Association between depression and the development of end‐stage kidney disease in people with diabetes: A population‐based cohort study
Hellena Hailu Habte‐Asres, Sarah Afuwape, Adrian Heald, David C. Wheeler, Angus ForbesAbstract
Introduction
Diabetes is the leading cause of end‐stage kidney disease (ESKD; CKD stage 5). Depression is common among people with diabetes and CKD and is associated with poorer outcomes. However, its relationship with progression to ESKD remains unclear, particularly given the competing risk of death. We examined the association between depression and progression to ESKD in people with diabetes and CKD.
Methods
We conducted a retrospective population‐based cohort study using UK primary care data from the Clinical Practice Research Datalink. Adults aged ≥ 18 years with diabetes and CKD stages 1–4 were included. Depression was defined by the presence of a depression Read code together with ≥ 12 months of continuous antidepressant prescribing during the baseline period. The primary outcome was progression to ESKD. We compared the risk of progression to ESKD between people with and without depression, accounting for differences in demographic, socioeconomic and clinical characteristics, as well as the competing risk of death.
Results
Among 58,769 individuals (mean age 76.8 ± 10.2 years; 45.5% male), 14.3% had depression. Over a mean follow‐up of 5.6 ± 3.4 years, 1720 progressed to ESKD and 25,127 died before ESKD. Depression was associated with a lower sub‐distribution hazard of ESKD in crude (SHR 0.67; 95% CI 0.57–0.78) and adjusted analyses (SHR 0.82; 95% CI 0.68–0.99). Older age was associated with a lower cumulative incidence of ESKD.
Conclusions
After accounting for the competing risk of death, depression was associated with a lower observed cumulative incidence of ESKD. This paradoxical finding may reflect competing mortality or residual confounding.