Associations Between Depressive Symptoms and Incident End-Stage Renal Disease in a Diabetic Cohort

Abstract

<bold>Context:</bold> Though the presence of major depression is associated with adverse health outcomes, little is known regarding its associations with long-term renal outcomes in patients with diabetes. Furthermore, few studies have examined the impact of minor depression in this patient population. <bold>Objective:</bold> To evaluate the associations between the presence of major or minor depressive symptoms and risk of incident end-stage renal disease (ESRD) at 10 years in an outpatient diabetic cohort. <bold>Design:</bold> The Pathways Study is a prospective, observational cohort study conducted from 2001 to 2012. <bold>Setting and Participants: Large health maintenance organization, population-based primary care cohort study of 3,877 men and women with diabetes without ESRD at baseline. <bold>Exposure:</bold> Major or minor depressive symptoms at study entry based on the Patient Health Questionnaire-9 (PHQ-9). <bold>Main Outcome and Measure:</bold> ESRD. <bold>Results:</bold> During up to 10 years of follow-up, 78 patients (2.0%) initiated dialysis. Major depressive symptoms at study enrollment were associated with an increased risk of incident ESRD (hazard ratio [HR] 1.87, 95% confidence interval [CI] 1.02-3.44), adjusting for age, sex, race/ethnicity, marital status, education, smoking, body mass index, duration of diabetes, hemoglobin A1c, baseline kidney function, microalbuminuria, and adherence to diabetes self-care. There was no association between minor depressive symptoms and incident ESRD (HR 1.11, 95% CI 0.53-2.48). <bold>Conclusion:</bold> Major depressive symptoms, but not minor depressive symptoms, were associated with an increased risk of incident ESRD at 10 years. Additional studies are needed to determine whether treatment for depression can improve renal outcomes in patients with diabetes.