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 GFR (eGFR) stages. Study Design Cross-sectional. Setting & Participants Participants included 5,805 members of Kaiser Permanente Northern California age 60 or older with diabetes from the 2005–2006 Diabetes Study of Northern California (DISTANCE) survey. Predictor eGFR categories were defined as ≥90 (referent category), 75–89, 60–74, 45–59, 30–44 or ≤29 ml/min/1.73m2. Outcomes 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 comorbidities, and taking into account interactions with proteinuria, none of the eGFR categories were significantly or substantively associated with PCS or MCS score. In both unadjusted and adjusted analyses, higher risk of depressive symptoms was observed among respondents with eGFR ≤29 ml/min/1.73m2 (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 levels. Limitations 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.

Relationship between diabetic nephropathy and depression: a cross-sectional analysis using the Diabetes Study from the Center of Tokyo Women's Medical University (DIACET)

“…Similar to the Pathway Study,10 we found a significant association between albuminuria and depression, although unlike the DISTANCE survey,11 we found no significant association between reduced eGFR and depression. These cross-sectional studies, including ours, were unable to clarify the causal relationship of albuminuria and GFR with depression.…”

“…Among the limited number of studies, the Pathway Study consisting of 4082 US community-dwelling patients with diabetes demonstrated that PHQ-9 scores ≥10 were associated with an up to 1.5-fold increase in adjusted OR of albuminuria 10. In the Diabetes and Aging Study, an ancillary study to the Diabetes Study of Northern California (DISTANCE), the risk of depression defined as PHQ-8 scores ≥10, in which the ninth question assessing suicidal or self-injurious thoughts was eliminated from PHQ-9, was high in patients with reduced eGFR among 5805 patients with diabetes aged 60 years or older 11. Our results are in line with these studies; however, to the best of our knowledge, no previous studies have evaluated prevalence of depression, based on PHQ-9 scores or other items, in each nephropathy stage, including ESKD.…”

Kidney dysfunction, systemic inflammation and mental well-being in elderly post-myocardial infarction patients

“…with an estimated glomerular filtration rate [eGFR] <30 ml/min/1.73 m 2 ) had more depressive symptoms than those without CKD (eGFR ≥ 60 ml/min/1.73 m 2 ). However, in only one of those studies (that included patients with diabetes) did the increased risk of depressive symptoms remain significant after adjustment for all relevant covariates [15]. Whether or not less severe forms of impaired kidney function (30 ml/min/1.73 m 2 or higher) are associated with more depressive symptoms is still largely unknown.…”

Association between chronic kidney disease and physical activity level in patients with ischemic heart disease

“…Finally, depressive symptoms are known to attenuate the urge to leave the home, resulting in physical inactivity for CKD patients [23]. In a previous study surveying approximately 6000 communitydwelling elderly, patients with stage G3-G5 CKD had double the risk of depression compared to those with stage G1-G2 CKD [24]. On the basis of these reasons, stage G3-G4 CKD may hinder acquiring appropriate physical activity after discharge.…”