Study: Chronic Kidney Disease Associated with Higher Incidence of Depression

Chronic kidney disease (CKD) is associated with a slightly higher incidence of depression that requires treatment, wrote researchers who published their findings in Clinical Kidney Journal.¹ Not only were younger patients at a greater risk of depression, but these findings support prior research which demonstrated an association between the 2 conditions.^1-3

Depression is one of the most common psychiatric conditions in patients with CKD, wrote the study authors. It is often associated with a decreased adherence and quality of life in patients in addition to increased risks for dialysis, hospitalizations, and mortality.¹

To assess this further, the authors conducted a retrospective cohort study to investigate the incidence of depression after the diagnosis of CKD in a large cohort derived from the IQVIA Disease Analyzer database. Specifically, a 10-year cumulative incidence of depression was compared between the cohorts, and the associations between CKD and depression, and antidepressant prescriptions were identified.¹

Investigators enrolled 331,574 individuals and assigned them to 1 of 2 cohorts depending on whether they had CKD or not at the time of enrollment (n = 165,787 per group). The 10-year incidence of depression was approximately 24.2% in patients with CKD and 22.2% in patients who did not have CKD (P < .001). Further, the incidence of depression followed by an antidepressant prescription was approximately 9.0% in the CKD cohort and 3.5% in the non-CKD cohort (P < .001), resulting in a hazard ratio (HR) of about 2.63 (95% CI 2.51–2.75). Notably, this association was strongest in patients below 60 years of age (HR: 6.03 [95% CI 5.17–7.01]).¹

A prior study published in BMC Psychiatry² assessed depression among patients with CKD, coronary heart disease, diabetes, and hypertension. These investigators found that the 2 leading comorbid conditions among the 314 patients were hypertension (83.4%) and diabetes (56.1%). Of the 261 (83.1%) patients with recorded estimated glomerular filtration rate, 113 (43.3%) had stage 3 CKD. The mean depression (PHQ-9) score was 13.0/27 (±9.15), with 306 (97.5%) patients diagnosed as having depression (mild severity: n = 116, 37.9%; moderate: n = 138, 45.1%; moderately severe: n = 38; 12.4%; and severe: n = 14; 4.6%).²

Of note, depression was independent of sex, and there were 9 sociodemographic variables observed to be associated with depression; however, level of education was the only predictor of depression with greater severity associated with lower levels of education. Additionally, at least 78.3% of the patients who self-reported “no depression” had clinical depression (moderate, moderately severe, or severe) PHQ-9 scores of 10 or greater.²

Another 2016 literature review³ found that depression is highly prevalent in patients with CKD and end-stage renal disease (ESRD). These authors identified a systematic review and meta-analysis that found, in patients with CKD, the summary prevalence of depression was about 26.5% when evaluated by screening questionnaires and 21.4% when evaluated by clinical interview. Prevalence rates were higher in ESRD than in CKD when questionnaires were used to diagnose depression (39.3% vs 26.5%); however, incidences were similar when depression was diagnosed by clinical interview (22.8% vs 21.4%). The authors speculated that this difference is likely related to uremic symptoms (eg, fatigue, insomnia, poor appetite) in ESRD populations that could overlap with somatic symptoms of depression when measured using questionnaires.³

“[Our] study demonstrates a robust association between CKD and an incident depression diagnosis with subsequent initiation of an antidepressant in German patients treated in primary care. Clinicians caring for patients with CKD should be aware of the slightly increased risk in these patients. However, our findings argue against strict screening protocols for the detection of depression in all patients with CKD,” wrote the authors of the Clinical Kidney Journal study. “Despite this, some awareness should be raised for younger patients, given that depression risk was highest in this subgroup.”¹

REFERENCES

1. Kommer A, Claßen PC, Schleicher EM, Weinmann-Menke J, Kostev K, Labenz C. Chronic kidney disease is associated with incident depression requiring treatment: a retrospective cohort study. Clin Kidney J. 2025;18(7):sfaf186. doi:10.1093/ckj/sfaf186

2. Bahall, M., Legall, G. & Lalla, C. Depression among patients with chronic kidney disease, associated factors, and predictors: a cross-sectional study. BMC Psychiatry 23, 733 (2023). doi:10.1186/s12888-023-05249-y

3. Shirazian S, Grant CD, Aina O, Mattana J, Khorassani F, Ricardo AC. Depression in Chronic Kidney Disease and End-Stage Renal Disease: Similarities and Differences in Diagnosis, Epidemiology, and Management. Kidney Int Rep. 2016;2(1):94-107. Published 2016 Sep 20. doi:10.1016/j.ekir.2016.09.005