Researchers Explore Link Between Depression, Renal Dysfunction

Baseline eGFR and increasing age were good predictors of eGFR.

While it warrants future studies, thus far there is no connection between treatment for major depressive disorder (MDD) and improving renal function.

A team, led by Melissa Claros-Erazo, Department of Psychiatry and Behavioral Sciences, Jackson Behavioral Health Hospital, Identified whether effective treatments for depression also results in an improvement in renal function.

Researchers often believe there is a bidirectional relationship between depression and renal dysfunction. However, there is still a lack of longitudinal data exploring this link in patients with major depressive disorder, as depression could contribute to the progression of chronic kidney disease.

In the retrospective analysis, the researchers examined 1600 outpatients who underwent double-blind, placebo-controlled, randomized antidepressant treatment (DBPCRAT) of MDD in 13 Eli Lilly and Company clinical trials.

The team measured magnitude of depression symptoms using the Hamilton Depression Rating scale (HAMD) and estimated glomerular filtration rate (eGFR) using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation.

Results

Following 7 weeks of treatment, HAMD scores decreased by 11.8 points, compared to just 9.3 points in the placebo group (P <0.0001). In the antidepressant treatment cohort, eGFR decreased by 0.28 ml/min/1.73 m2 and by 0.88 ml/min/1.73 m2 in the placebo-treated group (P = 0.17).

The researchers also identified various predictors of HAMD scores at week 7, including baseline HAMD scores (B = 0.237; P <0.001), and antidepressant treatment (B = −2.28, P <0.001).

The best predictors forecasting eGFR were baseline eGFR (B = 0.651, P <0.0001), increasing age (B = −0.194, P <0.0001), and female gender (B = −0.984, P = 0.013).

“Short-term, MDD was not associated with clinically significant decrements in eGFR,” the authors wrote. “Future studies will determine whether depression treatment over a more prolonged period of time is associated with improvement in eGFR, especially in minorities and other high-risk populations.”

eGFR Trends

While the prevalence of chronic kidney disease (CKD) has stabilized in recent years in the US, it is unclear whether this trend is consistent throughout all major sociodemographic groups.

A team, led by Priya Vart, PhD, Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, identified trends in the prevalence of chronic kidney disease for all major sociodemographic groups in recent years.

In the repeated cross-sectional study, the investigators analyzed data from the National Health and Nutrition Examination Surveys for 1988-1994 and every 2 years from 1999-2016 on 54,554 individuals at least 20 years old with information on race and ethnicity, socioeconomic status, and serum creatinine levels.

The age-, sex-, and race/ethnicity-adjusted overall prevalence of stage 3 and 4 chronic kidney disease increased from 3.9% in the 1988-1994 time period to 5.2% in the 2003-2004 (difference, 1.3%; 95% CI, 0.9%-1.7%).

This remained relatively stable after 2004 at 5.1% in 2015-2016 (difference, −0.1%; 95% CI, −0.7% to 0.4%). The trend in adjusted disease prevalence overall differed substantially based on race/ethnicity (= 0.009 for interaction).

The investigators also discovered higher disease prevalence for those with lower educational levels, while income largely remained consistent throughout the entire study period. The results were similar in most subgroups when including albuminuria to define chronic kidney disease.

The study, “Randomized, Placebo-controlled, Antidepressant Treatment of Patients with Major Depressive Disorder: Changes in Glomerular Filtration Rate,” was published online in Personalized Medicine in Psychiatry.