title: Factors associated with depressive symptoms and use of antidepressant medications among participants in the Chronic Renal Insufficiency Cohort (CRIC) and Hispanic-CRIC Studies.
abstract: BACKGROUND
  Depressive symptoms are correlated with poor health outcomes in adults with chronic kidney disease (CKD). The prevalence, severity, and treatment of depressive symptoms and potential risk factors, including level of kidney function, in diverse populations with CKD have not been well studied.
  
  
  METHODS
  Cross-sectional analysis.
  
  
  METHODS
  Participants at enrollment into the Chronic Renal Insufficiency Cohort (CRIC) and Hispanic-CRIC (H-CRIC) Studies. CRIC enrolled Hispanics and non-Hispanics at 7 centers in 2003-2007, and H-CRIC enrolled Hispanics at the University of Illinois in 2005-2008.
  
  
  METHODS
  Depressive symptoms measured by Beck Depression Inventory (BDI).
  
  
  METHODS
  Demographic and clinical factors.
  
  
  RESULTS
  Elevated depressive symptoms (BDI score ≥11) and antidepressant medication use.
  
  
  RESULTS
  Of 3,853 participants, 27.4% had evidence of elevated depressive symptoms and 18.2% were using antidepressant medications; 31.0% of persons with elevated depressive symptoms were using antidepressants. The prevalence of elevated depressive symptoms varied by level of kidney function: 23.6% for participants with estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m(2) and 33.8% of those with eGFR <30 mL/min/1.73 m(2). Lower eGFR (OR per 10-mL/min/1.73 m(2) decrease, 1.10; 95% CI, 1.04-1.17), and non-Hispanic black race (OR, 1.42; 95% CI, 1.16-1.74) were each associated with increased odds of elevated depressive symptoms after controlling for other factors. In regression analyses incorporating BDI score, whereas female sex was associated with greater odds of antidepressant use, Hispanic ethnicity, non-Hispanic black race, and higher urine albumin levels were associated with decreased odds of antidepressant use (P < 0.05 for each).
  
  
  CONCLUSIONS
  Absence of clinical diagnosis of depression and use of nonpharmacologic treatments.
  
  
  CONCLUSIONS
  Although elevated depressive symptoms were common in individuals with CKD, use of antidepressant medications is low. Individuals of racial and ethnic minority background and with more advanced CKD had a greater burden of elevated depressive symptoms and lower use of antidepressant medications.
authors.affiliation: Medicine, Jesse Brown VA Medical Center and University of Illinois Medical Center, Chicago, USA. fischerm@uic.edu
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Fischer
authors.forename: Dawei
authors.initials: D
authors.lastname: Xie
authors.forename: Neil
authors.initials: N
authors.lastname: Jordan
authors.forename: Willem J
authors.initials: WJ
authors.lastname: Kop
authors.forename: Marie
authors.initials: M
authors.lastname: Krousel-Wood
authors.forename: Manjula
authors.initials: M
authors.lastname: Kurella Tamura
authors.forename: John W
authors.initials: JW
authors.lastname: Kusek
authors.forename: Virginia
authors.initials: V
authors.lastname: Ford
authors.forename: Leigh K
authors.initials: LK
authors.lastname: Rosen
authors.forename: Louise
authors.initials: L
authors.lastname: Strauss
authors.forename: Valerie L
authors.initials: VL
authors.lastname: Teal
authors.forename: Kristine
authors.initials: K
authors.lastname: Yaffe
authors.forename: Neil R
authors.initials: NR
authors.lastname: Powe
authors.forename: James P
authors.initials: JP
authors.lastname: Lash
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000453:epidemiology; D000928:Antidepressive Agents / Q000627:therapeutic use*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology*; D005260:Female; D005919:Glomerular Filtration Rate; D006630:Hispanic or Latino; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012044:Regression Analysis; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000523:psychology; D012307:Risk Factors
chemical_list: D000928:Antidepressive Agents