Potential Link Found Between Depression, Kidney Failure

Adults with normal kidney function who have comorbid depression are more likely to experience a decline in kidney function and have mental and physical impairments from that decline.

Adults with normal kidney function who have comorbid depression are more likely to experience a decline in kidney function, as measured by estimated glomerular filtration rate (eGFR) based on serum creatinine and cystatin C (eGFRcr-cys), according to a new study from the American Society of Nephrology published in Clinical Journal of the American Society of Nephrology.

The study also found that depression, a common condition in middle-aged and older adults, can contribute to both mental and physical problems and is a potential cause of rapid kidney function decline in patients with chronic kidney disease (CKD).

“While our study does not show causality, it demonstrated that high depressive symptoms were significantly associated with rapid decline in kidney function among Chinese adults with normal kidney function,” said lead investigator Xianhui Qin, MD (Nanfang Hospital, Southern Medical University, in China), in a statement.

The study cohort comprised 4763 individuals (mean [SD] age, 59 [9] years) with healthy kidneys (eGFR of > 60 mL/min/1.73 m2) enrolled from the China Health and Retirement Longitudinal Study. Their primary outcome was rapid decline in kidney function, defined as an annual eGFR decline of > 5 mL/min/1.73 m2, and the secondary outcome of interest was an annual eGFR decline of > 5 mL/min/1.73 m2 to < 60 mL/min/1.73 m2 at the exit visit.

Overall, during the median (interquartile range [IQR]) follow-up of 4 (IQR, 3.92-4.00) years, 6% of participants experienced rapid decline in kidney function. Following adjustment for such covariates as demographic, clinical, or psychosocial characteristics, a significant positive association was seen between baseline symptoms of depression and rapid decline in kidney function (adjusted odds ratio [aOR], 1.15; 95% CI, 1.03-1.28).

eGFRcr-cys was a mean 89 (15) mL/min/1.73 m2 at baseline and 92 (16) mL/min/1.73 m2 by the time of the exit interview. Thiry-nine percent of participants had high symptoms of depression at baseline as measured by Center for Epidemiologic Studies Depression (CES-D) score of 10 or above.

Qin called CKD “a leading risk factor for cardiovascular disease, kidney failure, and mortality worldwide,” adding, “the identification of more modifiable risk factors may possibly reduce the huge burden of CKD and its related complications by leading to early detection and prevention.”

Analyses also found:

  • 39% greater chance of rapid kidney decline was seen among the participants with high depressive symptom (aOR, 1.39; 95% CI, 1.03-1.88) vs low depressive symptoms
  • 24% and 118% greater chances of rapid kidney decline were seen among those with moderate (aOR, 1.24; 95% CI, 0.90-1.72; total CES-D score, 10 to < 21) and higher (aOR, 2.18; 95% CI, 1.32-3.62; CES-D score, > 21) depressive symptoms, respectively, vs low (total CES-D score, < 10)
  • 44% greater chance of rapid kidney decline for patients in depressive symptom quintiles 4 and 5 (aOR, 1.44; 95% CI, 1.07-1.93; total CES-D score, > 9) vs quintiles 1-3 (total CES-D score, < 9)

Adjustment for low-density lipoprotein cholesterol level or for a possible association between depressive symptoms and eGFRcr or eGFRcys alone did not change the authors’ findings.

“If further confirmed, our data provide some evidence for depressive symptom screening and effective psychosocial interventions to improve the prevention of CKD,” Qin concluded.

Maggie L. Shaw contributed to this article.


Zhang Z, He P, Lie C, et al. Association of depressive symptoms with rapid kidney function decline in adults with normal kidney function. Clin J Am Soc Nephrol. 2021;16(6):889-897. doi: 10.2215/CJN.18441120

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