed to investigate the association between depressive symptoms and the incidence of CKD in middle-aged and older Chinese adults.

METHODS

We utilized data from the 2011-2020 China Health and Retirement Longitudinal Study (CHARLS). Depressive symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression Scale (CES-D). Incident CKD was defined based on the estimated glomerular filtration rate ≤ 60 mL/min/m2 or self-reported. Cox proportional hazard models were used to estimate the hazard ratio (HR) and 95 % confidence intervals (95 % CI) for incident CKD, adjusting for potential confounders.

RESULTS

Among the 10,996 participants without baseline CKD, 890 developed CKD during a median follow-up of 9.0 years. After adjusting for potential covariates, participants with depressive symptoms had a significantly higher risk of developing CKD compared to those without depressive symptoms (HR: 1.450; 95 % CI: 1.249-1.682). The association remained statistically significant when the CES-D was scored according to the severity of depressive symptoms, i.e., quintiles. A linear positive association between total CES-D score and risk of incident CKD was also found using restricted cubic spline regression (Pfor non-linearity = 0.114).

CONCLUSIONS

Depressive symptoms are significantly associated with an increased risk of incident CKD in middle-aged and older Chinese adults. These findings underscore the importance of mental health screening and interventions in preventing CKD in this population.

Challenges in predictive modelling of chronic kidney disease: A narrative review

The exponential rise in the burden of chronic kidney disease (CKD) worldwide has put enormous pressure on the economy. Predictive modeling of CKD can ease this burden by predicting the future disease occurrence ahead of its onset. There are various regression methods for predictive modeling based on the distribution of the outcome variable. However, the accuracy of the predictive model depends on how well the model is developed by taking into account the goodness of fit, choice of covariates, handling of covariates measured on a continuous scale, handling of categorical covariates, and number of outcome events per predictor parameter or sample size. Optimal performance of a predictive model on an independent cohort is desired. However, there are several challenges in the predictive modeling of CKD. Disease-specific methodological challenges hinder the development of a predictive model that is cost-effective and universally applicable to predict CKD onset. In this review, we discuss the advantages and challenges of various regression models available for predictive modeling and highlight those best for future CKD prediction.

Mapping the global research landscape on depression for patients with chronic kidney disease: a bibliometric and visualized analysis from 2006 to 2022

Background

Chronic Kidney Disease (CKD), a complex and multifaceted health issue, significantly contributes to global mortality rates. Accompanying chronic conditions, depression notably exacerbates health outcomes, increasing both mortality risk and the burden on affected individuals. This study employs bibliometric and visual analytics to evaluate the evolution, current trends, and future research directions in the field of CKD and depression.

Methods

We conducted a thorough investigation using the Web of Science Core Collection, focusing on literature published from 2006 to 2022 that examines the interplay between CKD and depression. The analysis was enriched with bibliometric and visualization tools such as bibliometrix, CiteSpace, and VOSviewer to distill the essence of the research corpus.

Results

Our analysis incorporated 2,409 CKD-related publications, with significant contributions from the United States, China, and England. BMC Nephrology emerged as the leading publication outlet, while the American Journal of Kidney Diseases featured the most cited articles. Key terms such as "depression," "quality-of-life," "mortality," "prevalence," and "hemodialysis" dominated the keyword landscape, indicating the research focus areas.

Conclusion

This bibliometric analysis offers an in-depth view of the research trajectory in CKD and depression. It provides valuable insights for researchers seeking relevant literature, potential collaborators, and an understanding of the field's current hotspots and emerging frontiers. The findings of this study are instrumental in guiding and enriching future research endeavors in this domain.

Associations of comorbid depression with cardiovascular-renal events and all-cause mortality accounting for patient reported outcomes in individuals with type 2 diabetes: a 6-year prospective analysis of the Hong Kong Diabetes Register

Background

Psychosocial status and patient reported outcomes (PRO) [depression and health-related quality-of-life (HRQoL)] are major health determinants. We investigated the association between depression and clinical outcomes in Chinese patients with type 2 diabetes (T2D), adjusted for PRO.

Methods

Using prospective data from Hong Kong Diabetes Register (2013-2019), we estimated the hazard-ratio (HR, 95%CI) of depression (validated Patient Health Questionnaire 9 (PHQ-9) score≥7) with incident cardiovascular disease (CVD), ischemic heart disease (IHD), chronic kidney disease (CKD: eGFR<60 ml/min/1.73m2) and all-cause mortality in 4525 Chinese patients with T2D adjusted for patient characteristics, renal function, medications, self-care and HRQoL domains (mobility, self-care, usual activities, pain/discomfort, anxiety/depression measured by EQ-5D-3L) in linear-regression models.

