About 7.3% of Swedish adults with chronic kidney disease (CKD) have serious mental illness (SMI), which is about 56% higher than the 4.7% prevalence of SMI in the general Swedish population. For this study, SMI included schizophrenia, bipolar disorder, and major depressive disorder. Among those with CKD, the prevalence of schizophrenia was 0.5%, the prevalence of bipolar disorder was 2.1%, and the prevalence of depression was 5.6%.
People with CKD and SMI had a higher mortality rate. SMI affected other CKD outcomes in terms of experiencing a 30% decline in estimated glomerular filtration rate (eGFR); and the rate of initiation of kidney replacement therapy (KRT), which includes hemodialysis, peritoneal dialysis, and continuous renal replacement therapy. The outcomes by diagnosis were as follows:
- Schizophrenia: A lower rate of initiating KRT, not associated with a 30% decline in eGFR.
- Bipolar disorder: A higher percentage of people had a 30% decline in eGFR and a lower rate of initiating KRT.
- Depression: Not associated with 30% decline in eGFR or lower initiation of KRT.
These findings were reported in “Prevalence of Severe Mental Illness and Its Associations With Health Outcomes in Patients With CKD: A Swedish Nationwide Study” by Nanbo Zhu, Ph.D.; Anne-Laure Faucon, M.D., Ph.D.; Ralf Kuja-Halkola, Ph.D.; and colleagues. The researchers analyzed data from the Swedish Renal Registry to identify people with incident CKD G3b-5 or kidney replacement therapy (KRT) between 2008 and 2020. KRT includes hemodialysis, peritoneal dialysis, and continuous renal replacement therapy. They identified 32,943 people in total, 30,103 had not received KRT, and 2,840 were receiving KRT. The analysis focused on those not receiving KRT to examine the association between SMI and subsequent health outcomes in terms of a 30% decline in eGFR, initiation of KART, and all-cause mortality.
For this study, a person was determined to have SMI if the condition was diagnosed during an inpatient stay or in specialist outpatient care before the person was entered into the Swedish Renal Registry. Almost all nephrology clinics in Sweden report to the Swedish Renal Registry, which covers more than 75% of people with CKD G4–5 and more than 95% of those on dialysis.
For more information, contact: Nanbo Zhu, Ph.D., Postdoctoral Researcher, Karolinska Institutet, Nobels väg 12A, Stockholm Sweden; 17177; Email: nanbo.zhu@ki.se; Website: https://ki.se/en/people/nanbo-zhu