Association of Depression and Antidepressant Use with Mortality in a Large Cohort of Patients with Nondialysis-Dependent CKD

Balogun, Rasheed A.; Abdel‐Rahman, Emaad M.; Balogun, Seki A.; Lott, Evan H.; Malakauskas, Sandra M.; Jennie, Z.; Kalantar-Zadeh, Kamyar; Kövesdy, Csaba P.

doi:10.2215/cjn.02650312

Cited by 35 publications

(46 citation statements)

References 36 publications

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“…material B3) [7,57,78,85,86,87]. This reduced our number of summary measures from 55 to 16, and only 3 of the measures involved cardiovascular samples.…”

Section: Resultsmentioning

confidence: 99%

The Mortality and Myocardial Effects of Antidepressants Are Moderated by Preexisting Cardiovascular Disease: A Meta-Analysis

Maslej

Bolker²,

Russell³

et al. 2017

Psychother Psychosom

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Background: Antidepressants (ADs) are commonly prescribed medications, but their long-term health effects are debated. ADs disrupt multiple adaptive processes regulated by evolutionarily ancient biochemicals, potentially increasing mortality. However, many ADs also have anticlotting properties that can be efficacious in treating cardiovascular disease. We conducted a meta-analysis assessing the effects of ADs on all-cause mortality and cardiovascular events in general-population and cardiovascular-patient samples. Methods: Two reviewers independently assessed articles from PubMed, EMBASE, and Google Scholar for AD-related mortality controlling for depression and other comorbidities. From these articles, we extracted information about cardiovascular events, cardiovascular risk status, and AD class. We conducted mixed-effect meta-analyses testing sample type and AD class as moderators of all-cause mortality and new cardiovascular events. Results: Seventeen studies met our search criteria. Sample type consistently moderated health risks. In general-population samples, AD use increased the risks of mortality (HR = 1.33, 95% CI: 1.14-1.55) and new cardiovascular events (HR = 1.14, 95% CI: 1.08-1.21). In cardiovascular patients, AD use did not significantly affect risks. AD class also moderated mortality, but the serotonin reuptake inhibitors were not significantly different from tricyclic ADs (TCAs) (HR = 1.10, 95% CI: 0.93-1.31, p = 0.27). Only “other ADs” were differentiable from TCAs (HR = 1.35, 95% CI: 1.08-1.69). Mortality risk estimates increased when we analyzed the subset of studies controlling for premedication depression, suggesting the absence of confounding by indication. Conclusions: The results support the hypothesis that ADs are harmful in the general population but less harmful in cardiovascular patients.

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“…material B3) [7,57,78,85,86,87]. This reduced our number of summary measures from 55 to 16, and only 3 of the measures involved cardiovascular samples.…”

Section: Resultsmentioning

confidence: 99%

The Mortality and Myocardial Effects of Antidepressants Are Moderated by Preexisting Cardiovascular Disease: A Meta-Analysis

Maslej

Bolker²,

Russell³

et al. 2017

Psychother Psychosom

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“…[41][42][43][44][45] Our results indicated a high burden of sleep disturbances in kidney patients. In addition, female gender and having low MCS scores may influence sleep quality.…”

Section: Discussionmentioning

confidence: 98%

Sleep quality and its correlates in patients with chronic kidney disease: a cross-sectional design

et al. 2015

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Purpose: Since sympathovagal imbalance influences clinical phenomena, such as hypertension, diabetes mellitus, chronic kidney disease (CKD) and sleeping problems, there should be correlations between these conditions. We hypothesized that sleep quality would be correlated with estimated glomerular filtration rate (eGFR), blood pressure and the presence of diabetes. Methods: We included 303 CKD patients in this study. We employed the Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI) and Short Form 36 Quality of Life Health Survey Questions (SF-36) to screen sleeping disturbances, depression and quality of life, respectively. A chart review was performed for the patients' demographics, diagnoses and certain laboratory parameters-including blood glucose, hemoglobin, albumin, calcium, phosphate, parathyroid hormone and eGFR. Multivariate logistic regression models were employed to estimate odds ratios with 95% confidence intervals. Results: We included 303 patients in this cross-sectional study. A total of 101 patients were on dialysis. In the univariate models, gender, calcium and mental component summary scores (MCS) reached a significant level of 0.1, and those covariates were included in the multivariate analysis. The reduced models included gender and MCS categories. Female gender increases the risk for poor sleep quality. In our report, evidence suggests MCS domain scores are inversely related to the risk for impaired sleep. Conclusion: Our results indicated a high burden of sleep disturbances in kidney patients. In addition, female gender and having low MCS scores may influence sleep quality in kidney patients.

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“…[52][53][54] Briefly, study subjects were identified by using measurements of serum creatinine in the Veterans Affairs (VA) Decision Support System National Data Extracts Laboratory Results file 55 56 Patients with eGFR,60 ml/min per 1.73 m 2 on at least two occasions no less than 3 months apart and available BMI measurements within this period were included in the study. Cohort entry was defined as the date of the first baseline eGFR used to define CKD status.…”

Section: Study Populationmentioning

confidence: 99%

Association of Body Mass Index with Outcomes in Patients with CKD

Lü

Kalantar-Zadeh

Jennie

et al. 2014

Journal of the American Society of Nephrology

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217

207

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Obesity is associated with higher mortality in the general population, but this association is reversed in patients on dialysis. The nature of the relationship of obesity with adverse clinical outcomes in nondialysisdependent CKD and the putative interaction of the severity of disease with this association are unclear. We analyzed data from a nationally representative cohort of 453,946 United States veterans with eGFR,60 ml/min per 1.73 m 2 . The associations of body mass index categories (,20, 20 to ,25, 25 to ,30, 30 to ,35, 35 to ,40, 40 to ,45, 45 to ,50, and $50 kg/m 2 ) with all-cause mortality and disease progression (using multiple definitions, including incidence of ESRD, doubling of serum creatinine, and the slopes of eGFR) were examined in Cox proportional hazards models and logistic regression models. Multivariable adjustments were made for age, race, comorbidities and medications, and baseline eGFR. Body mass index showed a relatively consistent U-shaped association with clinical outcomes, with the best outcomes observed in overweight and mildly obese patients. Body mass index levels ,25 kg/m 2 were associated with worse outcomes in all patients, independent of severity of CKD. Body mass index levels $35 kg/m 2 were associated with worse outcomes in patients with earlier stages of CKD, but this association was attenuated in those patients with eGFR,30 ml/min per 1.73 m 2 . Thus, until clinical trials establish the ideal body mass index, a cautious approach to weight management is warranted in this patient population.

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Association of Depression and Antidepressant Use with Mortality in a Large Cohort of Patients with Nondialysis-Dependent CKD

Cited by 35 publications

References 36 publications

The Mortality and Myocardial Effects of Antidepressants Are Moderated by Preexisting Cardiovascular Disease: A Meta-Analysis

The Mortality and Myocardial Effects of Antidepressants Are Moderated by Preexisting Cardiovascular Disease: A Meta-Analysis

Sleep quality and its correlates in patients with chronic kidney disease: a cross-sectional design

Association of Body Mass Index with Outcomes in Patients with CKD

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