title: Albuminuria is associated with a higher prevalence of depression in a population-based cohort study: the Maastricht Study.
abstract: Depression is common in individuals with chronic kidney disease (CKD). However, data on the association of albuminuria, which together with reduced estimated glomerular filtration rate (eGFR) defines CKD, with depression are scarce and conflicting. In addition, it is not clear when in the course from normal kidney function to CKD the association with depression appears.
  
  
  
  We examined the cross-sectional associations of albuminuria and eGFR with depressive symptoms and depressive episodes in 2872 and 3083 40- to 75-year-old individuals, respectively, who completed the baseline survey of an ongoing population-based cohort study conducted in the southern part of The Netherlands between November 2010 and September 2013. Urinary albumin excretion (UAE) was the average UAE in two 24-h urine collections and eGFR was calculated with the Chronic Kidney Disease Epidemiology Collaboration equation based on creatinine and cystatin C. Depressive symptoms were assessed with the 9-item Patient Health Questionnaire (PHQ-9) and the presence of a minor or major depressive episode was assessed with the MINI-International Neuropsychiatric Interview.
  
  
  
  In total, 5.4% had a minor or major depressive episode. UAE was <15 mg/24 h in 81.2%, 15-<30 mg/24 h in 10.3% and ≥30 mg/24 h in 8.6%. In a multivariable logistic regression analysis adjusted for potential confounders, and with UAE <15 mg/24 h as reference category, the odds ratio for a minor or major depressive episode was 2.13 [95% confidence interval (CI) 1.36-3.36] for UAE 15-<30 mg/24 h and 1.81 (95% CI 1.10-2.98) for UAE ≥30 mg/24 h. The average eGFR was 88.2 ± 14.7 mL/min/1.73 m2. eGFR was not associated with the presence of a minor or major depressive episode. Results were similar when we assessed associations with depressive symptoms or clinically relevant depressive symptoms (PHQ-9 score ≥10).
  
  
  
  Albuminuria was associated with depressive symptoms and depressive episodes, even at levels of UAE that do not fulfil the CKD criteria. Future longitudinal studies should examine the direction of this association and whether albuminuria could serve as a biomarker to identify individuals at risk of depression.
authors.affiliation: Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center+, Maastricht, The Netherlands.|NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
authors.forename: Remy J H
authors.initials: RJH
authors.lastname: Martens
authors.affiliation: Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center+, Maastricht, The Netherlands.|NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
authors.forename: Jeroen P
authors.initials: JP
authors.lastname: Kooman
authors.affiliation: Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands.|CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.
authors.forename: Coen D A
authors.initials: CDA
authors.lastname: Stehouwer
authors.affiliation: CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.|CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.|Department of Epidemiology, Maastricht University, Maastricht, The Netherlands.
authors.forename: Pieter C
authors.initials: PC
authors.lastname: Dagnelie
authors.affiliation: Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands.|CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.
authors.forename: Carla J H
authors.initials: CJH
authors.lastname: van der Kallen
authors.affiliation: Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands.|CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.
authors.forename: Abraham A
authors.initials: AA
authors.lastname: Kroon
authors.affiliation: Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center+, Maastricht, The Netherlands.|NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
authors.forename: Karel M L
authors.initials: KML
authors.lastname: Leunissen
authors.affiliation: Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center+, Maastricht, The Netherlands.
authors.forename: Frank M
authors.initials: FM
authors.lastname: van der Sande
authors.affiliation: Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands.|CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.|CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
authors.forename: Nicolaas C
authors.initials: NC
authors.lastname: Schaper
authors.affiliation: Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands.|CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.
authors.forename: Simone J S
authors.initials: SJS
authors.lastname: Sep
authors.affiliation: Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, Maastricht University Medical Center+, Maastricht, The Netherlands.|MHeNs School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Köhler
authors.affiliation: Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands.|CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.|Heart and Vascular Centre, Maastricht University  Medical Center+, Maastricht, The Netherlands.
authors.forename: Miranda T
authors.initials: MT
authors.lastname: Schram
authors.affiliation: Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands.|CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.|Heart and Vascular Centre, Maastricht University  Medical Center+, Maastricht, The Netherlands.
authors.forename: Ronald M A
authors.initials: RMA
authors.lastname: Henry
mesh_terms: D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000150:complications*; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies
keywords: albuminuria; depression; depressive symptoms; estimated glomerular filtration rate; urinary albumin excretion