
==== Front
Kidney Med
Kidney Med
Kidney Medicine
2590-0595
Elsevier

S2590-0595(24)00097-9
10.1016/j.xkme.2024.100886
100886
Correspondence
Letter to the Editor
Frailty May Mediate the Relationship Between Depressive Symptoms, Antidepressant Use, and Mortality in Patients With Chronic Kidney Disease
Hung Kuo-Chin MD 12
Chao Chia-Ter MD, PhD b88401084@gmail.com
1345∗
1 Division of Nephrology, Department of Internal Medicine, Min-Sheng General Hospital, Taoyuan City, Taiwan
2 Department of Pharmacy, Tajen University, Pingtung, Taiwan
3 Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
4 Graduate Institute of Toxicology, National Taiwan University College of Medicine, Taipei, Taiwan
5 Graduate Institute of Medical Education and Bioethics, National Taiwan University College of Medicine, Taipei, Taiwan
∗ Address for Correspondence: Chia-Ter Chao, MD, PhD, Min-Sheng General Hospital, No.168, Jingguo Road, Taoyuan District, 330 Taoyuan City, Taiwan. b88401084@gmail.com
06 8 2024
9 2024
06 8 2024
6 9 100886© 2024 The Authors
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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pmcTo the Editor:

We read with keen interest the article by Hernandez et al,1 which delved into the intricate interplay among depressive symptoms, antidepressant use, and outcomes in patients with chronic kidney disease (CKD). The study compellingly demonstrated that greater depressive symptoms and antidepressant use independently correlated with heightened mortality and hospitalization rates. Intriguingly, the outcomes revealed a nuanced pattern, as greater depressive symptoms without antidepressant, lower depressive symptoms with antidepressant use, and greater depressive symptoms with antidepressant use were associated with progressively worse prognoses. We posit that the absence of discernible antidepressant benefits on outcomes may, in part, be attributed to concealed frailty influences in these patients.

Individuals with CKD are predisposed to frailty, a factor coinciding with and contributing to depression.2 Insights from the Chronic Renal Insufficiency Cohort (CRIC) revealed that depressive symptoms and frail phenotypes independently and cumulatively, escalated the risk of mortality and dialysis initiation in patients with CKD.3 Conversely, while antidepressant use can be beneficial in alleviating depressive symptoms, its efficacy diminishes in individuals with frailty, particularly among older adults.4 Antidepressants themselves may exert anticholinergic and antihistaminergic effects, rendering long-term users susceptible to falls and frailty development.5 From this vintage point, patients with CKD may manifest both frailty and concurrent depression, leading to antidepressants prescriptions that introduce side effects exacerbating frailty. Consequently, the heightened mortality risk associated with increased depressive symptoms and antidepressant use likely emanates from their joint influences on worsening frailty. Therefore, it would be advantageous for the authors to incorporate measurements of frail phenotype to unravel the intricate relationship between depression, antidepressants, and outcomes in patients with CKD.

Article Information

Support

The study is financially sponsored by 10.13039/501100005762 National Taiwan University Hospital (113-N0029 and 113-TMU172) and 10.13039/100020595 National Science and Technology Council , Taiwan (NSTC 112-2314-B-002-232-MY3) The sponsors have no role in the study design, data collection, analysis, and result interpretation of this study.

Financial Disclosure

The authors declare that they have no relevant financial interests.

Peer Review

Received February 29, 2024. Accepted March 13, 2024, after editorial review by the Editor-in-Chief.
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References

1 Hernandez R. Xie D. Wang X. Depressive symptoms, antidepressants, and clinical outcomes in chronic kidney disease: findings from the CRIC study Kidney Med 6 4 2024 100790 10.1016/j.xkme.2024.100790
2 Chi C.Y. Lee S.Y. Chao C.T. Huang J.W. Frailty as an independent risk factor for depression in patients with end-stage renal disease: a cross-sectional study Front Med (Lausanne) 9 2022 799544 10.3389/fmed.2022.799544
3 Chiu V. Gross A.L. Chu N.M. Domains for a comprehensive geriatric assessment of older adults with chronic kidney diseasE: results from the CRIC study Am J Nephrol 53 11-12 2022 826 838 10.1159/000528602 36502797
4 Brown P.J. Ciarleglio A. Roose S.P. Frailty and depression in late life: a high-risk comorbidity with distinctive clinical presentation and poor antidepressant response J Gerontol A Biol Sci Med Sci 77 5 2022 1055 1062 10.1093/gerona/glab338 34758065
5 Aprahamian I. Borges M.K. Hanssen D.J. Jeuring H.W. Oude Voshaar R.C. The frail depressed patient: a narrative review on treatment challenges Clin Interv Aging 17 2022 979 990 10.2147/CIA.S328432 35770239
