Factors And Related Biomarkers Of Depression In Elderly Patients With Chronic Kidney Disease

Background and Objectives:Elderly patients with chronic kidney disease(CKD)is associated with various complications such as depression,cognitive impairment,malnutrition,and activity of daily living dependent.Thus,these patients require comprehensive geriatric assessment.Depression is a common mental disorder in CKD patients.The relationship between depression and renal function is ambiguous.There is no research on the relationship between depression and kidney disease-specific targeted domains of health-related quality of life in China.It is necessary to screen clinical markers to improve the diagnosis of depression.Thus,the study aimed to evaluate depression,cognition function,nutrition and activity of daily living and health-related quality of life in elderly patients with CKD.To investigate the incidence of depression and its influencing factors and to study the correlation between depression and renal function and quality of life in elderly CKD patients.To screen biomarkers for elderly CKD patietns with depression.Methods:This study collected baseline datas from prospective cohort studies conducted at 34 centers in China.The subjects were elderly CKD patients who met the inclusion criteria at each center from March 1,2017 to December 31,2018.Inclusion criteria:age>60 years;eGFR<60 mL/min/1.73m2 or ACR>30 mg/g or urine protein excretion>150 mg/24 h,a history of CKD>3months.Exclusion criteria:hemodialysis or peritoneal dialysis;acute kidney injury;patients who had undergone organ or bone marrow transplantation;active or metastatic tumors within 2 years;severe cardiac insufficiency;HIV infection;patients who were unable to complete the assessment because of dementia or other mental cognitive impairment,restricted limb activity,severe visual impairment.Data were collected and analysed the questionnaires.Correlations between depression and kindey function were analyzed by Spearman's rank correlation.Factors affecting depression and quality of life were identified by Logistic multivariate regression analysis.Protein chip was used to screen the biomarker in depressive patients or not.Using liquid protein chip and ELISA to verify the selected protein.Diagnostic performance was identified by ROC curve.Results:1.A total of 1192 elderly CKD patients were included.The top three causes of CKD were primary glomerular disease,diabetic nephropathy and hypertension-related renal damage.The rate of CKD stage 1-5 was 14.3%,19.7%,37.9%,21.6%and 6.5%,respectively.The prevalence of depression,mild cognitive impairment,malnutrition and instrumental activities of daily living(IADL)dependent was 22.7%,33.6%,19.2%,17.2%,respectively.Lower eGFR patients had lower scores of quality of life.Age,hemoglobin,eGFR,depression,malnutrition and IADL dependent were predictors for HRQOL in more than one subscale.Depression was predictors for all subscales of HRQOL.2.The score of quality of life was lower in depressive CKD patients.Depression was negatively correlated with eGFR(r=-0.098,P=0.001).The prevalence of depression increased in CKD stage 4 and CKD stage 5.Low family's annual income,CKD stage 5,IADL dependent and malnutrition were independent factors of depression.3.There were 48 differential proteins screened by protein chip.The expression of 37 proteins were decreased and the expression of 9 proteins were increased in the depressive CKD patients.The expression of MIP-1?and TGF-?1 were different in the depressive and non-depressive patients after verification.The level of TGF-?1 and MIP-1? was lower in the higher GDS score group.The area under the curve of MIP-la and TGF-?1 was 0.683 and 0.652,respectively.The area under the combined curve of MIP-1? and TGF-?1 was 0.729.Conclusion:1.The prevalence of depression,mild cognitive impairment,malnutrition and IADL dependent was high in elderly CKD patients.Lower eGFR patients had lower socres of quality of life.Age,hemoglobin,eGFR,depression,malnutrition and IADL dependent were predictors for HRQOL in more than one subscale.Depression was predictors for all subscales of HRQOL.2.The score of quality of life was lower in depressive CKD patients.Depression was negatively correlated with eGFR.Low family's annual income,CKD stage 5,malnutrition and IADL dependent were independent factors of depression.3.MIP-1?and TGF-?1 were possible markers that may judge CKD patients with depression.