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Depression is associated with progression of diabetic nephropathy in type 1 diabetes

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posted on 11.11.2020, 16:07 by Aila J. Ahola, Valma Harjutsalo, Carol Forsblom, François Pouwer, Per-Henrik Groop, the FinnDiane Study Group
OBJECTIVE To investigate the relationship between depression and diabetic nephropathy progression in type 1 diabetes.

RESEARCH DESIGN AND METHODS Data from 3730 participants without end-stage renal disease at baseline, participating in the Finnish Diabetic Nephropathy Study, were included. Depression was assessed in three ways. Depression diagnoses were obtained from the Finnish Care Register for Health Care. Antidepressant agent purchase data were obtained from the Drug Prescription Register. Symptoms of depression were assessed using the Beck Depression Inventory (BDI). Based on their urinary albumin excretion rate (AER) participants were classified into those with normal AER, microalbuminuria, and macroalbuminuria. Progression from normal AER to either microalbuminuria, macroalbuminuria, or end-stage renal disease; or from microalbuminuria to macroalbuminuria or ESRD; or from macroalbuminuria to ESRD, during the follow-up period was investigated.

RESULTS Over a mean follow-up period of 9.6 years, renal status deteriorated in 18.4% of the participants. Diagnosed depression and antidepressant purchases before baseline were associated with 53% and 32% increased risk of diabetic nephropathy progression, respectively. Diagnosed depression assessed during follow-up remained associated with increased risk of disease progression (32%). BDI-derived symptoms of depression showed no association with the progression, but the total number of antidepressant purchases modestly reduced the risk [0.989 (0.982–0.997), P=0.008]. Dividing the sample based on median age, the observations followed those seen in the whole group. However, symptoms of depression additionally predicted progression in those ≤36.5 years.

CONCLUSIONS Diagnosed depression and antidepressant purchases are associated with the progression of diabetic nephropathy in type 1 diabetes. Whether successful treatment of depression reduces the risk needs to be determined.

Funding

This study was supported by grants from Academy of Finland (grant number 316664); Novo Nordisk Foundation (#NNF OC0013659); Signe and Ane Gyllenberg Foundation; Folkhälsan Research Foundation; Helsinki University Hospital Research Funds (TYH2018207); Wilhelm and Else Stockmann Foundation; Liv och Hälsa Society; and Päivikki and Sakari Sohlberg Foundation. Funding agencies did not contribute to the study design, conduct of the study, analysis of samples or data, interpretation of the findings, writing of the manuscript, or in the decision to submit the manuscript for publication.

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