Psychiatric disorders and following risk of chronic kidney disease: a prospective cohort study from UK Biobank.

Abstract

Background: Psychiatric disorders have been reported to influence many health outcomes, but evidence about their impact on chronic kidney disease (CKD) has not been fully explored, as well as possible mechanisms implicated are still unclear.

Methods: Four hundred forty-one thousand eight hundred ninety-three participants from UK Biobank were included in this study. To assess the association between psychiatric disorders mainly including depression, anxiety, stress-related disorders, substance misuse as well as psychotic disorder, and CKD, a Cox regression model using age as the underlying time scale was employed. This approach considers the age progression of participants from the beginning to the end of the study as the elapsed time. Flexible nonparametric smoothing model was conducted to illustrate the temporal patterns. Subgroup analyses were performed by stratification of gender, genetic susceptibility to CKD, age at entry or exit the cohort, follow-up duration, and the number of psychiatric disorders at baseline. Mediation analysis was implemented to evaluate the roles of body mass index (BMI), hypertension, and diabetes.

Results: Compared with individuals without psychiatric disorders, an increased risk of CKD was observed in patients with psychiatric disorders (hazard ratios (HR) = 1.52, 95% confidence intervals (CI): 1.40-1.65, p-value < 0.001). The hazard ratio among psychiatric patients gradually increased, and became significant after about 10 years follow-ups. The HR for patients followed up for 10-12 years was 1.60 (95% CI: 1.34-1.91, p-value < 0.001), and the HR was 1.66 (95% CI: 1.29-2.13, p-value < 0.001) for patients followed up for 12-13 years. Five distinct psychiatric disorders were found to be significantly associated with an increased risk of developing CKD. The highest HR was observed between stress-related disorder and CKD (HR = 1.95, 95%CI: 1.28-2.97, p-value = 0.002). When adjusting genetic susceptibility to CKD, the HR for the association between stress-related disorders and CKD became 1.86 (95%CI: 1.14-3.04, p-value = 0.013). Although these associations were nominally significant, they did not reach statistical significance after applying the Bonferroni multiple corrections, potentially due to the limited sample size. Subgroup analysis revealed that psychiatric patients who are under age 60, with multiple psychiatric morbidities or having been diagnosed with psychiatric disorders for over 10 years may be high-risk populations. Hypertension, BMI and diabetes mediated 49.13% (95% CI: 37.60%-67.08%), 12.11% (95% CI: 8.49%-17.24%) and 3.78% (95% CI: 1.58%-6.52%) of the total effect, respectively.

Conclusions: Psychiatric disorders were associated with a delayed onset of an elevated risk for CKD, this association was only observed in patients with psychiatric disorders for more than 10 years. Our study highlights the significance of lifestyle interventions, routine monitoring of kidney function, early screening for CKD, and personalized management strategies for psychiatric patients as potential approaches to the precise prevention of CKD.