Higher levels of depression are associated with increased all-cause mortality in individuals with chronic kidney disease: A prospective study based on the NHANES database

IF 4.9 2区医学 Q1 CLINICAL NEUROLOGY

Journal of affective disorders Pub Date : 2025-07-01 DOI:10.1016/j.jad.2025.119785

Jingui Zhao , Mei Wu , Li Zhang , Xue Han , Jianrong Wu , Chaoban Wang

{"title":"Higher levels of depression are associated with increased all-cause mortality in individuals with chronic kidney disease: A prospective study based on the NHANES database","authors":"Jingui Zhao , Mei Wu , Li Zhang , Xue Han , Jianrong Wu , Chaoban Wang","doi":"10.1016/j.jad.2025.119785","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Chronic kidney disease (CKD) is a progressive condition associated with high mortality rates worldwide. Although depression is common in CKD patients, it is rarely addressed in current management guidelines, possibly due to limited long-term data.</div></div><div><h3>Methods</h3><div>We analyzed data from the National Health and Nutrition Examination Survey and the National Death Index from 2005 to 2020. CKD patients with complete data on mortality and covariate data were included. Depression was assessed using the PHQ-9 questionnaire, categorizing participants into four groups: four levels (<em>G1</em> <em>=</em> <em>0</em>, <em>G2</em> <em>=</em> <em>1–3</em>, <em>G3</em> <em>=</em> <em>4–9</em>, <em>G4</em> <em>≥</em> <em>10</em>). A Cox regression model evaluated the relationship between depression levels and all-cause mortality.</div></div><div><h3>Results</h3><div>Among 4438 CKD patients (mean age 58.28 years, 48 % male), and a dose-response relationship was observed, with increasing depression severity associated with progressively higher mortality risk. After adjusting for key prognostic indicators of CKD, the Cox regression model demonstrated that the high depression group (G4) exhibited a significantly higher risk of death compared to the no depression group (G1) (model 3-G4: HR = 1.69 (1.33, 2.14), <em>P</em> < 0.001). Subgroup analyses further revealed consistent trends across demographics.</div></div><div><h3>Conclusion</h3><div>Depression is an independent predictor of increased mortality in CKD patients. Even mild depression can adversely affect survival. Identifying and treating depression in CKD patients may improve prognosis, highlighting the need for further research into this relationship.</div></div>","PeriodicalId":14963,"journal":{"name":"Journal of affective disorders","volume":"390 ","pages":"Article 119785"},"PeriodicalIF":4.9000,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of affective disorders","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0165032725012273","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Chronic kidney disease (CKD) is a progressive condition associated with high mortality rates worldwide. Although depression is common in CKD patients, it is rarely addressed in current management guidelines, possibly due to limited long-term data.

Methods

We analyzed data from the National Health and Nutrition Examination Survey and the National Death Index from 2005 to 2020. CKD patients with complete data on mortality and covariate data were included. Depression was assessed using the PHQ-9 questionnaire, categorizing participants into four groups: four levels (G1 = 0, G2 = 1–3, G3 = 4–9, G4 ≥ 10). A Cox regression model evaluated the relationship between depression levels and all-cause mortality.

Results

Among 4438 CKD patients (mean age 58.28 years, 48 % male), and a dose-response relationship was observed, with increasing depression severity associated with progressively higher mortality risk. After adjusting for key prognostic indicators of CKD, the Cox regression model demonstrated that the high depression group (G4) exhibited a significantly higher risk of death compared to the no depression group (G1) (model 3-G4: HR = 1.69 (1.33, 2.14), P < 0.001). Subgroup analyses further revealed consistent trends across demographics.

Conclusion

Depression is an independent predictor of increased mortality in CKD patients. Even mild depression can adversely affect survival. Identifying and treating depression in CKD patients may improve prognosis, highlighting the need for further research into this relationship.

查看原文本刊更多论文

高水平的抑郁与慢性肾病患者全因死亡率增加有关：一项基于NHANES数据库的前瞻性研究

背景：慢性肾脏疾病（CKD）是一种进行性疾病，在世界范围内具有很高的死亡率。虽然抑郁症在CKD患者中很常见，但可能由于长期数据有限，目前的管理指南很少涉及抑郁症。方法分析2005 - 2020年全国健康与营养调查和全国死亡指数数据。纳入了具有完整死亡率数据和协变量数据的CKD患者。采用PHQ-9问卷进行抑郁评估，将参与者分为4组：4个水平（G1 = 0, G2 = 1-3, G3 = 4-9, G4≥10）。Cox回归模型评估抑郁水平与全因死亡率之间的关系。结果在4438例CKD患者中（平均年龄58.28岁，48%为男性），观察到一种剂量-反应关系，抑郁严重程度的增加与逐渐增加的死亡风险相关。在调整CKD的关键预后指标后，Cox回归模型显示，高抑郁组（G4）的死亡风险明显高于无抑郁组（G1）(模型3-G4: HR = 1.69 (1.33, 2.14), P <；0.001)。亚组分析进一步揭示了人口统计数据的一致趋势。结论抑郁是CKD患者死亡率升高的独立预测因子。即使是轻微的抑郁也会对生存产生不利影响。识别和治疗CKD患者的抑郁症可能会改善预后，因此需要进一步研究这种关系。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of affective disorders 医学-精神病学

CiteScore

10.90

自引率

6.10%

发文量

1319

审稿时长

9.3 weeks

期刊介绍： The Journal of Affective Disorders publishes papers concerned with affective disorders in the widest sense: depression, mania, mood spectrum, emotions and personality, anxiety and stress. It is interdisciplinary and aims to bring together different approaches for a diverse readership. Top quality papers will be accepted dealing with any aspect of affective disorders, including neuroimaging, cognitive neurosciences, genetics, molecular biology, experimental and clinical neurosciences, pharmacology, neuroimmunoendocrinology, intervention and treatment trials.