Depressive Symptoms in Adults with Autosomal Dominant Polycystic Kidney Disease.

Background: Individuals with autosomal dominant polycystic kidney disease (ADPKD) face mental health challenges linked to disease progression and its heritable nature. Prior studies reported mixed associations between depressive symptoms and ADPKD severity and progression. Here, we assessed depressive symptoms and disease severity over three years in ADPKD patients without end-stage kidney disease.

Methods: 283 adults with ADPKD were enrolled from April 2013 to June 2023 in a single-center prospective observational study. ADPKD severity was assessed with estimated GFR and htTKV. Depressive symptoms were assessed with the Beck Depression Inventory-II (BDI-II). Depressive symptom burden was compared to previously reported cohorts of patients with other chronic, progressive diseases. The relationship of ADPKD severity and ADPKD-related pain with depressive symptoms was estimated using multiple linear regression, adjusting for potential confounders.

Results: Among 283 adult ADPKD patients(mean age 45; 81% White; 61% female), 15.5% reported moderate depressive symptoms (BDI-II ≥ 11). Depressive symptom prevalence (all ages) was lower than in primary care samples. For the older individuals in our cohort, depressive symptom prevalence was similar to those in healthy older adults. ADPKD severity [eGFR: 73±33 ml/min/1.73m2, htTKV: 1104±80 cc/meter] was unrelated to depressive symptoms, although frequent pain (abdominal, back, and/or flank pain experienced at least daily) strongly associated with higher depressive symptom levels. Baseline depressive symptoms did not predict kidney function (eGFR, htTKV) at 36 months, adjusting for baseline measures and confounders.

Conclusions: Our results reveal a relatively low prevalence of clinically significant depressive symptoms in a large sample of adult patients with ADPKD who were not undergoing renal replacement therapy. However, frequent pain was associated with a greater degree of depressive symptoms, underscoring the importance of adequate pain control. While these findings highlight the resilience of patients with ADPKD, routine mental health screening is recommended, and validated pain assessment tools may provide useful resources to quantify and manage pain in ADPKD.