Results

In this cohort without prior events [mean ± SD age:55.7 ± 10.6, 43.7% women, median (IQR) disease duration of 7.0 (2.0-13.0) years, HbA1c, 7.2% (6.6%-8.20%), 26.4% insulin-treated], 537(11.9%) patients had depressive symptoms and 1923 (42.5%) patients had some problems with HRQoL at baseline. After 5.6(IQR: 4.4-6.2) years, 141 patients (3.1%) died, 533(11.8%) developed CKD and 164(3.6%) developed CVD. In a fully-adjusted model (model 4) including self-care and HRQoL, the aHR of depression was 1.99 (95% confidence interval CI):1.25-3.18) for CVD, 2.29 (1.25-4.21) for IHD. Depression was associated with all-cause mortality in models 1-3 adjusted for demographics, clinical characteristics and self-care, but was attenuated after adjusting for HRQoL (model 4- 1.54; 95%CI: 0.91-2.60), though HR still indicated same direction with important magnitude. Patients who reported having regular exercise (3-4 times per week) had reduced aHR of CKD [0.61 (0.41-0.89)]. Item 4 of PHQ-9 (feeling tired, little energy) was independently associated with all-cause mortality with aHR of 1.66 (1.30-2.12).

Conclusion

Depression exhibits significant association with CVD, IHD, and all-cause mortality in patients with diabetes, adjusting for their HRQoL and health behaviors. Despite the association between depression and all-cause mortality attenuated after adjusting for HRQoL, the effect size remains substantial. The feeling of tiredness or having little energy, as assessed by item Q4 of the PHQ-9 questionnaire, was found to be significantly associated with an increased risk of all-cause mortality after covariate adjustments. Our findings emphasize the importance of incorporating psychiatric evaluations into holistic diabetes management.

Social isolation, loneliness, and the risk of incident acute kidney injury in middle-aged and older adults: A prospective cohort study

OBJECTIVE

The relationships of social isolation and loneliness with acute kidney injury (AKI) risk remained uncertain. We aimed to investigate the associations of social isolation and loneliness with incident AKI.

METHODS

450,868 participants without prior AKI were included from the UK Biobank. The social isolation index was constructed based on living alone, social contact, and participation in social activities. Loneliness was assessed by asking about "Do you often feel lonely?". The study outcome was incident AKI.

RESULTS

During a median follow-up of 12.0 years, 18,679 (4.1%) participants developed AKI, including 18,428 participants ascertained by hospital admission records with a median duration of hospitalization of 3 (25th-75th, 1-8) days. The hazard ratio for incident AKI for social isolation compared with no social isolation was 1.50 (95% CI: 1.44-1.55) after adjusting for age and race (minimally adjusted), and was 1.10 (95% CI: 1.06-1.14) after further adjusting for socioeconomic factors, health behaviors, biological and health-related factors, psychologic factors, and loneliness (fully adjusted). The minimally adjusted and fully adjusted hazard ratios for incident AKI for loneliness compared with no loneliness was 1.57 (95% CI: 1.52-1.62), and 1.10 (95% CI: 1.06-1.15), respectively. In the fully adjusted models, the highest risk of AKI was found in those with both social isolation and loneliness. Living alone and less social contact, rather than less participation in social activities, were significantly associated with a higher risk of incident AKI.

CONCLUSIONS

Both social isolation and loneliness were independently and significantly associated with a higher risk of incident AKI.

Circadian syndrome is associated with the development of chronic kidney disease and rapid decline in kidney function in middle-aged and elder adults: a China nationwide cohort study

PURPOSE

The correlation between circadian syndrome (CircS) and kidney outcomes is currently supported by limited empirical evidence. Thus, the objective of this study was to determine the potential relationship between CircS and the development of chronic kidney disease (CKD), as well as the rapid decline in renal function.

MATERIALS AND METHODS

We utilized data from the 2011 China Health and Retirement Longitudinal Study (CHARLS), which involved 6002 Chinese adults ≥40 years of age. Among these participants, 3670 subsequently had follow-up evaluations in the 2015 survey. The primary outcome was the development of CKD, as defined by an estimated glomerular filtration rates decrease to a level <60 ml/min/1.73 m2, while the secondary outcome was rapid decline in renal function, as defined by an estimated glomerular filtration rates decrease of >5 ml/min/1.73 m2 per year. Multivariable logistic regression analysis was utilized to determine the association between CircS and kidney outcomes.

RESULTS

Compared to participants without CircS, those with CircS had a higher risk of CKD in the cross-sectional studies conducted in 2011 (OR, 1.292; 95% CI, 1.053-1.585) and 2015 (OR, 1.860; 95% CI, 1.469-2.355). Participants with CircS in the longitudinal cohort study had a higher risk of progressing to CKD (OR, 3.050; 95% CI, 2.052-4.534) and a rapid decline in renal function (OR, 1.959; 95% CI, 1.433-2.677) after 4 years of follow-up evaluations and adjustment for covariates. Moreover, participants who had CircS with ≥6 CirS components had the highest risk of a rapid decline in renal function (OR, 1.703; 95% CI, 1.054-2.753).

CONCLUSION

CirS significantly increased the risk of CKD progression and rapid decline in renal function among middle-aged and elder individuals. Our study findings highlights the importance of recognizing and managing CirC as a preventative strategy for CKD.

