Kidney Week

Abstract: FR-PO374

Sex Differences in the Association of Cardiovascular Risk Factors with Post-traumatic Stress Disorder (PTSD) among Veterans with CKD

Session Information

• Hypertension, CVD, and the Kidneys: Epidemiology
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Hypertension and CVD

• 1602 Hypertension and CVD: Clinical

Authors

• Zhang, Helena, Baylor College of Medicine, Houston, Texas, United States

Helena Zhang, MD

• Ramsey, David Jed, Baylor College of Medicine, Houston, Texas, United States

David Jed Ramsey, PhD

• Navaneethan, Sankar D., Baylor College of Medicine, Houston, Texas, United States

Sankar D. Navaneethan, MD, MS, MPH, FASN

• Chilcot, Joseph, King's College London, London, United Kingdom

Joseph Chilcot, PhD

• Gregg, Lucile Parker, Baylor College of Medicine, Houston, Texas, United States

Lucile Parker Gregg, MD, MS, FASN

Background

Post-traumatic stress disorder (PTSD) is common among veterans and is associated with chronic kidney disease (CKD) progression and cardiovascular (CV) risk. It is unknown if sex modifies associations of CV risk factors with PTSD in veterans with CKD, who have a unique CV risk profile.

Methods

Using data from the VA Corporate Data Warehouse from 1/1/2009 to 12/31/2020, we conducted a retrospective cohort study of U.S. veterans with incident CKD stages 3-5 (defined as two eGFR values <60 mL/min/1.73 m² measured ≥90 days apart with no intervening values ≥60) with and without a diagnosis of PTSD. The index date was the date of the second qualifying eGFR. PTSD was defined by diagnosis codes in ≥2 clinical encounters within 1 year prior to the index date. Multivariable logistic regression assessed associations of demographics, comorbidities, medications, and laboratory values with PTSD, with multiplicative interaction terms to assess if sex modifies these associations.

Results

Of 1,443,878 veterans with CKD, 143,473 (9.9%) had a diagnosis of PTSD. Compared to those without PTSD, those with PTSD were younger (mean [SD] 65 [9] vs 73 [10], standardized mean difference [SMD] .78), more likely to be female (7% vs 3%, SMD .16) and Black (29% vs 16%, SMD .08), and more likely to have CKD stage 3 (97% vs 93%, SMD .15), hypertension (81% vs 70%, SMD .25), atherosclerotic CV disease (23% vs 18%, SMD .13), and depression (43% vs 13%, SMD .70). PTSD was associated with younger age, Black race, hypertension, higher body mass index, depression, anxiety, alcohol or substance use disorder, antidepressant use, and higher eGFR, with significant sex interactions for each. PTSD was more strongly associated with Black race, hypertension, depression, antidepressant use, and eGFR among men, and with anxiety and substance use disorder among women (Figure).

Conclusion

PTSD is differentially associated with CV risk factors among men and women veterans with CKD. Studies to improve CV outcomes in patients with PTSD and CKD should stratify by sex.

CV risk factors and PTSD

Funding

• Veterans Affairs Support