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Stress Related Disorders and the Risk of Kidney Disease

Stress Related Disorders and the Risk of Kidney Disease

Title: Stress Related Disorders and the Risk of Kidney Disease
Author: Su, Guobin
Song, Huan   orcid.org/0000-0003-3845-8079
Lanka, Vivekananda
Liu, Xusheng
Fang, Fang
Valdimarsdóttir, Unnur A.
Carrero, Juan Jesus
Date: 2021-03
Language: English
Scope: 10
Department: Faculty of Medicine
Series: Kidney International Reports; 6(3)
ISSN: 2468-0249
DOI: https://doi.org/10.1016/j.ekir.2020.12.032
Subject: Nýrnasjúkdómar; Streita; Áfallastreita; acute kidney injury; chronic kidney disease; cohort; posttraumatic stress disorder; reaction to severe stress; SCREAM; Nephrology
URI: https://hdl.handle.net/20.500.11815/3072

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Su , G , Song , H , Lanka , V , Liu , X , Fang , F , Valdimarsdóttir , U A & Carrero , J J 2021 , ' Stress Related Disorders and the Risk of Kidney Disease ' , Kidney International Reports , vol. 6 , no. 3 , pp. 706-715 . https://doi.org/10.1016/j.ekir.2020.12.032


Introduction: Stress related disorders (SRDs, i.e., psychiatric disorders induced by significant life stressors) increase vulnerability to health problems. Whether SRDs associate with risk of acute kidney injury (AKI) and chronic kidney disease (CKD) is unknown. Methods: A population-matched cohort study in Sweden included 30,998 patients receiving a SRDs diagnosis and 116,677 unexposed patients matched by age, sex and estimated glomerular filtration rates (eGFR). The primary outcome was CKD progression, defined as a sustained relative decline in eGFR of more than 40% or commencement of kidney replacement therapy. The secondary outcome was AKI, defined by death or hospitalization attributed to AKI or rapid creatinine changes (increase ≥ 0.3 mg/d over 48 hours or 1.5x over 7 days). Cox models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). Results: During a medium follow-up of 3.2 years, compared to the unexposed, patients with SRDs (median age 45 years, 71% women), were at increased risk of CKD progression (HR 1.23, 95% CI 1.10-1.37) and AKI (HR 1.22, 95% CI 1.04-1.42). While the HR of CKD progression remained similarly elevated during the entire follow-up period, the association with AKI was only observed during the first year after SRDs diagnosis. Results were consistent in stratified analyses, when only considering AKI-hospitalizations/death, and when disregarding eGFR measurements close to index date. Conclusions: A diagnosis of SRDs is associated with subsequent risk of AKI and CKD progression. While studies should confirm this observation and characterize underlying mechanisms, close monitoring of kidney function following SRDs diagnosis may be indicated.


This study is supported by the Swedish Research Council (grant number 2019-01059). The funding source was not involved in design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. GS is supported by European Renal Association?European Dialysis Transplant Association Young Fellowship Programme, Karolinska Institutet Research Grant (No. 2020-01616), the Science and Technology Research Fund from Guangdong provincial hospital of Chinese medicine, China (No. YN2018QL08), National Nature Science Foundation of China (No. 82004205), China Postdoctoral Science Foundation (No. 2020M672741; No. 2020TQ0137). The European Renal Nutrition Working Group is an initiative of and supported by the European Renal Association?European Dialysis Transplant Association. GS and JJC had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis; Concept and design: GS and JJC; Acquisition, analysis, or interpretation of data: All authors; Drafting of the manuscript: GS, HS, JJC; Critical revision of the manuscript for important intellectual content: All authors; Statistical analysis: GS, HS; Administrative, technical, or material support: VL Publisher Copyright: © 2021 International Society of Nephrology

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