Maternal exposure of mice to glyphosate induces depression- and anxiety-like behavior in the offspring via alterations of the gut-brain axis

The past decade has been characterized by increased awareness and de-stigmatization of mental health issues, in particular the most common neuropsychiatric disorders depression and anxiety. Further, with growing understanding of neurodevelopmental disorders such as attention deficit and hyperactivity disorder and autism spectrum disorder, the number of diagnosed patients has increased. The pathogenesis of these behavioral disorders is multifactorial and early-life exposure to environmental chemicals has been proposed to be a relevant risk factor that might mediate these effects by disturbances on the gut-brain-axis. However, for glyphosate, the most widely used pesticide worldwide, there are only limited and inconsistent findings that link chronic low-dose exposure in particular during early life to neurobehavioral disorders. Here, we explored the impact of maternal oral glyphosate exposure (0.5 and 50 mg/kg body weight/day) during pregnancy and the lactational period on offspring's behavior, brain gene expression and gut microbiota using a cross-generational mouse model. Behavioral analyses revealed a depression- and anxiety-like behavior as well as social deficits most notably in adult female offspring of glyphosate-exposed dams. Furthermore, the expression of tryptophan hydroxylase 2, an enzyme discussed to be linked to behavioral problems, was reduced in the hippocampus of female offspring and correlated to a glyphosate-induced DNA hypermethylation of the gene. Moreover, maternal glyphosate exposure significantly altered the gut microbiota in the female offspring including a decreased abundance of Akkermansia and increased abundance of Alistipes and Blautia, bacteria involved in tryptophan metabolism and associated with depression- and anxiety-like disorders. Our results suggest that glyphosate might influence the gut-brain axis crosstalk following in-utero and lactational exposure. This study underlines the importance of understanding the impact of exposure to pesticides on the gut-brain axis and further emphasizes the need for microbiome analyses to be compulsorily included in health risk assessments of pesticides.

Depressive symptoms and sleep duration in relation to chronic kidney disease: Evidence from the China health and retirement longitudinal study

OBJECTIVE

Nowadays, the joint effects of depressive symptoms and sleep duration on the risk of chronic kidney disease (CKD) are still unclear. We aimed to prospectively assess the combined effect of depressive symptoms and sleep duration on the incidence of CKD in middle-aged and elderly Chinese population.

METHODS

A total of 10,953 participants from the China Health and Retirement Longitudinal Study (CHARLS) were included. Depressive symptoms were measured using the 10-item Center for Epidemiological Studies Depression scale (CESD-10). Sleep duration was evaluated by self-reported. CKD events were based on self-reported physicians' diagnosis or personal estimate glomerular filtration rate level (eGFR <60 mL/min/1.73 m2). Cox regression models were established to analyze the correlation between depressive symptoms, sleep duration and the risk of CKD.

RESULTS

Over a mean follow-up time was 6.76 ± 0.98 years, 851 (7.8%) participants had reported CKD events during the follow-up. Elevated depressive symptoms (HR = 1.65, 95% CI = 1.43-1.90) and short sleep duration (HR = 1.48, 95% CI = 1.27-1.72) were independently associated with an increased CKD risk after adjusting for potential confounding factors. Participants with short sleep duration (< 6 h)/elevated depressive symptoms (HR = 2.24, 95% CI = 1.89-2.65) were associated with the highest risk of CKD than those with normal sleep duration/low depressive symptoms.

CONCLUSIONS

Elevated depressive symptoms and short sleep duration were independent risk factors for CKD. There was a combined effect between depressive symptoms and sleep duration in increasing the risk of CKD.

CKD and Rapid Kidney Function Decline During the COVID-19 Pandemic

Rationale & Objective

The direct and indirect effects of the coronavirus disease 2019 (COVID-19) pandemic on kidney function in the chronic kidney disease (CKD) population are not well understood.

Study Design

Cohort study.

Setting & Participants

Retrospective study of kidney function trajectories using deidentified administrative claims and laboratory data for Medicare Advantage and commercially insured enrollees with CKD stages G3-4 between 2018 and 2021.

Predictors

COVID-19 infection.

Outcome

Rapid kidney function decline defined as annual estimated glomerular filtration rate (eGFR) decline of ≥40%.

Analytical Approach

Propensity score matching was used to identify individuals without COVID-19 infection matched 1:1 to a COVID-19 infected cohort and indexed on the date of diagnosing COVID-19 infection, age, sex, race or ethnicity, and Charlson comorbidity index score. Outpatient kidney function was compared during the prepandemic period (January 1, 2018, to February 29, 2020) with the pandemic period (March 1, 2020, to August 31, 2021). Two creatinine measurements, after the infection date and ≥60 days apart, were required to reduce correlation with acute infection.

Results

Of 97,203 enrollees with CKD G3-4, 9% experienced a COVID-19 infection. Characteristics of 8,901 propensity matched enrollees include mean age 74 years, 58% women, 67% White, and 63% CKD G3a, 28% CKD G3b, and 9% CKD G4. Median overall annual eGFR change was -2.65 ml/min/1.73m2, with 76% of the cohort experiencing worsened eGFR in the pandemic period. Rapid kidney function decline was observed in 1.9% and 2.0% of enrollees in the prepandemic and pandemic periods, respectively. Rapid kidney function decline was observed in 2.5% of those with COVID-19 infection and 1.5% of those without COVID-19 infection (P < 0.05). Factors associated with increased odds of rapid kidney function decline during pandemic included Asian race, higher Charlson comorbidity index, advancing CKD stage, prepandemic rapid kidney function decline, and COVID-19 infection.

Limitations

Retrospective study design with potential bias.

