TY - JOUR
T1 - Albuminuria is associated with a higher prevalence of depression in a population-based cohort study: the Maastricht Study
AU - Martens, Remy J. H.
AU - Kooman, Jeroen P.
AU - Stehouwer, Coen D. A.
AU - Dagnelie, Pieter C.
AU - van der Kallen, Carla J. H.
AU - Kroon, Abraham A.
AU - Leunissen, Karel M. L.
AU - van der Sande, Frank M.
AU - Schaper, Nicolaas C.
AU - Sep, Simone J. S.
AU - Kohler, Sebastian
AU - Schram, Miranda T.
AU - Henry, Ronald M. A.
PY - 2018/1/1
Y1 - 2018/1/1
N2 - Background. Depression is common in individuals with chronic kidney disease (CKD). However, data on the association of albuminuria, which together with reduced estimated glomerular filtration rate (eGFR) defines CKD, with depression are scarce and conflicting. In addition, it is not clear when in the course from normal kidney function to CKD the association with depression appears. Methods. We examined the cross-sectional associations of albuminuria and eGFR with depressive symptoms and depressive episodes in 2872 and 3083 40- to 75-year-old individuals, respectively, who completed the baseline survey of an ongoing population-based cohort study conducted in the southern part of The Netherlands between November 2013. Urinary albumin excretion (UAE) was the average UAE in two 24-h urine collections and eGFR was calculated with the Chronic Kidney Disease Epidemiology Collaboration equation based on creatinine and cystatin C. Depressive symptoms were assessed with the 9-item Patient Health Questionnaire (PHQ-9) and the presence of a minor or major depressive episode was assessed with the MINI-International Neuropsychiatric Interview. Results. In total, 5.4% had a minor or major depressive episode. UAE was <15 mg/24 h in 81.2%, 15-<30 mg/24 h in 10.3% and >= 30 mg/24 h in 8.6%. In a multivariable logistic regression analysis adjusted for potential confounders, and with UAE <15 mg/24 h as reference category, the odds ratio for a minor or major depressive episode was 2.13 [95% confidence interval (CI) 1.36-3.36] for UAE 15-<30 mg/24 h and 1.81 (95% CI 1.10-2.98) for UAE-30 mg/24 h. The average eGFR was 88.2 +/- 14.7 mL/min/1.73 m(2). eGFR was not associated with the presence of a minor or major depressive episode. Results were similar when we assessed associations with depressive symptoms or clinically relevant depressive symptoms (PHQ-9 score >= 10). Conclusions. Albuminuria was associated with depressive symptoms and depressive episodes, even at levels of UAE that do not fulfil the CKD criteria. Future longitudinal studies should examine the direction of this association and whether albuminuria could serve as a biomarker to identify individuals at risk of depression.
AB - Background. Depression is common in individuals with chronic kidney disease (CKD). However, data on the association of albuminuria, which together with reduced estimated glomerular filtration rate (eGFR) defines CKD, with depression are scarce and conflicting. In addition, it is not clear when in the course from normal kidney function to CKD the association with depression appears. Methods. We examined the cross-sectional associations of albuminuria and eGFR with depressive symptoms and depressive episodes in 2872 and 3083 40- to 75-year-old individuals, respectively, who completed the baseline survey of an ongoing population-based cohort study conducted in the southern part of The Netherlands between November 2013. Urinary albumin excretion (UAE) was the average UAE in two 24-h urine collections and eGFR was calculated with the Chronic Kidney Disease Epidemiology Collaboration equation based on creatinine and cystatin C. Depressive symptoms were assessed with the 9-item Patient Health Questionnaire (PHQ-9) and the presence of a minor or major depressive episode was assessed with the MINI-International Neuropsychiatric Interview. Results. In total, 5.4% had a minor or major depressive episode. UAE was <15 mg/24 h in 81.2%, 15-<30 mg/24 h in 10.3% and >= 30 mg/24 h in 8.6%. In a multivariable logistic regression analysis adjusted for potential confounders, and with UAE <15 mg/24 h as reference category, the odds ratio for a minor or major depressive episode was 2.13 [95% confidence interval (CI) 1.36-3.36] for UAE 15-<30 mg/24 h and 1.81 (95% CI 1.10-2.98) for UAE-30 mg/24 h. The average eGFR was 88.2 +/- 14.7 mL/min/1.73 m(2). eGFR was not associated with the presence of a minor or major depressive episode. Results were similar when we assessed associations with depressive symptoms or clinically relevant depressive symptoms (PHQ-9 score >= 10). Conclusions. Albuminuria was associated with depressive symptoms and depressive episodes, even at levels of UAE that do not fulfil the CKD criteria. Future longitudinal studies should examine the direction of this association and whether albuminuria could serve as a biomarker to identify individuals at risk of depression.
KW - albuminuria
KW - depression
KW - depressive symptoms
KW - estimated glomerular filtration rate
KW - urinary albumin excretion
KW - CHRONIC KIDNEY-DISEASE
KW - QUALITY-OF-LIFE
KW - GLOMERULAR-FILTRATION-RATE
KW - SMALL VESSEL DISEASE
KW - CHRONIC RENAL-INSUFFICIENCY
KW - GENERAL ELDERLY POPULATION
KW - OLDER-ADULTS
KW - ENDOTHELIAL DYSFUNCTION
KW - VASCULAR DEPRESSION
KW - NORMATIVE DATA
U2 - 10.1093/ndt/gfw377
DO - 10.1093/ndt/gfw377
M3 - Article
C2 - 27965374
SN - 0931-0509
VL - 33
SP - 128
EP - 138
JO - Nephrology Dialysis Transplantation
JF - Nephrology Dialysis Transplantation
IS - 1
ER -