Association of depressive symptom trajectories with chronic kidney disease in middle-aged and older adults

Introduction: This study aimed to investigate the association between trajectories of depressive symptoms and the subsequent risk of chronic kidney disease (CKD) by measuring depressive symptoms repeatedly in older adults with normal renal function. Methods: A total of 9650 participants, comprising community-dwelling middle-aged and older adults from the China Health and Retirement Longitudinal Study, were included. Depressive symptoms were assessed at three time points: Wave 1 (2011-2012), Wave 2 (2013-2014), and Wave 3 (2015-2016). Trajectories of depressive symptoms were determined using latent mixed models, and the association between these trajectories and CKD was verified using COX proportional hazards models. Results: Five trajectory patterns of depressive symptoms were identified: low CESD-10 score (Low-Stable, 3702 participants, 38.36 %), moderate CESD-10 score (Moderate-Stable, 3602 participants, 37.33 %), continuously increasing CESD-10 score from moderate initiation (Moderate-Increasing, 825 participants, 8.55 %), continuously decreasing CESD-10 score from high initiation (High-Decreasing, 1032 participants, 10.69 %), and stable high CESD-10 score (High-stable, 489 participants, 5.07 %). During the two-year follow-up period from Wave 3 to Wave 4 (2017-2018), 420 CKD events occurred. Participants in the Moderate-Stable, Moderate-Increasing, High-Decreasing, and High-Stable groups had an increased risk of developing CKD compared to those in the LowStable group, with multivariable-adjusted hazard ratios (95 % confidence interval) were 1.32 (1.02-1.71), 1.68 (1.15-2.45), 2.26 (1.63-3.13), and 3.73 (2.57-5.43), respectively, comparted to those with low-stable trajectory. Conclusion: Middle-aged and older adults with increasing (Moderate-Increasing) and persistent depressive symptoms (including Moderate-Stable, High-Decreasing, and High-Stable) face a higher risk of developing CKD over time.