[13, 20] In contrast, data for individuals with pre-dialysis CKD are sparse with few prospective cohort studies published to date (Table 1).[20] In summary, Hedayati and colleagues concluded that a diagnosis major depression at baseline was a significant predictor of premature death in patients with CKD 4–5 and congestive heart failure.[16] Further, a recent study involving predominantly male veterans with CKD 2–5, found that a major depressive episode at baseline was associated with an increased risk of a composite of death, hospitalization, or progression to dialysis, independent of comorbidities and kidney disease

severity (adjusted hazards ratio (HR) 1.86).[21] High depressive symptoms in non-dialysed MK0683 CKD patients have also been found to predict a more rapid decline in kidney function, and an increased risk of first hospitalization (adjusted HR 1.59) and progression to CKD 5D or death (adjusted HR 1.66).[17] Similarly, elevated depressive symptoms at baseline were associated with an increased risk of a composite of cardiovascular death/hospitalization in an outpatient population with hypertensive CKD (adjusted HR 1.63).[23] Finally, Kellerman et al.

found that increased nonsomatic (cognitive) depressive symptoms at baseline Ku-0059436 ic50 predicted an increased risk of mortality over 7 years suggesting that observed associations are not merely because of the overlap of somatic symptoms between depression and uraemia.[22] While preliminary, these studies suggest that interventions targeting depression have the potential to modify the clinical course of CKD. Anxiety disorders (e.g. panic disorder, generalized anxiety disorder) are characterized by a range of psychological and somatic symptoms including

excessive worry, fear, nervousness, obsessive thoughts, heart palpitations and gastrointestinal problems. Anxiety disorders rarely exists in isolation and anxiety and are frequently comorbid with depressive disorders.[9] As with depression, clinical anxiety is associated Casein kinase 1 with decreased HRQOL, increased physical disability and greater utilization of healthcare resources across various chronic diseases.[4] Around 20% to 40% of dialysis patients meet the diagnostic criteria for an anxiety disorder.[14, 24] Prevalence of anxiety is currently undefined in people with CKD; however, preliminary data indicate that anxiety disorders may be common around 9% of patients with CKD 4 reporting at least moderate levels of clinical anxiety (Beck Anxiety Inventory).[25] This is substantially higher than the 12-month prevalence of anxiety disorders (5.2%) observed in older Australians aged 65–85 years.[26] Further, a recent study found that around 28% of patients with CKD 3–5 reported high levels of anxiety symptoms, the prevalence not differing across CKD stages.