OBJECTIVES: To understand the role of depression in the CKD progression to end-stage renal disease (ESRD) or dialysis, and to examine the incidence of depression during each CKD stages.

METHODS: This was a retrospective cohort study using electronic medical record in TriNetX for the years 1999 -2022 from West Virginia Healthcare organizations, including the individuals who were 18 years old or above with a diagnosis of CKD. For the primary objective, the study cohort was divided into two groups by those diagnosed with depression or anxiety and those who were not. For the secondary objective, the study cohort was divided into three groups: Stage ≤3, stage 4, and stage 5. Cox regression and survival analysis were used to examine both associations.

RESULTS: Among 44.078 patients with CKD, most was found to be White (83.02%), male (54.21%), aged 65 or older (80.97%), and non-Hispanic or Latino (81.51%). About 19% of the patients progressed to ESRD/dialysis, about 12% was diagnosed with depression after their CKD diagnosis. Compared to those without depression, patients with depression had significantly higher risk of progressing to ESRD by 79%. (HR=1.79 [CI=1.64-1.97], p<0.05). The median time to ESRD/dialysis was significantly longer in the no depression group (730 days vs 365 days). When comparing the three groups of CKD stages, Stage ≤3 cohort had the highest median time to depression diagnosis (1,260 days [1,197-1,350]), which was significantly higher than Stage 4 (617 days [561-700]) and Stage 5 (391 days [298-526]), with hazardous ratio of 1.92 [1.77-2.08] and 2.20 [1.92-2.52] respectively.

CONCLUSIONS: The study highlights the importance of monitoring mental health, particularly in the later stages of CKD, to ensure timely intervention and support for patients at higher risk of depression. Early detection and management of depression in CKD patients may improve patient clinical outcomes and could potentially impact the trajectory of CKD progression.