Abstract
BackgroundThe relationship between kidney function and depressive symptoms among elderly people has been rarely investigated in settings of the general population. The aim of our study was to examine the association of serum cystatin C (cysC) and impaired kidney function with geriatric depressive symptoms among older people living in a rural community in China.MethodsThis population-based cohort study included 1440 individuals (age ≥ 60 years) who were recruited for the Confucius Hometown Aging Project in 2010–2011; of the 1124 persons who were free of depressive symptoms, 669 (59.5%) were re-examined in 2014–2016. At baseline, data on demographics, lifestyle factors, health conditions, and medical history were collected through interviews, clinical examinations, and laboratory tests. We defined impaired kidney function as the cystatin C-based estimated glomerular filtration rate (eGFRcysC) < 60 ml/min/1.73 m2, and depressive symptoms as a score ≥ 5 on the 15-item Geriatric Depression Scale. Data were analyzed using multiple logistic and Cox proportional-hazards models.ResultsOf the 1440 participants, 316 (21.9%) were defined to have geriatric depressive symptoms at baseline. Serum cysC levels of 1.01–1.25 and > 1.25 mg/L (vs. ≤1.00 mg/L) were associated with a multiple-adjusted odds ratio (OR) of 1.41 (95% CI 1.01–1.97) and 3.20 (2.32–4.41), respectively, for having geriatric depressive symptoms (Ptrend < 0.001). Of the 669 people who were free of depressive symptoms at baseline, 157 had incident depressive symptoms at the follow-up examination. The multiple-adjusted hazard ratio (HR) for incident depressive symptoms were 2.16 (95% CI 1.43–3.27) for serum cysC > 1.25 mg/L (vs. < 1.00 mg/L). Impaired kidney function was cross-sectionally (multiple-adjusted OR = 2.95; 95% CI 2.22–3.92) and longitudinally (multiple-adjusted HR 1.54; 95% CI 1.03–2.30) associated with an increased risk of geriatric depressive symptoms.ConclusionElevated serum cysC levels and impaired kidney function are associated with an increased risk of geriatric depressive symptoms among Chinese older people living in a rural community.
Highlights
The relationship between kidney function and depressive symptoms among elderly people has been rarely investigated in settings of the general population
In the Cox models, the follow-up time from the date of baseline assessment to the date of follow-up examination was used as the time scale. For both cross-sectional and longitudinal associations, we reported results from three models, in which we controlled for different factors that potentially confounded the examined associations: model 1 was controlled for age, gender, and education; model 2 was controlled for alcohol consumption and history of chronic diseases; and model 3 was further controlled for Mini-Mental State Examination (MMSE) score and activities of daily living (ADL)-disability
People with depressive symptoms had a higher level of low-density lipoprotein (LDL), serum cystatin C (cysC), and creatinine, but a lower level of high-density lipoprotein (HDL), eGFRcysC, and MMSE score than those
Summary
The relationship between kidney function and depressive symptoms among elderly people has been rarely investigated in settings of the general population. The aim of our study was to examine the association of serum cystatin C (cysC) and impaired kidney function with geriatric depressive symptoms among older people living in a rural community in China. Geriatric depression has become a public health concern. Depression in older people is related to poor health-related quality of life [1], and to morbidity, mortality, and even suicide [2]. In China, the meta-analyses showed that the prevalence of depression ranges from ~ 20% to ~ 30% among older adults living in communities, with the pooled prevalence being ~ 23% [4, 5]. It is important to identify risk factors related to geriatric depression for possible intervention
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