title: Association between estimated GFR, health-related quality of life, and depression among older adults with diabetes: the Diabetes and Aging Study.
abstract: BACKGROUND
  Although chronic kidney disease (CKD) is a highly prevalent condition among older adults with diabetes, the associations between health-related quality of life (HRQoL) and severity of CKD in this population are not well understood. The objective of this study was to assess HRQoL and depressive symptoms across estimated glomerular filtration rate (eGFR) stages.
  
  
  METHODS
  Cross-sectional.
  
  
  METHODS
  5,805 members of Kaiser Permanente Northern California, 60 years or older with diabetes, from the 2005-2006 Diabetes Study of Northern California (DISTANCE) survey.
  
  
  METHODS
  eGFR categories were defined as ≥90 (referent category), 75-89, 60-74, 45-59, 30-44, or ≤29 mL/min/1.73 m(2).
  
  
  RESULTS
  HRQoL was measured using the modified Short Form-8 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. Depressive symptoms were measured using the Patient Health Questionnaire-8.
  
  
  RESULTS
  In unadjusted linear regression analyses, physical (PCS) and mental (MCS) HRQoL scores were significantly lower with worsening eGFR level. However, after adjustment for sociodemographics, diabetes duration, obesity, and cardiovascular comorbid conditions and taking into account interactions with proteinuria, none of the eGFR categories was significantly or substantively associated with PCS or MCS score. In both unadjusted and adjusted analyses, higher risk of depressive symptoms was observed in respondents with eGFR ≤29 mL/min/1.73 m(2) (relative risk, 2.02; 95% CI, 1.10-3.71; P < 0.05) compared with the referent group. However, this eGFR-depression relationship was no longer significant after adjusting for hemoglobin level.
  
  
  CONCLUSIONS
  Participants are part of a single health care delivery system.
  
  
  CONCLUSIONS
  Our findings suggest the need for greater attention to and potential interventions for depression in patients with reduced eGFR.
authors.affiliation: Department of Medicine, University of Chicago, Chicago, IL 60637, USA. kcampbel@medicine.bsd.uchicago.edu
authors.forename: Kellie Hunter
authors.initials: KH
authors.lastname: Campbell
authors.forename: Elbert S
authors.initials: ES
authors.lastname: Huang
authors.forename: William
authors.initials: W
authors.lastname: Dale
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Parker
authors.forename: Priya M
authors.initials: PM
authors.lastname: John
authors.forename: Bessie A
authors.initials: BA
authors.lastname: Young
authors.forename: Howard H
authors.initials: HH
authors.lastname: Moffet
authors.forename: Neda
authors.initials: N
authors.lastname: Laiteerapong
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Karter
mesh_terms: D000368:Aged; D000375:Aging / Q000502:physiology / Q000523:psychology*; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology*; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology*; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006306:Health Surveys / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology*; D012042:Registries; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology*
keywords: Aging; chronic kidney disease (CKD); depression; quality of life