Dose-dependent association between estimated glomerular filtration rate and the subsequent risk of depression: An analysis of a nationwide epidemiological dataset.

IF 4.4 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Clinical Investigation Pub Date : 2024-09-27 DOI:10.1111/eci.14322

Toshiyuki Ko, Hidehiro Kaneko, Yuta Suzuki, Akira Okada, Tatsuhiko Azegami, Katsuhito Fujiu, Norifumi Takeda, Hiroyuki Morita, Takashi Yokoo, Kaori Hayashi, Issei Komuro, Hideo Yasunaga, Masaomi Nangaku, Norihiko Takeda

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引用次数: 0

Abstract

Background: 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.

Methods: 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.

Results: 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 m²) 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 m².

Conclusions: 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.

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估计肾小球滤过率与后续抑郁风险之间的剂量依赖关系：全国流行病学数据集分析。

背景：尽管众所周知肾功能不全患者有患抑郁症的风险，尤其是在晚期，但人们对估计肾小球滤过率（eGFR）下降开始显著增加抑郁症风险的确切时间点知之甚少。在本研究中，我们分析了一个全国性的流行病学数据集，以调查基线 eGFR 与普通人群未来患抑郁症风险之间的剂量依赖关系：我们回顾性分析了由DeSC Healthcare（日本东京）提供的全国流行病学数据库中2014年4月至2022年11月期间发现的1,518,885名无抑郁症病史者（男性：46.3%）。我们利用 Cox 回归分析研究了 eGFR 与抑郁症发病率之间的关系，还进行了立方样条分析，以研究 eGFR 与抑郁症之间的剂量依赖关系：结果：在平均为 1218 ± 693 天的随访中，共记录了 45,878 例抑郁症病例（占所有参与者的 3.0%，男性为 2.6%，女性为 3.3%）。抑郁的风险随着 eGFR 的下降和蛋白尿的出现而增加。多变量考克斯回归分析显示，各肾功能类别（eGFR ≥90、60-89、45-59、30-44、15-29 和 2）的抑郁危险比（95% CI）分别为 1.14（1.11-1.17）、1（参考）、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）。在立方样条分析中，当 eGFR 低于约 65 mL/min/1.73 m2 时，抑郁风险随着 eGFR 的下降而单调上升：我们利用大规模流行病学数据集进行的分析表明，eGFR 下降与抑郁风险之间存在剂量依赖关系，这凸显了将心理健康评估纳入肾功能不全患者日常护理的重要性，无论患者处于哪个疾病阶段。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Clinical Investigation 医学-医学：内科

CiteScore

9.50

自引率

3.60%

发文量

192

审稿时长

1 months

期刊介绍： EJCI considers any original contribution from the most sophisticated basic molecular sciences to applied clinical and translational research and evidence-based medicine across a broad range of subspecialties. The EJCI publishes reports of high-quality research that pertain to the genetic, molecular, cellular, or physiological basis of human biology and disease, as well as research that addresses prevalence, diagnosis, course, treatment, and prevention of disease. We are primarily interested in studies directly pertinent to humans, but submission of robust in vitro and animal work is also encouraged. Interdisciplinary work and research using innovative methods and combinations of laboratory, clinical, and epidemiological methodologies and techniques is of great interest to the journal. Several categories of manuscripts (for detailed description see below) are considered: editorials, original articles (also including randomized clinical trials, systematic reviews and meta-analyses), reviews (narrative reviews), opinion articles (including debates, perspectives and commentaries); and letters to the Editor.