Frequent depressive symptoms correlate with rapid decline in kidney function in healthy adults, a new Chinese study finds.

In the China Health and Retirement Longitudinal Study (CHARLS), 260 (5.5%) of 4763 adults aged 45 years and older who were initially free of chronic kidney disease (CKD) later experienced an annual decline in estimated glomerular filtration rate (eGFR) of 5 mL/min/1.73 m2 or more. Investigators calculated eGFR using the Chronic Kidney Disease Epidemiology Collaboration equation including both serum creatinine and cystatin C.

At baseline, patients completed the 10-item Center for Epidemiologic Studies Depression (CES-D) scale to assess their frequency of depressive symptoms. Scoring 10 or more (out of 30 total) defined moderate-to-high depressive symptoms.

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The odds of rapid kidney function decline significantly increased by 15% for every 5-point increase in CES-D score, Xianhui Qin, MD, of Nanfang Hospital, Southern Medical University, in Guangzhou, China and colleagues reported in the Clinical Journal of the American Society of Nephrology. The odds of rapid decline increased 1.24-fold for a moderate CES-D score of 10 or higher but less than 21 and 2.18-fold for a high score of 21 or more, compared with a reference score of less than 10.

The odds of the secondary outcome, rapid progression to CKD stage 3 or higher, significantly increased by 26% per 5-point increment in CES-D, the investigators also reported. A moderate or high CES-D score was significantly associated with 1.33- and 2.38-fold increased odds of CKD, compared with a low score.

Particular depressive symptoms including bother, difficulty concentrating, thinking everything is an effort, and feeling lonely significantly associated with rapid kidney function decline. Conversely, demographic factors, diabetes, systolic blood pressure, total cholesterol, uric acid, and high-sensitivity C-reactive protein did not modify the association.

“CKD is a leading risk factor for cardiovascular disease, kidney failure, and mortality worldwide. Therefore, the identification of more modifiable risk factors may possibly reduce the huge burden of CKD and its related complications by leading to early detection and prevention,” Dr Qin stated in a news release from the American Society of Nephrology.

Acknowledging that association cannot prove causation, the investigators concluded: “If further confirmed, our data provide some evidence for depressive symptom screening and effective psychosocial intervention to improve primary prevention of CKD.”


Zhang Z, He P, Liu M, et al. Association of depressive symptoms with rapid kidney function decline in adults with normal kidney function. Clin J Am Soc Nephrol. Published online May 29, 2021. doi:10.2215/CJN.18441120

Depressive symptoms linked to rapid kidney function decline [news release]. American Society of Nephrology; May 25, 2021.