title: Elevated depressive affect is associated with adverse cardiovascular outcomes among African Americans with chronic kidney disease.
abstract: This study was designed to examine the impact of elevated depressive affect on health outcomes among participants with hypertensive chronic kidney disease in the African-American Study of Kidney Disease and Hypertension (AASK) Cohort Study. Elevated depressive affect was defined by Beck Depression Inventory II (BDI-II) thresholds of 11 or more, above 14, and by 5-Unit increments in the score. Cox regression analyses were used to relate cardiovascular death/hospitalization, doubling of serum creatinine/end-stage renal disease, overall hospitalization, and all-cause death to depressive affect evaluated at baseline, the most recent annual visit (time-varying), or average from baseline to the most recent visit (cumulative). Among 628 participants at baseline, 42% had BDI-II scores of 11 or more and 26% had a score above 14. During a 5-year follow-up, the cumulative incidence of cardiovascular death/hospitalization was significantly greater for participants with baseline BDI-II scores of 11 or more compared with those with scores <11. The baseline, time-varying, and cumulative elevated depressive affect were each associated with a significant higher risk of cardiovascular death/hospitalization, especially with a time-varying BDI-II score over 14 (adjusted HR 1.63) but not with the other outcomes. Thus, elevated depressive affect is associated with unfavorable cardiovascular outcomes in African Americans with hypertensive chronic kidney disease.
authors.affiliation: Department of Medicine and Biostatistics and Epidemiology, Jesse Brown VA Medical Center and University of Illinois Medical Center, 5000 S. 5th Avenue, Hines, IL 60141, USA. fischerm@uic.edu
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Fischer
authors.forename: Paul L
authors.initials: PL
authors.lastname: Kimmel
authors.forename: Tom
authors.initials: T
authors.lastname: Greene
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Gassman
authors.forename: Xuelei
authors.initials: X
authors.lastname: Wang
authors.forename: Deborah H
authors.initials: DH
authors.lastname: Brooks
authors.forename: Jeanne
authors.initials: J
authors.lastname: Charleston
authors.forename: Donna
authors.initials: D
authors.lastname: Dowie
authors.forename: Denyse
authors.initials: D
authors.lastname: Thornley-Brown
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Cooper
authors.forename: Marino A
authors.initials: MA
authors.lastname: Bruce
authors.forename: John W
authors.initials: JW
authors.lastname: Kusek
authors.forename: Keith C
authors.initials: KC
authors.lastname: Norris
authors.forename: James P
authors.initials: JP
authors.lastname: Lash
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000523:psychology; D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality / Q000523:psychology; D015331:Cohort Studies; D003863:Depression / Q000150:complications*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000401:mortality / Q000523:psychology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000523:psychology*; D014481:United States / Q000453:epidemiology; D055815:Young Adult