Conclusions

COVID-19 infection increased odds of rapid kidney function decline during the pandemic. The downstream impact of pandemic-related eGFR decline on health outcomes, such as kidney failure or mortality, requires further study.

Plain-Language Summary

We used a cohort of insured individuals with moderate-to-severe chronic kidney disease (CKD) to compare the rates of rapid kidney function decline in prepandemic and pandemic periods and to evaluate the impact of the coronavirus disease 19 (COVID-19) on kidney function decline. We found that overall rates of rapid kidney function decline did not change during the prepandemic and pandemic periods but were significantly higher in both periods among individuals with a COVID-19 infection. As CKD severity increased, rates of both rapid kidney function decline and COVID-19 increased. Advancing CKD, higher comorbid condition, Asian race, prepandemic rapid kidney function decline, and COVID-19 were all associated with higher odds of rapid kidney function decline in the pandemic. These findings suggest close monitoring is warranted for individuals with CKD and COVID-19.

Coping Behaviors and Incident Kidney Disease

Key Points

Adaptive coping behaviors are associated with lower odds of incident CKD. Coping behaviors could represent a target to prevent CKD.

Background

How someone copes may alter the trajectory of their kidney function. We aimed to evaluate whether coping behaviors were associated with incident CKD or rapid kidney function decline.

Methods

We used data from the Healthy Aging in Neighborhoods of Diversity across the Life Span study (Baltimore, MD) for this longitudinal analysis. Adaptive and maladaptive coping behavioral constructs were measured using the Brief COPE Inventory at visit 1. We used multiple logistic regression to assess the odds of incident CKD and rapid kidney function decline per point increase in coping scales and adjusted for baseline demographics and clinical variables.

Results

Of 1935 participants, mean age was 48 years, 44% were male, 56% were Black persons, and baseline mean (SD) eGFR was 91 (16) ml/min per 1.73 m2. After a median of 8.2 years, 113 participants developed incident CKD and 341 had rapid kidney function decline. Compared with those who reported they usually did not use adaptive coping behaviors at all (such as emotional support), those with the highest use of adaptive coping had lower odds of incident CKD. Every 1-unit increase in adaptive coping corresponded with a 2% lower adjusted odds of incident CKD (odds ratio, 0.98; 95% confidence interval, 0.95 to 0.99). There was no association between maladaptive coping behaviors and incident CKD. Coping behaviors were not associated with rapid kidney function decline.

Conclusions

Adaptive coping behaviors were associated with lower odds of incident CKD and could represent a target to facilitate CKD prevention. The role of medical care in this association is an area worthy of further investigation.

Association of depressive symptoms with retirement in Chinese employees: evidence from national longitudinal surveys from 2011 to 2018

BACKGROUND

The relationship between depressive symptoms and retirement remains controversial. Thus, we aimed to explore the effect of retirement on individuals' depressive symptoms in Chinese employees.

METHODS

In this panel data analysis, a data set from China Health and Retirement Longitudinal Study (CHARLS) in 2011, 2013, 2015 and 2018 was adopted with a total of 1390 employees aged ≥ 45-years-old who had complete follow-up for the four waves. Random-effects logistic regression was used to examine the associations between retirement and depressive symptoms.

RESULTS

After adjusting several socio-demographic variables, retirement still increases the risk of depressive symptoms in the retirees (odds ratio 1.5, 95% CI 1.14-1.97). Through subgroup analysis, we found that people who are male, with lower education level, married, living in rural areas, suffering from chronic diseases, and those who do not participate in social activities are more likely to experience depression after retirement.

CONCLUSIONS

Retirement can increase the depression risk of Chinese employees. It is necessary to formulate relevant supporting policies to reduce the risk of depression.

Prevalence of Self-Reported Kidney Disease in Older Adults by Sexual Orientation: Behavioral Risk Factor Surveillance System Analysis (2014-2019)

SIGNIFICANCE STATEMENT

Studies discusses CKD disparities by age, race and ethnicity, and socioeconomics. However, despite well-documented disparities in CKD risk factors in LGBT+ adults, limited literature addresses CKD prevalence in this population. This analysis uses Behavioral Risk Factor Surveillance System (2014-2019) data to compare self-reported kidney disease prevalence in LGBT+ older adults (older than 50 years) with their heterosexual peers. Our findings indicate that LGBT+ older adults have higher rates of self-reported kidney disease and a higher incidence of CKD risks including smoking, activity limitations, adverse health outcomes, and limited access to health care, housing, and employment. These results support increasing access to screening for CKD risk factors, providing culturally responsive health care, and addressing societal drivers of vulnerability in older LGBT+ adults.

BACKGROUND

Existing research documents disparities in CKD by age, race and ethnicity, and access to health care. However, research on CKD in lesbian, gay, bisexual, and trans (LGBT+) older adults, despite their higher rates of diabetes, heart disease, smoking, and alcohol use, is limited.

METHODS

Pooled data from the Behavioral Risk Factor Surveillance System (2014-2019) for 22,114 LGBT+ adults and 748,963 heterosexuals aged 50 and older were used to estimate the prevalence of self-reported kidney disease. Logistic regressions were used to compare older adults by sexual orientation.

