title: Kidney dysfunction, systemic inflammation and mental well-being in elderly post-myocardial infarction patients.
abstract: BACKGROUND
  The aim was to investigate whether mild kidney dysfunction and low-grade inflammation in post-myocardial infarction patients are independently associated with markers of mental well-being (i.e. depressive and apathy symptoms, and dispositional optimism).
  
  
  METHODS
  In post-myocardial infarction patients, kidney function was assessed by estimated glomerular filtration rate (eGFR) calculated from the combined CKD-EPI formula based on serum levels of both creatinine and cystatine C. Systemic inflammation was assessed using high sensitivity C-reactive protein (hs-CRP) levels. The 15-item Geriatric Depression Scale (GDS-15), the 3-item apathy subscale and the 4-item optimism questionnaire (4Q) were used to measure mental well-being and were analyzed using linear multivariable regression analysis.
  
  
  RESULTS
  Of the 2355 patients, mean age was 72.3 (range 63-84) years and 80.1% were men. After multivariable adjustment, a poorer kidney function was associated with more depressive symptoms (β = -0.084, p < 0.001), more apathy symptoms (β = -0.101, p < 0.001), and less dispositional optimism (β = 0.072, p = 0.002). Moreover, higher levels of hs-CRP were associated with more depressive symptoms (β = 0.051, p = 0.013), more apathy symptoms (β = 0.083, p < 0.001) and less dispositional optimism (β = -0.047 p = 0.024). Apathy showed the strongest independent relation with both low eGFR and high hs-CRP.
  
  
  CONCLUSIONS
  In post-myocardial infarction patients, impaired kidney function and systemic inflammation showed a stronger association with apathy than with depressive symptoms and dispositional optimism.
authors.affiliation: Department of Psychiatry, Leiden University Medical Center, Postbus 9600, 2300, RC, Leiden, Netherlands. heeresrick@gmail.com.
authors.forename: Rick H M
authors.identifier: http://orcid.org/0000-0002-0598-8973
authors.initials: RH
authors.lastname: Heeres
authors.affiliation: Departments of Internal Medicine and Nephrology, Jeroen Bosch Hospital, Den Bosch, Netherlands.
authors.forename: Ellen K
authors.initials: EK
authors.lastname: Hoogeveen
authors.affiliation: Division of Human Nutrition, Wageningen University, Wageningen, Netherlands.
authors.forename: Johanna M
authors.initials: JM
authors.lastname: Geleijnse
authors.affiliation: Division of Human Nutrition, Wageningen University, Wageningen, Netherlands.
authors.forename: Janette
authors.initials: J
authors.lastname: de Goede
authors.affiliation: Division of Human Nutrition, Wageningen University, Wageningen, Netherlands.
authors.forename: Daan
authors.initials: D
authors.lastname: Kromhout
authors.affiliation: Department of Psychiatry, Leiden University Medical Center, Postbus 9600, 2300, RC, Leiden, Netherlands.
authors.forename: Erik J
authors.initials: EJ
authors.lastname: Giltay
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D057565:Apathy; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000453:epidemiology; D005260:Female; D006801:Humans; D007249:Inflammation / Q000453:epidemiology / Q000523:psychology*; D007674:Kidney Diseases / Q000453:epidemiology / Q000523:psychology*; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000523:psychology*; D000067656:Optimism
keywords: Apathy; Depressive symptoms; Dispositional optimism; Kidney dysfunction; Myocardial infarction; Systemic inflammation