Individuals diagnosed with a stress-related disorder (SRD) may have increased risks for both acute kidney injury (AKI) and progression of chronic kidney disease (CKD).

In an analysis of the SCREAM (Stockholm CREAtinine Measurements) project, investigators compared kidney outcomes between 30,998 Swedish patients with a new SRD diagnosis and 116,677 healthcare users without SRD matched by age, sex, and estimated glomerular filtration (eGFR) category.

Patients with an SRD diagnosis had a 23% higher risk for CKD progression, defined as an eGFR decline of more than 40% or initiation of kidney replacement therapy, compared with their matched counterparts over 3.2 years of follow up, Guobin Su, MD, PhD, of Karolinska Institutet in Stockholm, Sweden, and colleagues reported in Kidney International Reports. Patients with an SRD also had a 22% higher risk for AKI, defined as death or hospitalization attributed to AKI or rapid creatinine decline. AKI risk was highest during the first year of follow up, but CKD risk persisted throughout.

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SRD diagnoses included acute stress reaction, post-traumatic stress disorder (PTSD), adjustment disorders, and other disorders that result from a specific trauma, such as the death of a loved one, the diagnosis of a life-threatening illness, natural disasters, or violence. SRDs differ from depression or anxiety, the investigators pointed out.

The results were robust after adjustment for a variety of relevant potential confounders, including history of other psychiatric disorders, comorbidities (such as heart failure, hypertension, and diabetes), and medications (such as nephrotoxic nonsteroidal anti-inflammatory drugs, selective serotonin reuptake inhibitors, and lithium), as well as age, sex, and eGFR. However, the investigators lacked information on albuminuria, socioeconomic status, and air pollution, which has been increasingly linked with CKD.

Although potential mechanisms have yet to be identified, Dr Su’s team noted that some physiological compensations for allostatic overload relate to renal effects or CKD risk factors. For example, psychological stress induces changes in cortisol, enhances sympathetic nervous system activity, and results in sodium and water retention, they explained. Stress also induces tissue ischemia and hemodynamic changes and impairs insulin sensitivity.

“Close monitoring of kidney function following SRDs diagnosis may be indicated,” Dr Su’s team concluded.


Su G, Song H, Lanka V, et al. Stress related disorders and the risk of kidney disease. Published online January 13, 2021. Kidney Int Reps. doi:10.1016/j.ekir.2020.12.032