title: Diabetes self-care, major depression, and chronic kidney disease in an outpatient diabetic population.
abstract: OBJECTIVE
  The associations between major depression and chronic kidney disease (CKD) in patients with diabetes are incompletely characterized. Depressed patients with diabetes are known to have worse diabetes self-care, but it is not known whether this mediates the association between depression and CKD in this population.
  
  
  METHODS
  We conducted a cross-sectional study of the associations between major depressive symptoms and CKD in the Pathways Study (n = 4,082), an observational cohort of ambulatory diabetic patients from a managed care setting. Depression status was ascertained using the Patient Health Questionnaire-9 (PHQ-9). Stepwise logistic regression models examined the associations between depression and impaired estimated glomerular filtration rate (<60 ml/min/1.73 m(2)) or microalbuminuria, after adjustment for demographics, CKD risk factors, and diabetes self-care variables.
  
  
  RESULTS
  Clinically significant depression symptoms (PHQ-9 ≥10) were associated with a greater risk of microalbuminuria after adjustment for demographic variables (OR 1.54, 95% CI 1.21-1.95) and traditional CKD risk factors (OR 1.36, 95% CI 1.04-1.77); this association persisted after additional adjustment for diabetes self-care (OR 1.34, 95% CI 1.02-1.75). Depression was not associated with impaired estimated glomerular filtration rate in any of the models.
  
  
  CONCLUSIONS
  In this cohort of diabetic subjects, clinically significant depression symptoms were associated with microalbuminuria, which could not be entirely explained by differences in diabetes self-care.
authors.affiliation: Division of Nephrology, University of Washington, Seattle, Wash., USA.
authors.forename: Margaret K
authors.initials: MK
authors.lastname: Yu
authors.forename: Wayne
authors.initials: W
authors.lastname: Katon
authors.forename: Bessie A
authors.initials: BA
authors.lastname: Young
mesh_terms: D000419:Albuminuria / Q000453:epidemiology*; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000453:epidemiology*; D048909:Diabetes Complications / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000628:therapy; D012307:Risk Factors; D012648:Self Care / Q000706:statistics & numerical data*; D016896:Treatment Outcome