ASN Kidney Week Data Demonstrate Links Between CKD, Mental Health Disorders

Abstracts presented at American Society of Nephrology Kidney Week 2025 demonstrate associations between chronic kidney disease (CKD) and mental health disorders, such as depression and posttraumatic stress disorder (PTSD). These data, according to the investigators, emphasize a need for further research into the biological and psychological mechanisms behind the elevated rates of depression and other mental illnesses in patients with CKD.^1,2

CKD occurs when the kidneys become damaged and cannot properly remove waste products or maintain normal blood pressure. Many people with CKD do not have any symptoms until the more advanced, later stages of the disease or when complications develop. Common symptoms include urinating more often or less often than usual, foamy urine, nausea, feeling tired, loss of appetite, and weight loss without trying to lose weight. Advanced stages present other symptoms, such as difficulty concentrating; numbness or swelling in the arms, legs, ankles, or feet; and achy muscles.³

Abstract #1: Prevalence of Diagnosed Mental Health Disorders in Patients With CKD

CKD frequently occurs concurrently with mental health disorders, often leading to poor treatment adherence, increased hospitalizations, and higher mortality. Despite these associations, the prevalence and management of mental health disorders among CKD populations still remain unclear. For this study, the investigators aimed to determine the incidence of mental health conditions and current treatment strategies among patients with CKD in the United Kingdom.¹

This retrospective cross-sectional analysis utilized data from over 157,000 participants who completed the Mental Health Questionnaire in the UK Biobank cohort study. For this study, CKD was defined using ICD-10 codes from both inpatient and primary care data, self-reported diagnoses, and a baseline (estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m² or urine albumin-creatinine ratio (uACR) greater than or equal to 30 mg/g). Psychiatric diagnoses were based on self-reported conditions that a health care professional previously diagnosed. Additionally, group comparisons were performed using Pearson’s chi-squared test.¹

Results

Among the participants who completed the Mental Health Questionnaire, approximately 12% (n = 18,195) were diagnosed with CKD. Of these, 6037 (33.2%) reported a history of at least one mental disorder. Compared with participants who did not have CKD, those with CKD had a higher prevalence of depression (22% vs 21%; p < .001) and anxiety disorders, including panic attacks (6.2% vs 5.4%; p = .022) and phobic disorders (2.3% vs 1.7%; p < .001). Additionally, eating disorders, such as overeating or binge eating disorder, were also more common in those with CKD (0.6% vs 0.4%; p = .022), while anorexia nervosa was less prevalent (0.4% vs 0.6%; p < .001).¹

Individuals with CKD and depression were also more likely to take prescribed medication (46% vs 42%; p < .001) and less likely to engage in talk therapies such as cognitive behavioral therapy or psychotherapy (37% vs 40%; p < .001) or other therapeutic activities such as mindfulness and yoga (11% vs 15%; p < .001), compared to individuals without CKD.¹

Abstract #2: Higher Incidence of CKD and ESKD Among US Veterans With PTSD, Depressive Disorders

Mental disorders, such as PTSD and major depressive disorder (MDD), are common among US veterans. In this study, investigators assessed whether these conditions cause individuals to be more susceptible to CKD and if disease progression is accelerated compared with those who are unaffected by mental disorders.²

The investigators assessed the association between the presence of PTSD and/or MDD and the risk of CKD or end-stage kidney disease (ESKD) among 2 cohorts. The first cohort included data on US veterans with at least 1 inpatient or outpatient visit between 2010 and 2012 who did not have any laboratory indication or diagnosis of CKD or ESKD during that time period (N = 4,502,210). The second cohort included about 427,000 individuals in the Stony Brook University TriNetX dataset, who were selected and enrolled based on the same criteria as cohort 1. In this study, incident CKD was defined by at least 2 laboratory measurements at least 3 months apart indicating CKD or a diagnosis of CKD.²

Cox models assessed the association between PTSD and/or MDD and CKD and/or ESKD, with adjustments made for age, sex, race/ethnicity, and comorbidities (e.g., cardiovascular disease, diabetes, hypertension, alcohol use disorder, and smoking status) if needed. The closed cohort of US veterans was followed for 10 years (2013–2022) and the closed cohort of TriNetX patients for 5 years (2017–2022). Patients without the outcome or who left the cohort for other reasons were censored at the end of the study.²

Results

Significant associations were found between PTSD and/or MDD and kidney outcomes in the 2 studied cohorts. Specifically, veterans with MDD and/or PTSD had significantly greater rates of incident CKD (MDD: HR 1.33 [95% CI 1.29–1.36]; PTSD: HR 1.72 [95% CI 1.66–1.78]) and ESKD (MDD: HR 1.83 [95% CI 1.64–2.04]; PTSD: HR 2.10 [95% CI 1.80–2.46]). In the TriNetX cohort, similar significant associations were seen (CKD and MDD: HR 1.51 [95% CI 1.36–1.66]; CKD and PTSD: HR 1.80 [95% CI 1.45–2.20]; and ESKD and MDD: HR 1.94 [95% CI 1.63–2.29]), except for the association between PTSD and ESKD (HR 1.53 [95% CI 0.89–2.49]); however, the investigators acknowledged that this was likely due to the shorter follow-up time.²

What Should Pharmacists Know About CKD and Mental Health Disorders?

Pharmacists play a crucial role at the intersection of CKD and mental health because the emerging data highlight significant gaps in diagnosis, treatment access, and medication use among these high-risk populations. Because of the elevated prevalence of depression, anxiety disorders, PTSD, and other mental illnesses in patients with CKD, pharmacists are uniquely positioned to identify untreated or undertreated conditions through medication reconciliation, screening for adherence challenges, and recognizing behavioral or symptomatic signs that indicate insufficient treatment.

Pharmacists must also be prepared to help patients manage the complexities of psychotropic therapy in the context of renal impairment, including dose adjustments, drug accumulation risks, and heightened susceptibility to adverse effects.

Pharmacists should also understand the bidirectional relationship between mental health and CKD progression, as poor psychological health is linked to reduced treatment adherence, higher hospitalization rates, and faster renal decline. By coordinating with interdisciplinary teams, counseling on available therapies—including pharmacologic and nonpharmacologic options—and advocating for mental health support, pharmacists can help close care gaps and improve outcomes for individuals navigating both CKD and mental health disorders.

The study authors emphasized that more attention must be paid to these mental health conditions, not only as significant health conditions themselves but also as important risk factors for the new onset of CKD and its progression to ESKD. Being on the frontlines, pharmacists can be crucial to recognizing this.^1,2

REFERENCES

1. Arbaugh S, Zhao R, Verma A, et al. Prevalence of Diagnosed Mental Health Disorders Among Patients with CKD: Findings from the UK Biobank Cohort. Presented at: American Society of Nephrology Kidney Week 2025; Houston, Texas. November 5–9. https://www.asn-online.org/education/kidneyweek/2025/program-abstract.aspx?controlId=4345922

2. Bragg-Gresham JL, Bano R, Han Yun, et al. Higher Incidence of CKD and ESKD Among Adults with Post-Traumatic Stress Disorder (PTSD) and Major Depressive Disorder (MDD). Presented at: American Society of Nephrology Kidney Week 2025; Houston, Texas. November 5–9. https://www.asn-online.org/education/kidneyweek/2025/program-abstract.aspx?controlId=4349107

3. National Kidney Foundation. Chronic kidney disease (CKD). September 11, 2023. Accessed November 18, 2025. https://www.kidney.org/kidney-topics/chronic-kidney-disease-ckd