title: Association of depressive and anxiety symptoms with adverse events in Dutch chronic kidney disease patients: a prospective cohort study.
abstract: BACKGROUND
  Depressive symptoms have been reported to be associated with adverse clinical outcome in patients with chronic kidney disease (CKD) not on dialysis. This association has not been examined in Europe. Anxiety and depressive symptoms often co-occur. However, as yet there are no data concerning a possible association of anxiety symptoms with adverse clinical outcome. We examined the association of depressive and anxiety symptoms with adverse clinical outcome in Dutch CKD patients not on dialysis.
  
  
  METHODS
  In this 3-year follow-up prospective cohort study, CKD patients not on dialysis with an estimated glomerular filtration rate (eGFR) ≤ 35 ml/min/1.73 m(2) from an urban teaching hospital were selected. Symptoms of depression and anxiety were evaluated using the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI). Cox proportional hazards models were used to calculate hazard ratio's (HRs) with a composite event of death, initiation of dialysis, and hospitalization as outcome. HRs were adjusted for age, gender, diabetes, cardiovascular disease and eGFR.
  
  
  RESULTS
  Of 100 included CKD patients depressive and anxiety symptoms were present in 34 and 31 %, respectively. Adjusted HRs for the composite event for patients with depressive and anxiety symptoms were 2.0 (95 % confidence interval (CI) 1.2-3.5) and 1.6 (95 % CI 0.9-2.7), respectively. Twenty three patients had both depressive and anxiety symptoms of whom adjusted HRs were 2.2 (95 % CI 1.2-4.0) for a composite event.
  
  
  CONCLUSIONS
  Depressive and anxiety symptoms are common in patients with CKD in The Netherlands. Depressive symptoms are associated with an increased risk of poor clinical outcome. Anxiety symptoms show a trend for an increased risk of poor clinical outcome. There seems to be no additive effect of anxiety symptoms in addition to depressive symptoms with regard to poor clinical outcome.
authors.affiliation: Department of Nephrology, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands. b.loosman@slaz.nl.|Department of Psychiatry, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands. b.loosman@slaz.nl.
authors.forename: Wim L
authors.initials: WL
authors.lastname: Loosman
authors.affiliation: Department of Nephrology, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands. markrottier@gmail.com.
authors.forename: Marcus A
authors.initials: MA
authors.lastname: Rottier
authors.affiliation: Department of Psychiatry, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands. a.honig@slaz.nl.|Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands. a.honig@slaz.nl.
authors.forename: Adriaan
authors.initials: A
authors.lastname: Honig
authors.affiliation: Department of Nephrology, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands. c.siegert@slaz.nl.
authors.forename: Carl E H
authors.initials: CE
authors.lastname: Siegert
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005919:Glomerular Filtration Rate; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D006435:Renal Dialysis / Q000706:statistics & numerical data; D051436:Renal Insufficiency, Chronic / Q000401:mortality / Q000523:psychology* / Q000628:therapy