Key result
Severe depression in CKD linked to ~251% higher mortality and dose-dependent ESKD risk.
Why the study?
Although depression is common among patients with chronic kidney disease, its impact on the incidence of end-stage kidney disease and all-cause mortality remains unclear.
Does depression severity increase the incidence of end-stage kidney disease and all-cause mortality in patients with chronic kidney disease?
Cohort
Does depression severity increase the incidence of end-stage kidney disease and all-cause mortality in patients with chronic kidney disease?
Moderate to severe depression is independently associated with a significantly increased risk of all-cause mortality, but not end-stage kidney disease, in patients with chronic kidney disease.
Answers are grounded in this paper and cite their sources.
Depression severity was associated with higher ESKD and mortality risk in CKD; hypothesis-generating and requires prospective trials before guiding care.
BACKGROUND: Although depression is common among patients with chronic kidney disease (CKD), its impact on the incidence of end-stage kidney disease (ESKD) and all-cause mortality remains unclear. METHODS: This retrospective cohort study used Cox proportional hazards (CPH) models and CPH models with penalized splines to assess the association between depression severity and the incidence of ESKD and mortality in patients with CKD, drawing on data from the Chronic Kidney Disease Japan Cohort (CKD-JAC) Study. RESULTS: ; median Beck Depression Inventory-II (BDI-II) score 8). Depression severity was classified into four categories: normal (0-13), mild (14-19), moderate (20-28), and severe (≥ 29). In Multivariable CPH models, ESKD risk showed a stepwise elevation in hazard ratios (HRs) without reaching statistical significance, whereas, mortality risk increased significantly in the moderate and severe group: HR 3.11 (95%CI 1.61-6.03) and 3.51 (1.40-8.80). Additionally, CPH models demonstrated a dose-dependent association between BDI-II categories and the incidence of both ESKD and mortality. CPH Models with penalized splines further revealed a gradual increase in ESKD risk, and a J-shaped association in mortality risk. CONCLUSION: Depression severity showed dose-dependent associations with increased the incidence of ESKD and mortality in patients with CKD. Although mortality risk was significantly higher in the moderate and severe groups (BDI-II score ≥ 20), the stepwise elevation in ESKD risk did not reach statistical significance, and an optimal threshold for ESKD risk could not be identified.
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Shinzawa et al. (2026) conducted a cohort in chronic kidney disease (CKD). Depression severity (BDI-II score) vs. Normal depression severity (BDI-II score 0-13) was evaluated on all-cause mortality (HR 3.51, 95% CI 1.40-8.80). In patients with CKD, severe depression was associated with significantly increased all-cause mortality (HR 3.51; 95% CI 1.40-8.80) and a dose-dependent increase in ESKD risk.
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