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Kidney Week

Abstract: FR-PO1120

Association of Depression and eGFR Decline in World Trade Center Responders

Session Information

Category: CKD (Non-Dialysis)

  • 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Koraishy, Farrukh M., Stony Brook University, Stony Brook, New York, United States
  • Clouston, Sean, Stony Brook University, Stony Brook, New York, United States
  • Mann, Frank D., Stony Brook University, Stony Brook, New York, United States
  • Waszczuk, Monika, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, United States
  • Luft, Benjamin J., Stony Brook University, Stony Brook, New York, United States
  • Bano, Ruqiyya, Stony Brook University, Stony Brook, New York, United States
Background

Depression is associated with kidney disease, however if this association is independent of a closely associated condition, posttraumatic disorder (PTSD), is not known. To address this question, we studied the World trade Center (WTC) Responders who have a higher incidence of depression and PTSD compared to the general population.

Methods

Serum creatinine measurements were obtained from 9313 WTC Responders from 2015 to 2022. eGFR was calculated using the CKD-EPI 2021 Equation after excluding individuals with end-stage kidney disease. CKD was defined as an eGFR measurement < 60 ml/min/1.73 m2 or by ICD codes, stratified by mild (eGFR > 45) and moderate/severe (eGFR < 45). eGFR decline was characterized as normal (± 1.0 ml/min/1.73 m2 per year) or rapid (≥5 ml/min/1.73 m2 per year). Depression was defined as a score > 10 on the Patient Health Questionnaire (PHQ)-9 questionnaire administered during annual WTC visits. Stepwise logistic regression (LR) was employed to test the associations.

Results

At baseline, 12% had depression and 3% had CKD. Individuals with baseline CKD had a higher baseline PHQ and were more likely to have depression at the end of their follow-up period, seen mostly in those with moderate/severe CKD. After adjustment for relevant covariates, the association between baseline moderate/severe CKD and final depression was highly significant (OR: 3.76, p = 0.001). Assessing only eGFR decline, 11% had rapid eGFR decline and 41% had normal eGFR decline. Individuals with rapid eGFR decline had a higher proportion of depression diagnosis during their follow-up period. After adjustment for relevant covariates, the association between rapid eGFR decline and depression was significant (OR: 1.37, p = 0.001). 4% developed incident CKD during the observation period. PHQ was higher in those with who developed incident CKD during follow up and PTSD was also more prevalent. Evaluating individuals with only depression and no PTSD at baseline, the association of baseline depression with incident CKD was highly significant (OR: 1.935, p = 0.009) after adjustment.

Conclusion

Moderate to severe CKD at baseline is associated with depressive symptoms, but the prospective prediction of incident CKD by depressive symptoms appears to depend on the relative absence of comorbid PTSD.