Depression and incident cardiovascular disease among patients with chronic kidney disease

Anthony D'Oro; Devansh Himanshu Patel; Sojin Wass; Trygve Dolber; Khurram Nasir; Mirela Dobre; Mahboob Rahman; Sadeer Al-Kindi

doi:10.1016/j.ijcrp.2023.200199

Depression and incident cardiovascular disease among patients with chronic kidney disease

Int J Cardiol Cardiovasc Risk Prev. 2023 Jul 18:18:200199. doi: 10.1016/j.ijcrp.2023.200199. eCollection 2023 Sep.

Authors

Anthony D'Oro¹, Devansh Himanshu Patel², Sojin Wass², Trygve Dolber³, Khurram Nasir⁴, Mirela Dobre⁵, Mahboob Rahman⁵, Sadeer Al-Kindi⁶

Affiliations

¹ School of Medicine, Case Western Reserve University, Cleveland, OH, USA. This author Takes responsibility for all aspects of the reliability and freedom from bias of the data presented and Their discussed interpretation.
² Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH, USA. This author Takes responsibility for all aspects of the reliability and freedom from bias of the data presented and Their discussed interpretation.
³ Department of Psychiatry, University Hospitals and Case Western Reserve University, Cleveland, OH, USA. This author Takes responsibility for all aspects of the reliability and freedom from bias of the data presented and Their discussed interpretation.
⁴ Division of Cardiovascular Prevention and Wellness, Debakey Heart and Vascular Institute, Houston Methodist Hospital, Houston, TX, USA. This author Takes responsibility for all aspects of the reliability and freedom from bias of the data presented and Their discussed interpretation.
⁵ School of Medicine, Case Western Reserve University, Cleveland, OH, USA; Division of Nephrology and Hypertension, Department of Medicine, University Hospitals, Cleveland, OH, USA. This author Takes responsibility for all aspects of the reliability and freedom from bias of the data presented and Their discussed interpretation.
⁶ School of Medicine, Case Western Reserve University, Cleveland, OH, USA; Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH, USA. This author Takes responsibility for all aspects of the reliability and freedom from bias of the data presented and Their discussed interpretation.

Abstract

Background: Depression is associated with an increased risk of cardiovascular disease (CVD) and is prevalent among patients with chronic kidney disease (CKD). We aimed to identify the association of depression with incident CVD.

Methods: We studied patients with CKD stages 2-4 enrolled in the Chronic Renal Insufficiency Cohort (CRIC) and excluded participants with preexisting CVD. The Cox proportional hazard model was used to examine the association between baseline depression [Beck's Depression Inventory (BDI) score ≥11] and incidence of CVD (cerebrovascular accident, myocardial infarction, heart failure, or peripheral artery disease). Models were adjusted for age, sex, race, estimated glomerular filtration rate (eGFR), urine albumin-creatinine ratio (UACR), systolic and diastolic blood pressure, and 10-year estimated CVD risk.

Results: Among 2585 CRIC study participants, 640 (25%) patients had depression at study baseline. Compared to patients without depression, patients with depression were more likely to be women (56% vs. 46%), non-White (68% vs. 53%), with household income <$20,000 (53% vs. 26%), without a high school degree (31% vs. 15%), uninsured (13% vs. 7%), with lower eGFR (42 vs. 46 ml/min/1.73 m (Palmer et al., 2013 Jul)22), and with higher UACR (90 vs. 33 mg/g). In multivariate analyses, depression was associated with a 29% increased risk of developing CVD (adjusted hazard ratio 1.29, 95% confidence interval 1.03-1.62, p = 0.03). BDI (as a continuous variable) was associated with CVD (adjusted hazard ratio 1.017, 95% confidence interval 1.004-1.030, p = 0.012).

Conclusions: Among patients with CKD stages 2-4 enrolled in CRIC without preexisting CVD, depression was associated with a 29% increased risk of incident CVD.

Keywords: Cardiovascular risk; Psychosocial risk factors.

Grants and funding

P50 MD017351/MD/NIMHD NIH HHS/United States