Association between Depressive Symptom Trajectory and Chronic Kidney Disease Progression: Findings from the Chronic Renal Insufficiency Cohort Study.

Abstract

While depression is highly prevalent among individuals with chronic kidney disease (CKD), little is known about the course of depressive symptoms over time. We characterized trajectories of depressive symptoms and CKD progression and evaluated the association between depressive symptoms trajectory and CKD progression. 2361 individuals with mild-to-moderate CKD enrolled in the Chronic Renal Insufficiency Cohort Study. The Beck Depression Inventory (BDI) was used to assess depressive symptoms at baseline and biennially. Higher BDI scores indicate worse depressive symptoms. Estimated glomerular filtration rate (eGFR) was calculated using the 2021 CKD-EPI equation. Group-based trajectory models were used to determine trajectories of BDI score and eGFR change over time. Multinomial logistic regression was used to examine factors associated with BDI trajectories and to evaluate the association of BDI trajectories with eGFR change. Over 8 years of follow-up, three patterns of depressive symptoms were identified: persistently low BDI score (57.7%), persistently moderate BDI score (33.1%), and persistently high BDI score (9.2%). Three eGFR trajectory groups were identified: non-linear, rapid eGFR decline (21.5%); linear, expected eGFR decline (54.8%); and stable eGFR (23.7%). Predictors of persistently moderate and high BDI trajectories included low educational attainment, smoking, and poor quality of life. Compared to those with a persistently low BDI score, the odds for non-linear, rapid eGFR decline were higher for those with persistently moderate BDI scores (OR, 1.45; 95% CI, 1.04-2.03) and persistently high BDI scores (OR, 1.90; 95% CI, 1.02-3.56). No association between moderate BDI score and linear, expected eGFR decline was observed. Depressive symptoms remained largely stable among individuals with mild-to-moderate CKD, and persistently moderate and high BDI scores were associated with non-linear, rapid eGFR decline. Future work is needed to better understand the interplay between depression and CKD progression.