RESULTS

Older LGBT+ men (adjusted odds ratio=1.3; 95% confidence interval [CI], 1.09-1.54) were more likely than their heterosexual counterparts to report kidney disease, after controlling for sociodemographic factors, health behaviors, access to health care, and self-reported coronary heart disease, HIV, and diabetes; LGBT+ men and women also reported higher incidences of known risk factors for CKD. For example, both LGBT+ men (odds ratio [OR]=1.39; [95% CI], 1.26-1.54) and LGBT+ women (OR=1.39; [95% CI], 1.25-1.55) were more likely to be smokers and have a higher incidence of activity limitations, adverse health outcomes, and limited access to health care, housing, and employment.

CONCLUSION

These results support increasing access to screenings for CKD risk factors, providing preventative education and culturally responsive and affirming care, and addressing other societal drivers of vulnerability in older LGBT+ adults. The findings also support the value of interventions that address the interaction between CKD risk factors and the social marginalization that older LGBT+ adults experience.

Sex difference in the associations among risk factors with depression in a large Taiwanese population study

Background

Depression is a common psychiatric health issue affecting an estimated 5% of adults worldwide, and it can lead to disability and increased economic burden. Consequently, identifying the factors associated with depression as early as possible is a vital issue. The aim of this study was to explore these associations in a large cohort of 121,601 Taiwanese participants in the Taiwan Biobank, and also to identify sex differences in the associations.

Methods

The study cohort included 77,902 women and 43,699 men (mean age, 49.9 ± 11.0 years), who were further classified into those with depression (n = 4,362; 3.6%) and those without depression (n = 117,239; 96.4%).

Results

The results of multivariable analysis showed that female sex (vs. male sex; odds ratio = 2.578; 95% confidence interval = 2.319–2.866; p &lt; 0.001) was significantly associated with depression. Older age, diabetes mellitus (DM), hypertension, low systolic blood pressure (SBP), smoking history, living alone, low glycated hemoglobin (HbA1c), high triglycerides, and low uric acid were significantly associated with depression in the men. In the women, older age, DM, hypertension, low SBP, smoking history, alcohol history, education level of middle and high school (vs. lower than elementary school), living alone, high body mass index (BMI), menopause, low HbA1c, high triglycerides, high total cholesterol, low estimated glomerular filtration rate (eGFR), and low uric acid were significantly associated with depression. Further, there were significant interactions between sex and DM (p = 0.047), smoking history (p &lt; 0.001), alcohol use (p &lt; 0.001), BMI (p = 0.022), triglyceride (p = 0.033), eGFR (p = 0.001), and uric acid (p = 0.004) on depression.

Conclusion

In conclusion, our results showed sex differences in depression, and the women were significantly associated with depression compared to men. Furthermore, we also found sex differences among the risk factors associated with depression.

Gut microbiome and tissue metabolomics reveal the compatibility effects of Xiaoyaosan on depression based on "gut-liver-kidney" axis

BACKGROUND

Depression affects not only the central nervous system, but also the peripheral system. Xiaoyaosan (XYS), a classical traditional Chinese medicine (TCM) prescription, exhibits definite anti-depression effects demonstrated both clinically and experimentally. However, its compatibility has not been entirely revealed due partly to the complex compositions of herbs contained.

AIM

Based on the strategy of "Efficacy Group", this study aimed to reveal the compatibility of XYS from the perspective of "gut-liver-kidney" axis.

METHODS

Firstly, XYS was divided into two efficacy groups, i.e. Shugan (SG) and Jianpi (JP) groups. Classic behaviors of rats were measured to confirm the anti-depression effects of XYS and its two efficacy groups. On top of this, gut microbiota analysis and kidney metabolomics were performed by 16S rRNA sequencing and ¹H NMR, respectively.

RESULTS

We found that XYS and its efficacy groups significantly regulated the abnormalities of behaviors and kidney metabolism of depressed rats, as well as intestinal disorders, but to different degrees. The regulatory effects of XYS and its efficacy groups on behaviors and kidney metabolomics of depressed rats had the same order, i.e. XYS > SG > JP, while the order of regulating gut microbiota was XYS > JP > SG. Both XYS and its efficacy groups significantly ameliorated gut microbiota disturbed, especially significant modulation of Peptostreptococcaceae. XYS significantly regulated nine kidney metabolites, while SG and JP regulated four and five differential metabolites, respectively, indicating that the two efficacy groups synergistically exhibited anti-depression effects, consequently contributing to the overall anti-depression effects of XYS.

CONCLUSION

The current findings not only innovatively demonstrate the anti-depression effects and compatibility of XYS from the perspective of "gut-liver-kidney" axis, comprehensively using "Efficacy Group" strategy, macro behavioristics, metabolome and microbiome, and also provide a new perspective, strategy, and methodology for studying complex diseases and the compatibility of TCMs.

