Effect of Psychosocial Distress on the Rate of Kidney Function Decline

Jae Young Kim; Young Su Joo; Jong Hyun Jhee; Seung Hyeok Han; Tae-Hyun Yoo; Shin-Wook Kang; Jung Tak Park

doi:10.1007/s11606-020-06573-9

Effect of Psychosocial Distress on the Rate of Kidney Function Decline

J Gen Intern Med. 2021 Oct;36(10):2966-2974. doi: 10.1007/s11606-020-06573-9. Epub 2021 Jan 19.

Authors

Jae Young Kim¹, Young Su Joo^{1

2}, Jong Hyun Jhee^{1

3}, Seung Hyeok Han¹, Tae-Hyun Yoo¹, Shin-Wook Kang¹, Jung Tak Park⁴

Affiliations

¹ Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea.
² Division of Nephrology, Department of Internal Medicine, Myongji Hospital, Goyang, Gyeonggi-do, Republic of Korea.
³ Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
⁴ Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea. jtpark@yuhs.ac.

Abstract

Backgrounds: Chronic kidney disease is a growing global health problem. Psychosocial stress has been found to induce changes in biological processes and behavioral patterns that increase risks of cardiovascular and metabolic diseases. However, the association between psychosocial stress and kidney function is not well understood.

Objective: To evaluate the association between psychosocial stress and kidney function decline.

Design: In this prospective cohort study, psychosocial distress was assessed using the psychosocial well-being index short-form (PWI-SF).

Participants: Data of a total of 7246 participants were retrieved from a community-based cohort (Korean Genome and Epidemiology Study).

Main measures: The rate of estimated glomerular filtration rate (eGFR) decline was calculated for each individual. Rapid eGFR decline was defined as a decrease of ≥ 3 mL/min/1.73 m² per year. The presence of kidney disease was defined as eGFR < 60 mL/min/1.73 m² at baseline or proteinuria of higher than trace levels from two consecutive urine test results.

Key results: A total of 7246 participants were analyzed. The mean eGFR was 92.1 ± 14.0 mL/min/1.73 m². Rapid eGFR decline was observed in 941 (13.0%) participants during a median follow-up of 11.7 years. When the participants were categorized into tertiles according to PWI-SF score, rapid eGFR decline was more prevalent in the group with the highest PWI-SF score (15.8%) than in the group with the lowest score (12.2%). Multivariate logistic regression analysis revealed that the risk of rapid eGFR decline was significantly increased in the tertile group with the highest PWI-SF score compared to the lowest group (odds ratio, 1.35; 95% confidence interval, 1.15-1.59). This association was maintained even after adjusting for confounding variables and excluding participants with kidney disease.

Conclusions: Higher levels of psychosocial distress were closely associated with an increased risk of rapid kidney function decline.

Keywords: eGFR; kidney disease; psychosocial distress.

MeSH terms

Disease Progression
Glomerular Filtration Rate
Humans
Kidney
Prospective Studies
Renal Insufficiency, Chronic* / diagnosis
Renal Insufficiency, Chronic* / epidemiology
Renal Insufficiency, Chronic* / etiology
Risk Factors