Relationship of Depression With Incident Cardiovascular Disease in Individuals With Chronic Kidney Disease

Abstract

Background: Depression is common in patients with chronic kidney disease (CKD) and known to be associated with a greater risk of developing cardiovascular disease (CVD). However, it is uncertain whether, and to what extent, depression influences the incidence of CVD among individuals with CKD.

Methods and Results: We analyzed 281,961 individuals with CKD defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m²or proteinuria (≥ +1) including 14,527 (5.2%) individuals with depression registered in the DeSC database from April 2014 to August 2023. The DeSC database is commercially available from DeSC Healthcare Inc. A Cox proportional hazards regression analysis was conducted to estimate the hazard ratio associated with the presence of depression. The median age was 68 years and 47.8% were men. During the follow-up period, 48,359 composite CVD events were recorded. Multivariable Cox regression analysis showed that CKD individuals with depression had a greater risk of composite CVD events than those without (hazard ratio 1.36; 95% confidence interval 1.31–1.42). Given the limitations of real-world data, we performed multiple sensitivity analyses, which confirmed the results of our primary analysis. Notably, we found that the association between depression and a subsequent risk of developing CVD was not modified by eGFR.

Conclusions: Depression is independently associated with an increased risk of CVD among individuals with CKD regardless of baseline kidney function.