The association of post-traumatic stress disorder with glomerular filtration rate decline

While major depression is known to be associated with glomerular filtration rate (GFR) decline, there is a lack of data on the association of other mental illnesses like posttraumatic stress disorder (PTSD) with kidney disease. In 640 adult participants of the Heart and Soul Study (mean baseline age of 66.2 years) with a high prevalence cardiovascular disease, hypertension and diabetes, we examined the association of PTSD with GFR decline over a 5-year follow-up. We observed a significantly greater estimated (e) GFR decline over time in those with PTSD compared to those without (2.97 vs. 2.11 ml/min/1.73 m2 /year; p = .022). PTSD was associated with 91% (95% CI 12%-225%) higher odds of 'rapid' versus 'mild' (>3.0 vs. <3.0 ml/min/1.73 m2 /per year) eGFR decline. These associations remained consistent despite controlling for demographics, medical comorbidities, other mental disorders and psychiatric medications. In conclusion, our study provides evidence that PTSD is independently associated with GFR decline in middle-aged adults with a high comorbidity burden. This association needs to be examined in larger cohorts with longer follow-ups.

Association between sleep duration and quality with rapid kidney function decline and development of chronic kidney diseases in adults with normal kidney function: The China health and retirement longitudinal study

Research have shown that sleep is associated with renal function. However, the potential effects of sleep duration or quality on kidney function in middle-aged and older Chinese adults with normal kidney function has rarely been studied. Our study aimed to investigate the association of sleep and kidney function in middle-aged and older Chinese adults. Four thousand and eighty six participants with an eGFR ≥60 ml/min/1.73 m² at baseline were enrolled between 2011 and 2015 from the China Health and Retirement Longitudinal Study. Survey questionnaire data were collected from conducted interviews in the 2011. The eGFR was estimated from serum creatinine and/or cystatin C using the Chronic Kidney Disease Epidemiology Collaboration equations (CKD-EPI). The primary outcome was defined as rapid kidney function decline. Secondary outcome was defined as rapid kidney function decline with clinical eGFR of <60 ml/min/1.73 m² at the exit visit. The associations between sleep duration, sleep quality and renal function decline or chronic kidney disease (CKD) were assessed based with logistic regression model. Our results showed that 244 (6.0%) participants developed rapid decline in kidney function, while 102 (2.5%) developed CKD. In addition, participants who had 3-7 days of poor sleep quality per week had higher risks of CKD development (OR 1.86, 95% CI 1.24-2.80). However, compared with those who had 6-8 h of night-time sleep, no significantly higher risks of rapid decline in kidney function was found among those who had <6 h or >8 h of night time sleep after adjustments for demographic, clinical, or psychosocial covariates. Furthermore, daytime nap did not present significant risk in both rapid eGFR decline or CKD development. In conclusion, sleep quality was significantly associated with the development of CKD in middle-aged and older Chinese adults with normal kidney function.

Mobile Phone Use, Genetic Susceptibility and New-Onset Chronic Kidney Diseases

Objective: To examine the associations of mobile phone use and its use characteristics with new-onset CKD. Methods: 408,743 participants without prior CKD in the UK Biobank were included. The primary outcome was new-onset CKD. Results: During a median follow-up of 12.1 years, 10,797 (2.6%) participants occurred CKD. Compared with mobile phone non-users, a significantly higher risk of new-onset CKD was found in mobile phone users (HR = 1.07; 95% CI: 1.02-1.13). Moreover, among mobile phone users, compared with participants with weekly usage time of mobile phone making or receiving calls <30 min, a significantly higher risk of new-onset CKD was observed in those with usage time ≥30 min (HR = 1.12; 95% CI: 1.07-1.18). Moreover, participants with both high genetic risks of CKD and longer weekly usage time of mobile phones had the highest risk of CKD. Similar results were found using the propensity score matching methods. However, there were no significant associations of length of mobile phone use, and hands-free device/speakerphone use with new-onset CKD among mobile phone users. Conclusion: Mobile phone use was significantly associated with a higher risk of new-onset CKD, especially in those with longer weekly usage time of mobile phones making or receiving calls. Our findings and the underlying mechanisms should be further investigated.

The Association between Symptoms of Depression and Anxiety, Quality of Life, and Diabetic Kidney Disease among Chinese Adults: A Cross-Sectional Study

Depression and anxiety are common comorbid symptoms among patients with diabetic kidney disease (DKD). Little is known about the influence of poor psychological conditions on the disease progression and quality of life (QOL) in DKD patients. This study aimed to investigate the prevalence of, and risk factors for, depression and anxiety in Chinese DKD patients, and to analyze their impact on the renal function, proteinuria, and QOL. A total of 620 adult patients with Type 2 diabetes and DKD being treated at a tertiary hospital in East China were recruited. Depression and anxiety symptoms were assessed by the Zung Self-Rating Depression Scale and Anxiety Scale. Among the DKD participants, 41.3% had symptoms of depression and 45.0% had anxiety symptoms. A poor education, physical inactivity, stroke, low serum albumin, CKD stage 3-4, macroalbuminuria, and a poor QOL were independent risk factors for depression in the DKD patients. Whereas a higher education, physical inactivity, diabetic retinopathy and neuropathy, low hemoglobin, CKD stage 3-4, and a poor QOL were risk factors for anxiety. Depression and anxiety scores among the DKD patients were negatively correlated with the eGFR and QOL scores. Moreover, depression and anxiety symptoms were independent risk factors for DKD patients with CKD stage 3-4 and a poor QOL. Our findings suggest a high prevalence of depression and anxiety among Chinese DKD patients, and the severity of psychological symptoms is closely linked to the deterioration of renal function and the QOL. The early screening and intervention of psychopathological disorders is thus strongly recommended for improving the QOL and clinical outcomes among DKD patients.

