Association between Psychiatric Disorders and Glomerular Disease

Hailey E Desmond; Clare Lindner; Jonathan P Troost; Zack Held; Andrea Callaway; Gia J Oh; Richard Lafayette; Michelle O'Shaughnessy; Matthew Elliott; Sharon G Adler; Elaine S Kamil; Anne Pesenson; David T Selewski; Patrick E Gipson; Noelle E Carlozzi; Debbie S Gipson; Susan F Massengill

doi:10.1159/000516359

Association between Psychiatric Disorders and Glomerular Disease

Glomerular Dis. 2021 Jul 8;1(3):118-128. doi: 10.1159/000516359. eCollection 2021 Aug.

Authors

Hailey E Desmond¹, Clare Lindner¹, Jonathan P Troost², Zack Held³, Andrea Callaway⁴, Gia J Oh⁵, Richard Lafayette⁶, Michelle O'Shaughnessy⁷, Matthew Elliott⁸, Sharon G Adler⁹, Elaine S Kamil¹⁰, Anne Pesenson¹¹, David T Selewski¹², Patrick E Gipson^{1

13}, Noelle E Carlozzi¹⁴, Debbie S Gipson¹, Susan F Massengill³

Affiliations

¹ Division of Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA.
² Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, Michigan, USA.
³ Division of Pediatric Nephrology, Department of Pediatrics, Levine Children's Hospital, Atrium Health, Charlotte, North Carolina, USA.
⁴ Nephrotic Syndrome Foundation, Alamo, California, USA.
⁵ Department of Pediatric Nephrology, Randall Children's Hospital at Legacy Emanuel Medical Center, Legacy Health, Portland, Oregon, USA.
⁶ Division of Nephrology, Stanford University School of Medicine, Palo Alto, California, USA.
⁷ University College Cork, Cork University Hospital, Cork, Ireland.
⁸ Metrolina Nephrology Associates, Charlotte, North Carolina, USA.
⁹ Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-University of California, Torrance, California, USA.
¹⁰ Division of Pediatric Nephrology, Department of Pediatrics, Cedars-Sinai Medical Center, David Geffen School of Medicine at the University of California, Los Angeles, California, USA.
¹¹ The Polyclinic, Seattle, Washington, USA.
¹² Division of Nephrology, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA.
¹³ Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
¹⁴ Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA.

Abstract

Introduction: Patients with chronic health conditions, particularly chronic kidney disease, are at heightened risk for psychiatric disorders; yet, there are limited data on those with primary glomerular disease.

Methods: This study included patients with glomerular disease enrolled in the kidney research network multisite patient registry. Registry data include encounter, diagnoses, medication, laboratory, and vital signs data extracted from participants' electronic health records. ICD-9/10 diagnosis codes were used to identify a subset of psychiatric disorders focused on anxiety, mood, and behavioral disorders. Time-varying Cox proportional hazard models were used to analyze time from the onset of kidney disease to diagnosis of psychiatric disorder. Adjusted models retained significant covariates from the full list of potential confounders, including age, sex, race, ethnicity, time-varying treatment, the estimated glomerular filtration rate, and proteinuria (urine protein-to-creatinine ratio [UPCR]). Analogous models examined diagnosis of psychiatric disorder as a predictor of time to end-stage kidney disease (ESKD).

Results: Data were available for 950 participants, with a median of 58 months of follow-up. 110 (12%) participants were diagnosed with psychiatric disorder during the follow-up. The estimated rate of psychiatric diagnosis after kidney disease was 14.7 cases per 1,000 person-years and was highest among those of adolescent age at the time of kidney disease diagnosis. Adjusted analyses found adolescent age (vs. adult, hazard ratio [HR] = 3.11, 95% confidence interval [CI] 1.87-5.17) and Asian race (vs. white, HR = 0.34, 95% CI 0.16-0.71) were associated with psychiatric diagnosis. A higher UPCR per 1 log unit (HR 1.13, 95% CI 1.01-1.27) and a higher total number of oral medications were associated with psychiatric disorder (p < 0.001). Psychiatric diagnosis was also associated with progression to ESKD (HR = 2.45, 95% CI 1.53-3.92) in adjusted models.

Discussion/conclusion: Psychiatric disorders were documented in approximately one-eighth of patients with glomerular disease and correlated with clinical disease characteristics such as age, race, proteinuria, and oral medication burden. These findings suggest mental health screening is warranted in patients of all ages with glomerular disease.

Keywords: Anxiety; Electronic health record; End-stage kidney disease; Glomerular disease; Nephrotic syndrome; Psychiatric disorder.

Grants and funding

The Kidney Research Network (KRN) registry enrollment, data collection, analytic design, interpretation of data, and writing of this manuscript are supported by the Atrium Health Medical Foundation and the University of Michigan. Additional analytic work for this study was funded in part by the National Center for Advancing Translational Sciences (NCATS Grant number: UL1TR002240) for the Michigan Institute for Clinical and Health Research.