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August 6, 2026Clinical and Experimental NephrologyOpen Access

Dose-dependent association of depression with incidence of end-stage kidney disease and all-cause mortality, CKD-JAC study: a retrospective cohort study

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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?

Population

Patients with CKD from the Chronic Kidney Disease Japan Cohort Study

Comparison

Depression severity categories based on BDI-II score

Design

Retrospective cohort study

Key result

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.

Authors

MSMaki ShinzawaKMKenta MurotaniTITakahiro Imaizumi

Discussion

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Overview

Depression severity was associated with higher ESKD and mortality risk in CKD; hypothesis-generating and requires prospective trials before guiding care.

Key Points

  • This research aims to explore the relationship between depression severity and the risks of end-stage kidney disease (ESKD) and mortality in chronic kidney disease (CKD) patients.
  • Utilized a retrospective cohort design analyzing data from the Chronic Kidney Disease Japan Cohort (CKD-JAC) Study.
  • Applied Cox proportional hazards models to evaluate associations between depression severity (BDI-II scores) and outcomes of ESKD and mortality.
  • Classified depression into four severity categories and assessed risk trends based on these classifications.
  • Mortality risk was significantly elevated in moderate (HR 3.11, 95% CI 1.61-6.03) and severe depression (HR 3.51, 95% CI 1.40-8.80) groups.
  • A dose-dependent association between depression severity and both ESKD incidence and mortality was observed, although ESKD risk elevation lacked statistical significance.
  • A J-shaped relationship regarding depression impact on mortality risk was established, indicating varying effects at different severity levels.

Study Design

Type

Cohort

Structured PICO

Does depression severity increase the incidence of end-stage kidney disease and all-cause mortality in patients with chronic kidney disease?

P
Population
Patients with chronic kidney disease from the Chronic Kidney Disease Japan Cohort (CKD-JAC) Study.
E
Exposure
Moderate (BDI-II score 20-28) to severe (BDI-II score ≥ 29) depression severity
C
Comparator
Normal depression severity (BDI-II score 0-13)
O
Outcome
Time to all-cause mortality or end-stage kidney disease (ESKD), defined as initiation of kidney replacement therapyhard clinical

Main Result

Hazard Ratio: 3.51 (95% CI 1.4–8.8)

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.

Limitations

  • Only baseline BDI-II scores were available without follow-up assessments
  • 42.9% of participants were excluded due to missing BDI-II data, introducing potential selection bias
  • Limited statistical power due to smaller sample sizes in the mild, moderate, and severe depression groups
  • Missing data for educational background and annual income
  • Unmeasured confounders such as religion, residential area, family composition, marital status, frailty, malnutrition, and COPD

Cite This Study

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.

synapsesocial.com/papers/6a74379d764cddc9499d5007https://doi.org/10.1007/s10157-026-02908-8
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