Burden of Mental Illnesses High in Chronic Kidney Disease

TOPLINE: 

Severe mental illnesses affected 7.3% of patients with chronic kidney disease (CKD), representing a 56% higher prevalence than in the general population. The presence of mental illness was linked to increased mortality, whereas bipolar disorder was associated with an accelerated decline in kidney function.

METHODOLOGY:

• Researchers conducted a nationwide cross-sectional study to estimate the prevalence of severe mental illnesses in 32,943 patients with incident CKD G3b-5 or undergoing kidney replacement therapy (mean age, 70.4 years; 36.7% women) between 2008 and 2020 from the Swedish Renal Registry.
• They also conducted a cohort study to examine the association between severe mental illnesses and health outcomes in 30,103 patients not receiving kidney replacement therapy.
• The occurrence of severe mental illnesses (schizophrenia, bipolar disorder, or major depressive disorder) before the initial registration date in the registry was determined using diagnoses from inpatient or specialised outpatient care.
• The primary outcomes included a 30% decline in the estimated glomerular filtration rate (eGFR), initiation of kidney replacement therapy, and all-cause mortality.

TAKEAWAY:

• Among patients with CKD, the overall prevalence of severe mental illness was 7.3%, which was 56% higher than in the general population. The specific rates were 0.5% for schizophrenia, 2.1% for bipolar disorder, and 5.6% for major depressive disorder.
• Patients with CKD who did vs did not have serious mental illnesses had a greater rate of 30% decline in eGFR (hazard ratio [HR], 1.13; 95% CI, 1.04-1.24) and higher all-cause mortality (HR, 1.16; 95% CI, 1.08-1.24) but a lower likelihood of initiating kidney replacement therapy (HR, 0.88; 95% CI, 0.80-0.97).
• Schizophrenia was associated with a decreased rate of initiating kidney replacement therapy (HR, 0.56; 95% CI, 0.39-0.80).
• Bipolar disorder was associated with an increased rate of 30% decline in eGFR (HR, 1.47; 95% CI, 1.29-1.67) and a decreased rate of initiating kidney replacement therapy (HR, 0.79; 95% CI, 0.67-0.94).

IN PRACTICE:

“Recognizing the presence of SMI [severe mental illness] in patients with CKD needs to be emphasised, which should not be a barrier to accessing kidney care but rather an opportunity to improve health outcomes through the provision of appropriate treatment and support via multidisciplinary team care,” the authors wrote.

SOURCE:

The study was led by Nanbo Zhu, PhD, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. It was published online on February 23, 2025, in the American Journal of Kidney Diseases.

LIMITATIONS: 

The identification of severe mental illness relied solely on diagnoses from inpatient or specialist outpatient care, potentially underestimating its prevalence, particularly for major depressive disorder. The observational nature of the study prevented establishing causal relationships between severe mental illness and clinical outcomes. Additionally, as the data reflected Swedish clinical practice, generalisation to other settings should be made with caution.

DISCLOSURES:

The study was supported by grants from the Swedish Research Council, the US National Institutes of Health, the Strategic Research Area Neuroscience, and the Center for Innovative Medicine. Two authors disclosed receiving lecture honoraria, funding, or personal honoraria or being members of advisory boards for pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.