Sex differences in the associations of cardiovascular risk factors with post-traumatic stress disorder among Veterans with chronic kidney disease.

Post-traumatic stress disorder (PTSD) is associated with increased cardiovascular risk, in part through effects on traditional risk factors such as hypertension. People with chronic kidney disease (CKD) have elevated cardiovascular risk and a unique cardiovascular risk factor profile compared to the general population. We assessed associations of cardiovascular risk factors with PTSD among men and women with CKD. In this cross-sectional study, we identified adults with incident non-dialysis CKD stages 3-5 from 2009 to 2020 in the Veterans Affairs healthcare system. Prevalent PTSD was defined by the use of at least two PTSD diagnosis codes within 12 months prior to incident CKD. Of 1,443,878 Veterans in the cohort, PTSD was prevalent in 18.5% of women and 9.6% of men, p < 0.0001. In multivariable models, younger age, Black race, hypertension, depression, anxiety, alcohol, and/or substance use disorder, the use of antidepressant medications other than selective serotonin reuptake inhibitors (SSRIs), and higher estimated glomerular filtration rate were associated with increased odds of PTSD in both men and women, with significant interactions by sex for each of these (interaction p < 0.001 for each), except for anxiety (interaction p = 0.11). SSRI antidepressant use was associated with PTSD among men but not women. PTSD was differentially associated with cardiovascular risk factors among men and women with CKD. Further studies of the mechanisms of cardiovascular risk in people with CKD should stratify by sex.