CM MCKERCHER1, KA SANDERSON1,2, AJ VENN1, AL NEIL1, MD JOSE1,3,4
1Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania; 2School of Health Sciences, University of East Anglia, Norwich, UK; 3School of Medicine, University of Tasmania, Hobart, Tasmania; 3Royal Hobart Hospital, Hobart, Tasmania
Aim: To examine the prevalence and correlates of depressive symptoms in adults with advanced chronic kidney disease (CKD).
Background: Depression is independently associated with increased risk of mortality and poor health-related quality of life in dialysis patients, yet few studies have examined depression in adults with CKD prior to the initiation of renal replacement therapy.
Methods: 94 adults (29 women, 31%), aged ≥18 years (71.3±11.8 years) with CKD (eGFR <30 mls/min/1.73m2) and not receiving dialysis were recruited via treating physicians. Prevalence and severity of depressive symptoms was assessed using the 9-item Patient Health Questionnaire (PHQ-9). Cross-sectional associations between depressive symptoms and demographic, psychosocial, and clinical factors were examined using multivariable linear regression.
Results: Mean PHQ-9 score was 4.1±5.1, range 0-27. Prevalence of mild depression was 23% (PHQ-9 ≥5 & <10) and major depression was 12% (PHQ-9 ≥10). In partially adjusted models, lower age, increasing BMI, increasing number of symptoms of anxiety (Beck Anxiety Inventory, p<0.001), lower perceived social support (Multidimensional Scale of Perceived Social Support, p<0.05) and lower perceived physical health (SF-36 Physical Component Summary, p<0.05) were associated with increased severity of depressive symptoms. Anxiety, social support, and physical health remained significant in fully adjusted multivariable models. There was no association between kidney function (eGFR; mean 21.8±6.4 mls/min/1.73m2) and depressive symptoms.
Conclusions: Consistent with other chronic disease populations, the prevalence of major depression in this cohort was higher than the age-matched general population. Similarly, anxiety, social support and physical health appear to be important correlates of depressive symptoms in adults with pre-dialysis CKD. Prospective assessment of this cohort will allow us to examine the trajectory of depressive symptoms and their influence on health-related outcomes.