Division of Nephrology, Nanfang Hospital, Southern Medical University; National Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Guangdong Provincial Institute of Nephrology; Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou 510515, China.
Division of Nephrology, Nanfang Hospital, Southern Medical University; National Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Guangdong Provincial Institute of Nephrology; Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou 510515, China.
J Affect Disord. 2022 Aug 15;311:224-230. doi: 10.1016/j.jad.2022.05.104. Epub 2022 May 21.
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.
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 m or urinary albumin to creatinine ratio ≥30 mg/g.
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).
Depressive symptoms were only assessed using CES-D score, which is not the gold standard for the clinical diagnosis of depression.
This prospective cohort study monitored over 20 years indicated a bidirectional association between depression and CKD.
抑郁症和慢性肾脏病（CKD）常同时存在。然而，抑郁症与 CKD 进展的关系以及 CKD 与抑郁风险的关系仍不明确。我们旨在研究队列中年轻和中年成年人肾功能与抑郁之间的双向关系。
利用冠状动脉风险发展在年轻人研究的数据，在没有 CKD 的 3731 名参与者中进行了抑郁症状和 CKD 事件的分析（分析 1），在没有抑郁的 2994 名参与者中进行了肾功能和抑郁事件的分析（分析 2）。使用流行病学研究中心抑郁量表（-CES-D）测量抑郁症状，抑郁定义为 CES-D 评分≥16 或自我报告的抑郁病史或使用抗抑郁药物。CKD 定义为估计肾小球滤过率<60 ml/min/1.73 m 或尿白蛋白与肌酐比值≥30 mg/g。
在分析 1 中，485 名参与者在 61202 人年的随访中发生了 CKD 事件，CES-D 评分（≥16 与<16；调整后的 HR，1.28；95%CI，1.04 至 1.59）与 CKD 事件显著正相关。在分析 2 中，1029 名参与者在 42927 人年的随访中发生了抑郁事件，与非 CKD 相比，CKD 与抑郁事件风险增加 36%显著相关（HR，1.36；95%CI，1.05 至 1.76）。
抑郁症状仅使用 CES-D 评分评估，而 CES-D 评分不是抑郁临床诊断的金标准。
这项前瞻性队列研究监测了 20 多年，表明抑郁和 CKD 之间存在双向关联。
