Kidney disease is one of the most concerning possible complications of diabetes, both type 1 and type 2. When the tiny blood vessels in the kidneys are damaged by high blood glucose levels, the kidneys can gradually lose their ability to filter waste products from your blood — culminating, potentially, in end-stage kidney disease, which means that the kidneys can no longer function well enough to sustain life. People with end-stage kidney disease need dialysis or a kidney transplant to survive.
So for anyone with diabetes, avoiding kidney disease — or its progression to later stages of the disease — should be an important goal of diabetes management. But besides blood glucose control and related lifestyle factors, there is limited knowledge about what factors lead to progression of kidney disease in some people but not others.
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Now, a new study suggests that depression may be an important factor in kidney disease progression for people with type 1 diabetes.
Depression, antidepressants linked to disease progression
The study, published in the journal Diabetes Care, included over 3,700 participants with type 1 diabetes who didn’t have end-stage kidney disease at the beginning of the study. Participants were followed for an average of 9.6 years, during which 18.4% of participants saw their kidney function worsen.
When the researchers looked at a number of factors that influenced the risk of kidney function getting worse, they found that having been diagnosed with depression at the beginning of the study was associated with a 53% higher risk of worsening kidney function. Taking antidepressants at the beginning of the study was independently associated with a 32% higher risk of worsening kidney function, on top of the risk tied to depression itself.
For participants who were diagnosed with depression during the study’s follow-up period, the risk of worsening kidney function was 32% higher than in participants who didn’t have depression. An assessment of depression symptoms showed that having worse depression symptoms predicted greater worsening of kidney function only in participants at or younger than 36.5 years old. In other participants, there was no link between worse depression symptoms and greater worsening of kidney function.
When the whole group of participants was divided in half based on age, the links between depression status and worsening kidney function were the same in both groups.
Lessons for people with diabetes?
While this study shows a clear connection between having depression and worsening kidney function in people with type 1 diabetes, it isn’t clear whether there is anything people with diabetes can actually do to limit their kidney risk based on the scope of the study.
Unlike factors like managing blood glucose and following dietary guidelines, there probably isn’t much that people with diabetes can do to actively avoid depression or the need to take antidepressants. And the fact that depression symptoms weren’t associated with changes in kidney function, in most participants, suggests that effectively managing your depression may not limit the higher risk of worsening kidney function associated with having depression.
More studies are needed to explore whether any specific interventions in people with depression, besides taking antidepressants, could have a beneficial effect on kidney function in people with diabetes. Until then, the most this study can offer by way of practical advice is probably to be aware of the link between depression and kidney function. If you have diabetes and have been diagnosed with depression, it may be even more important to monitor your kidney function — especially if you’ve already been diagnosed with kidney disease at some stage. Talk to your doctor about getting appropriate kidney function screenings if you’re concerned you may not be getting them already.
Want to learn more about keeping your kidneys healthy with diabetes? Read “Managing Diabetic Kidney Disease,” “Kidney Disease: Your Seven-Step Plan for Prevention” and “Ten Things to Know About Kidney Disease.”