Margaret Yu, MD, MS
Fellow with UW Nephrology
Background and objectives: Comorbid major depression is associated with adverse health outcomes in patients with diabetes, yet little is known regarding its associations with long-term renal outcomes in this population. This study evaluated associations between depressive symptoms and risk of incident end-stage renal disease (ESRD) in a diabetic cohort. Design, setting, participants, and measurements: In this prospective, observational cohort study, 3,886 ambulatory adults with diabetes were recruited from primary care clinics of a large health maintenance organization in Washington State. Participants were considered depressed if they had the required number of depressive symptoms (≥5 for major or 2-4 for minor depressive symptoms) including depressed mood or anhedonia, >50% of the time for ≥2 weeks, and a Patient Health Questionnaire-9 (PHQ-9) score ≥10 for major and ≥5 for minor depressive symptoms. Risk of incident ESRD was estimated using Cox proportional hazards regression with pre-dialysis death as a competing risk. Results: During a median follow-up of 8.8 years, 87 patients (2.2%) developed ESRD. Major depressive symptoms were associated with a higher risk of incident ESRD (HR 1.85, 95% CI 1.02-3.33), after adjusting for demographics, diabetes characteristics, baseline kidney function, obesity, and hypertension. Minor depressive symptoms were not significantly associated with incident ESRD (HR 1.08, 95% CI 0.52-2.25). Conclusions: Major depressive symptoms, but not minor depressive symptoms, were associated with a higher risk of incident ESRD over up to 10 years. Additional studies are needed to determine whether treatment for depression can improve renal outcomes in patients with diabetes.
I came to Seattle, WA in 2008 after completing internal medicine residency at Northwestern University. I worked for two years as an internal medicine hospitalist at the University of Washington Medical Center before entering nephrology fellowship in 2010. During fellowship, I completed the MS in Epidemiology at the UW School of Public Health. In 2013 I joined the Seattle VA as a Health Services Research & Development postdoctoral research fellow. My research interests include sex disparities in chronic kidney disease, depression and kidney disease, and the decision process around dialysis initiation.