Cardiorenal Syndrome Associated With Depression

Cardiorenal syndrome is associated with increased risk for depression, though this relationship is not mediated by lipid indicators, according to study findings published in Lipids in Health and Disease.

The incidences of cardiovascular disease (CVD) and chronic kidney disease (CKD) are often linked due to the activation of the sympathetic-renin-angiotensin-aldosterone system. Impaired kidney function caused by decreased cardiovascular function or heart failure caused by decreased kidney function is known as cardiorenal syndrome (CRS). Although CVD, CKD, and lipids are positively correlated with depressive symptoms, the relationship between CRS and depression remains unclear.

Researchers collected data using the Centers for Disease Control and Prevention’s National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018. Individuals with cancer and pregnant individuals were excluded.

CVD was defined as a self-report of congestive heart failure, angina pectoris, coronary artery disease, heart attack, or stroke, while CKD was defined as an estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73m². Patients with CRS met the criteria for both categories.

Depression was measured using the Patient Health Questionnaire-9 (PHQ-9). Atherogenic Index of Plasma, triglyceride glucose index, and serum remnant cholesterol were collected from laboratory values.

After exclusions and propensity score matching, the study included 395 participants with CRS and 1114 patients without CRS. Patients with CRS, of whom 55.1% were male, had a mean age of 69.48 years.

Patients with CRS had increased odds of depression compared with patients without CVD or CKD (odds ratio [OR], 1.240; 95% CI, 1.237-1.243), with CVD only (OR, 0.646; 95% CI, 0.644-0.649), and with CKD only (OR, 1.432; 95% CI, 1.428-1.437). Depression affected 12.56% of patients with CRS and 7.93% of patients without either condition (P <.05).

Participants with PHQ-9 scores indicating major depression had higher triglycerides, triglyceride glucose, serum remnant cholesterol, Atherogenic Index of Plasma, fasting plasma glucose, hemoglobin A1c, uric acid, and urinary albumin-to-creatinine ratio (p<.05).

The researchers identified a positive correlation between CRS and depression symptoms, regardless of Atherogenic Index of Plasma, triglyceride glucose index, and serum remnant cholesterol changes. However, they observed a forward linear relationship between these values and depression.

When the researchers reduced levels of Atherogenic Index of Plasma and triglyceride glucose index, the risk for depression decreased among patients with CRS beyond that of patients without CVD or CKD.

Study limitations include the general, limited definition of cardiorenal syndrome, the possibility of recall bias, selection bias, and confounding factors due to the study design, and the possibility of a lack of generalizability to wider populations.

“There was a significant association between CRS and depression and a linear relationship between [Atherogenic Index of Plasma, triglyceride glucose index, and serum remnant cholesterol] and depression. Reducing [Atherogenic Index of Plasma, triglyceride glucose index, and serum remnant cholesterol] can significantly reduce the risk of depression especially in CRS patients,” the study authors concluded.

This article originally appeared on Endocrinology Advisor