Dose-dependent association of depression with incidence of end-stage kidney disease and all-cause mortality, CKD-JAC study: a retrospective cohort study.

Abstract

Background: Although depression is common among patients with chronic kidney disease (CKD), its impact on the incidence of end-stage kidney disease (ESKD) and all-cause mortality remains unclear.

Methods: This retrospective cohort study used Cox proportional hazards (CPH) models and CPH models with penalized splines to assess the association between depression severity and the incidence of ESKD and mortality in patients with CKD, drawing on data from the Chronic Kidney Disease Japan Cohort (CKD-JAC) Study.

Results: This study included 1,694 patients with CKD (median age 61 years; mean eGFR 29.0 ± 12.2 mL/min/1.73 m²; median Beck Depression Inventory-II (BDI-II) score 8). Depression severity was classified into four categories: normal (0-13), mild (14-19), moderate (20-28), and severe (≥ 29). In Multivariable CPH models, ESKD risk showed a stepwise elevation in hazard ratios (HRs) without reaching statistical significance, whereas, mortality risk increased significantly in the moderate and severe group: HR 3.11 (95%CI 1.61-6.03) and 3.51 (1.40-8.80). Additionally, CPH models demonstrated a dose-dependent association between BDI-II categories and the incidence of both ESKD and mortality. CPH Models with penalized splines further revealed a gradual increase in ESKD risk, and a J-shaped association in mortality risk.

Conclusion: Depression severity showed dose-dependent associations with increased the incidence of ESKD and mortality in patients with CKD. Although mortality risk was significantly higher in the moderate and severe groups (BDI-II score ≥ 20), the stepwise elevation in ESKD risk did not reach statistical significance, and an optimal threshold for ESKD risk could not be identified.