Association of depression and antidepressant use with mortality in a large cohort of patients with nondialysis-dependent CKD.
OBJECTIVE
Depression is common and is associated with higher mortality in patients with ESRD or CKD (stage 5). Less information is available on earlier stages of CKD. This study aimed to determine the prevalence of depression and any association with all-cause mortality in patients with varying severity of nondialysis-dependent CKD.


METHODS
This is a retrospective study of a national cohort of 598,153 US veterans with nondialysis-dependent CKD stages 1-5 followed for a median of 4.7 years in the US Department of Veterans Affairs Health System. Diagnosis of depression was established as a result of systematic screening and administration of antidepressants. Association of depression with all-cause mortality overall and stratified by CKD stages were examined with the Kaplan-Meier method and in Cox models.


RESULTS
There were 179,441 patients (30%) with a diagnosis of depression. Over median follow-up of 4.7 years, depression was associated with significantly higher age-adjusted mortality overall (hazard ratio, 1.55; 95% confidence interval, 1.54-1.57; P<0.001). Sequential adjustments for sociodemographic characteristics and especially for comorbid conditions attenuated this association, which nevertheless remained significant (hazard ratio, 1.25; 95% confidence interval, 1.23-1.26).


CONCLUSIONS
In this large cohort of predominantly elderly male patients with CKD, prevalence of depression and antidepressant use is high (30%) and is associated with significantly higher all-cause mortality independent of comorbid conditions.
Division of Nephrology, University of Virginia, Charlottesville, Virginia 22908, USA. rb8mh@virginia.edu
Rasheed A
RA
Balogun
Emaad M
EM
Abdel-Rahman
Seki A
SA
Balogun
Evan H
EH
Lott
Jun Ling
JL
Lu
Sandra M
SM
Malakauskas
Jennie Z
JZ
Ma
Kamyar
K
Kalantar-Zadeh
Csaba P
CP
Kovesdy
D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D003863:Depression / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000401:mortality* / Q000523:psychology*; D012189:Retrospective Studies
D000928:Antidepressive Agents