Journal of affective disorders · 2025
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.
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Zhao Jingui, Wu Mei, Zhang Li, Han Xue, Wu Jianrong, Wang Chaoban
Аннотация
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.
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.