Depression increases the risk of kidney stone: Results from the National Health and Nutrition Examination Survey 2007-2018 and Mendelian randomization analysis

BACKGROUND

To investigate whether depression increases the kidney stone risk.

METHODS

First, we performed an observational study in the National Health and Nutrition Examination Survey (NHANES) 2007-2018. Depression severity was evaluated using the Patient Health Questionnaire-9 (PHQ-9) and classified into no, mild, moderate, and severe depression groups. Multivariable-adjusted logistic regression was used to assess the correlation between depression severity and kidney stone risk. Second, Mendelian randomization (MR) was applied to decrease the bias and avoid the reverse causality in the observational study. Genetic instruments were obtained from a large genome-wide association study (GWAS) meta-analysis of depression involved 246,363 cases and 561,190 controls. We obtained summary data for kidney stone from another large GWAS, which integrates data from 6536 stone formers and 388,508 controls. Inverse variance weighted (IVW) was the primary analytical method.

RESULTS

In the observational study, a total of 24,892 individuals were enrolled. Individuals with moderate (OR 1.38, 95 % CI 1.05-1.83, P = 0.022) and severe (OR 1.56, 95 % CI 1.02-2.40, P = 0.040) depression had a higher risk of kidney stone (P for trend = 0.006) compared with the control. For the MR, results also showed that genetically predicted depression was causally associated with a higher risk of kidney stone disease (OR 1.26, 95 % CI 1.04-1.53, P = 0.017) in IVW.

CONCLUSIONS

Depression might be associated with kidney stone risk. This finding is needed to be verified in further prospective cohort studies with a large sample size and enough follow-up time.

Bidirectional relations between depression symptoms and chronic kidney disease

BACKGROUND

Depression and chronic kidney disease (CKD) often coexist. However, both the relations of depression with CKD development and CKD with depression risk were still elusive. We aimed to investigate the bidirectional relations between renal function and depression in a cohort of young and middle-aged adults.

METHODS

Using data from the Coronary Artery Risk Development in Young Adults study, the analysis of depressive symptoms and incident CKD (analysis 1) was performed in 3,731 participants without CKD, and the analysis of renal function and incident depression (analysis 2) was performed in 2,994 participants without depression. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (-CES-D), and depression was defined as CES-D scores ≥16 or self-reported history of depression or antidepressant medication use. CKD was defined as estimated glomerular filtration rate <60 ml/min/1.73 m² or urinary albumin to creatinine ratio ≥30 mg/g.

RESULTS

In analysis 1, 485 participants developed incident CKD during 61,202 person-years of follow-up, and CES-D scores (≥16 vs. <16; adjusted HR, 1.28; 95% CI, 1.04 to 1.59) were significant positive associated with incident CKD. In analysis 2, 1,029 participants developed incident depression during 42,927 person-years of follow-up, and CKD was significantly associated with a 36% increased risk of incident depression compared to non-CKD (HR, 1.36; 95% CI, 1.05 to 1.76).

LIMITATIONS

Depressive symptoms were only assessed using CES-D score, which is not the gold standard for the clinical diagnosis of depression.

CONCLUSIONS

This prospective cohort study monitored over 20 years indicated a bidirectional association between depression and CKD.

Associations of serum cystatin C and its change with new-onset cardiovascular disease in Chinese general population

BACKGROUND AND AIMS

The relation of serum cystatin C with new-onset cardiovascular disease (CVD) remains uncertain. We aimed to evaluate the prospective associations of serum cystatin C and its change with new-onset CVD in Chinese general population.

METHODS AND RESULTS

A total of 7064 participants free of CVD at baseline were enrolled from the China Health and Retirement Longitudinal Study. The change in serum cystatin C was calculated as cystatin C concentration at 2015 wave minus that at baseline (2011 wave). The primary outcome was new-onset CVD, defined as self-reported physician-diagnosed heart disease, stroke, or both during follow-up. The secondary outcomes were new-onset heart disease, and new-onset stroke. During a median follow-up duration of 7.0 years, a total of 1116 (15.8%) subjects developed new-onset CVD. Overall, after the adjustments for eGFR and other important covariates, there was a positive association between serum cystatin C and new-onset CVD (per SD mg/L increment; adjusted HR, 1.13; 95%CI: 1.08,1.18). When cystatin C was assessed as quintiles, the adjusted HRs for participants in the second, third, fourth and fifth quintiles were 1.15 (95%CI: 0.93, 1.41), 1.37 (95%CI: 1.11, 1.68), 1.47 (95%CI: 1.19, 1.81), and 2.03 (95%CI: 1.60, 2.56), respectively, compared with those in quintile 1 (P for trend<0.001). Furthermore, there was a positive association between the increase in cystatin C concentration and the subsequent new-onset CVD (per SD mg/L increment; adjusted HR, 1.14; 95%CI: 1.02,1.27).

CONCLUSION

Both serum cystatin C and its increase were positively associated with new-onset CVD among Chinese general population.

