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Renal Failure Associated with Depression in Adults with Diabetes

Diabetic patients who are depressed may be at an increased risk for developing end-stage renal disease…. 

In a prospective, observational cohort study, researchers at the University of Washington evaluated 3,886 ambulatory diabetic patients in a large health maintenance organization. Data collected included body-mass index (BMI), blood pressure, kidney function, patterns of diabetes self-care, years with diabetes, ethnicity, age, marital status, education and smoking history.

Participants were classified as depressed according to their number of depressive symptoms (≥5 for major depressive symptoms or 2 to 4 for minor depressive symptoms), for greater than 50% of the time for ≥2 weeks. A health survey (Patient Health Questionnaire-9) was also used with a score ≥10 for major depressive symptoms and ≥5 for minor depressive symptoms.

Researchers estimated the risk of incident end-stage renal disease using Cox proportional hazards regression, and considered death during a pre-dialysis stage as a competing risk.

Of depressed patients, 448 (11.5%) had symptoms consistent of major depression and 327 (8.4%) had minor depressive symptoms. Over a median follow-up period of 8.8 years, renal failure developed in 87 patients (2.2%). After adjusting for risk factors including age, sex, BMI and medical history, diabetics with major depression were found to be 85% more likely to develop end-stage renal disease (HR=1.85, CI 95%, 1.02 to 3.33). Researchers found no significant association in those with Minor depression (HR=1.08; 95% CI, 0.52 to 2.25).

In this study, researchers were able to identify an association between major depressive symptoms and kidney failure. These results are somewhat expected since people who are not depressed may be more likely to take better care of themselves. Additional studies will be necessary, however, to determine whether routine screening and treatment of depression in diabetics can reduce the risk of end-stage renal disease.

Practice Pearls:
  • Diabetic patients with major depressive symptoms may have a higher risk of renal failure than those without depression
  • Patients with diabetes may potentially benefit from routine depression screenings and treatment when deemed necessary
  • Managing depression in diabetic patients could possibly result in better renal function outcomes and less risk of progressing onto end-stage renal disease

Yu MK, Weiss, NS, Ding X, Katon WJ, Zhou X, Young BA. Associations between depressive symptoms and incident ESRD in a diabetic cohort. March 27, 2014, Clinical Journal of the American Society of Nephrology