Ko Toshiyuki, Kaneko Hidehiro, Suzuki Yuta, Okada Akira, Azegami Tatsuhiko, Fujiu Katsuhito, Takeda Norifumi, Morita Hiroyuki, Yokoo Takashi, Hayashi Kaori, Komuro Issei, Yasunaga Hideo, Nangaku Masaomi, Takeda Norihiko
Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Frontier Cardiovascular Science, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Eur J Clin Invest. 2025 Jan;55(1):e14322. doi: 10.1111/eci.14322. Epub 2024 Sep 27.
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.
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.
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 m) 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 m.
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.
尽管肾功能不全患者，尤其是晚期患者患抑郁症的风险众所周知，但对于估算肾小球滤过率（eGFR）下降开始显著增加抑郁症风险的确切临界点却知之甚少。在本研究中，我们分析了一项全国性的流行病学数据集，以调查普通人群中基线eGFR与未来患抑郁症风险之间的剂量依赖性关联。
我们回顾性分析了2014年4月至2022年11月期间在DeSC Healthcare（日本东京）提供的全国性流行病学数据库中识别出的1,518,885名无抑郁症病史的个体（男性：46.3%）。我们使用Cox回归分析研究eGFR与抑郁症发病率之间的关联，并进行三次样条分析以研究eGFR与抑郁症之间的剂量依赖性关联。
在平均1218±693天的随访中，记录了45,878例抑郁症病例（占总参与者的3.0%，男性为2.6%，女性为3.3%）。抑郁症风险随着eGFR下降以及蛋白尿的出现而增加。多变量Cox回归分析显示，各肾功能类别（eGFR≥90、60 - 89、45 - 59、30 - 44、15 - 29和<15 mL/min/1.73 m²）中抑郁症的风险比（95% CI）分别为1.14（1.11 - 1.17）、1（参考值）、1.11（1.08 - 1.14）、1.51（1.43 - 1.59）、1.77（1.57 - 1.99）和1.77（1.26 - 2.50）。在三次样条分析中，当eGFR降至约65 mL/min/1.73 m²以下时，抑郁症风险随着eGFR下降而持续单调增加。
我们使用大规模流行病学数据集进行的分析表明了eGFR下降与抑郁症风险之间的剂量依赖性关联，这突出了将心理健康评估纳入肾功能不全患者常规护理的重要性，无论其疾病处于何种阶段。