Frailty as an Independent Risk Factor for Depression in Patients With End-Stage Renal Disease: A Cross-Sectional Study

Background

Depression confers substantial disease burden globally, especially among those with chronic kidney disease (CKD). The presence of depression significantly impairs one's quality of life. Risk factors for depression in patients with CKD remain under-appreciated, and whether frailty, a geriatric phenotype, constitutes a risk factor for depression in this population is unknown.

Methods

We prospectively enrolled patients with end-stage renal disease (ESRD) undergoing hemodialysis for >3 months from National Taiwan University Hospital Yunlin Branch between 2019 and 2021. Clinical, physical, functional, and performance parameters were recorded, followed by frailty/sarcopenia assessment. Depression was screened for using the Geriatric Depression Scale. We analyzed the independent relationship between frailty and depression in these patients, using multiple regression analyses.

Results

Totally 151 patients with ESRD were enrolled (mean 61.1 years, 66.9% male), among whom 16.6% had screening-identified depression. ESRD participants with depression did not differ from those without regarding most parameters except serum creatinine, functional indices, and sarcopenia/frailty status. We found that having greater frail severities was independently associated with a higher probability of depression; having FRAIL- (odds ratio [OR] 5.418) and SOF-based (OR 2.858) frailty independently correlated with a higher depression probability. A linear relation exists between a greater frail severity and the probability of depression. Using a more relaxed criterion for detecting depression, higher SOF scores remained significantly associated with an increased depression risk.

Conclusions

In patients with CKD, frailty independently correlated with a higher probability of having depression. Strategies aiming to attenuate frailty may be able to benefit those with depression simultaneously in this population.

Social Isolation Is Associated With Rapid Kidney Function Decline and the Development of Chronic Kidney Diseases in Middle-Aged and Elderly Adults: Findings From the China Health and Retirement Longitudinal Study (CHARLS)

Background: There is limited evidence on the relationship between social isolation and renal outcomes. To address this gap, this study estimated the prospective relationship of social isolation with rapid kidney function decline and the development of chronic kidney disease (CKD) in middle-aged and elderly Chinese with normal kidney function. Methods: We analyzed data from 3,031 participants aged ≥ 45 years with baseline estimated glomerular filtration rates (eGFR) ≥ 60 ml/min/1.73 m². All data were obtained from the 2011 and 2015 waves of the Chinese Longitudinal Study of Health and Retirement (CHARLS). eGFR was estimated based on a combination of serum creatinine and cystatin C. The primary outcome was rapid decline in renal function, as defined by an eGFR decrease of > 5 ml/min/1.73 m² per year, while the secondary outcome was the development of CKD, as defined by an eGFR decrease to a level < 60 ml/min/1.73 m². Results: During the follow-up of 4 years, 258 (8.5%) participants experienced a rapid decline in renal function, while 87 (2.9%) developed CKD. In the fully adjusted model, high social isolation was significantly related to an increased risk of experiencing a rapid decline in renal function (OR 1.805, 95% CI 1.310-2.487) and CKD onset (OR 1.842, 95% CI 1.084-3.129). Among the five components of social isolation, being unmarried, not participating in social activities, and living alone independently predicted declined renal function. Conclusions: Social isolation is significantly associated with the risk of rapid eGFR decline and CKD onset in middle-aged and older adults with normal kidney function in China.

Associations between depressive symptoms and disease progression in older patients with chronic kidney disease: results of the EQUAL study

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.

The effect of triglycerides to high-density lipoprotein cholesterol ratio on the reduction of renal function: findings from China health and retirement longitudinal study (CHARLS)

BACKGROUND

Previous studies show that abnormal lipoprotein metabolism can increase the prevalence of chronic kidney disease (CKD). This study prospectively investigated the association of triglycerides to high-density lipoprotein cholesterol (TG/HDL-C) ratio and renal dysfunction in the Chinese population.

METHODS

This longitudinal cohort research examined 7,316 participants (age range: 22-93) from the China Health and Retirement Longitudinal Study (CHARLS), including 6,560 individuals with estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73 m2 (normal renal function, NRF) group and 756 with eGFR < 60 mL/min/1.73 m2 (impaired renal function, IRF) group. In NRF group, reduction in renal function was defined as eGFR < 60 mL/min/1.73 m2 at exit visit and in IRF group, it was defined as decline in eGFR category, average eGFR decline > 5 mL/min/1.73 m2 per year or > 30 % decrease in eGFR from baseline.

RESULTS

The study results showed that TG/HDL-C ratio was positively associated with the risk of renal function decline in the NRF group (OR 1.30, 95 %CI 1.03-1.65, P = 0.03) and the IRF group (OR 1.90, 95 %CI 1.21-3.23, P = 0.02) when adjusting for age, gender, obesity, diabetes, hypertension, waist circumference, drinking, smoking, history of heart disease and stroke, low-density lipoprotein cholesterol and eGFR category. Analysis of the IRF group indicated that relative to the group of TG/HDL-C < 1.60, the group of TG/HDL-C ≥ 2.97 had an increased risk for the decline of eGFR category (OR 1.89, 95 %CI 1.12-3.21, P = 0.02) and > 30 % decline in eGFR (OR 2.56, 95 %CI 1.05-6.38, P = 0.04).

CONCLUSIONS

The high TG/HDL-C ratio was an independent risk factor for declining renal function in the Chinese population.