Association of depressive and anxiety symptoms with adverse events in chronic kidney disease patients without dialysis: a prospective observational study

Objective Depressive symptoms have been reported to be associated with morbidity and mortality in patients with chronic kidney disease (CKD) not given dialysis. However, there is no research on the influence of depression in early stage of these patients. Anxiety and depressive symptoms often co-occur, as yet there are little data concerning a possible influence of anxiety symptoms in CKD patients. We studied the clinical outcome of depressive and anxiety symptoms in CKD patients without dialysis, and their effects on these patients.Methods In this 4-year follow-up prospective observational study, 178 cases of CKD were chosen from clinic of nephropathy, Hubei Provincial Hospital of Chinese Medicine followed up during Feb. 2012 to Feb. 2016. Estimated glomerular filtration rate (eGFR) was ≥15 mL·min^-1·(1.73 m²)^-1 or <90 mL·min^-1·(1.73 m²)^-1. Symptoms of depression and anxiety were evaluated using Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS). Cox proportional hazards models were used to calculate hazard ratio's (HRs) with a composite event of death and initiation of dialysis as outcome. All of the patients were followed up in the same time each year. If the patients had composite events or lost to follow-up, follow-up was terminated.Results In the 157 CKD patients receiving follow-up, there were 85 cases of depressive symptoms (54.14%), and 38 cases of anxiety symptoms (24.20%). During the follow-up period of 30.41±18.30 months, 41 CKD patients reached the end point (35 patients given dialysis, and 6 patients dead). HRs for the composite events for patients with depressive symptoms were 1.05 95% confidence interval (CI) 0.52-2.14), and those for patients with anxiety symptoms were 1.10 (95% CI: 0.48-2.52). There seemed to be no additive effect of anxiety symptoms in addition to depressive symptoms with regard to poor clinical outcome. Depression or anxiety of CKD patients did not lead to the trend of renal function decrease.Conclusions Depression and anxiety symptoms in CKD patients are relatively common. Depressive symptoms can increase the risk of adverse clinical outcomes, so do anxiety symptoms. There seems to be no additive effect of anxiety symptoms in addition to depressive symptoms with regard to poor clinical outcome. Depression or anxiety of CKD patients did not lead to the trend of renal function decrease. Depression and anxiety symptoms should be evaluated as early as possible. Future research should solve the corresponding treatment, and assess the effect of anxiety symptoms treatment on clinical outcomes.