P0698STRESS RELATED DISORDERS AND THE RISK OF KIDNEY DISEASE: A MATCHED COHORT STUDY BASED ON THE STOCKHOLM CREATININE MEASUREMENTS (SCREAM) PROJECT

Abstract Background and Aims Psychiatric reactions to life stressors are common in the general population and may increase the risk of acute (AKI) and chronic kidney disease (CKD). The aim of this study is to evaluate the association between stress related disorders and subsequent risk of AKI or CKD progression. Method Population-matched retrospective cohort study conducted in the Stockholm CREAtinine Measurement project (SCREAM), Sweden from 2006 to 2012. The cohort included 31,137 exposed patients with stress related disorders (ie, posttraumatic stress disorder, acute stress reaction, adjustment disorder, and other stress reactions, defined by 10th international Classification of diseases, ICD-10: F43) and known kidney function (estimated glomerular filtration rate, eGFR), and 117,144 unexposed matched by age, sex and eGFR category. The primary outcome was CKD progression, defined as a sustained relative decline in eGFR of more than 40% or commencement of kidney replacement therapy. The secondary outcome was acute kidney injury (AKI), defined by death or hospitalization attributed to AKI or detected transient plasma creatinine elevations (KDIGO classification). Conditional Cox models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). Results During a medium follow-up of 3.3 years and compared with the unexposed population, patients with stress related disorders were at increased risk of CKD progression (HR 1.16, 95% CI 1.04-1.30) and AKI (HR 1.17, 95% CI 1.01-1.37). While the relative risk of CKD progression remained constant over follow-up, the association with AKI was most evident during the first year after stress diagnosis (HR: 1.31, 95% CI 1.04-1.66), disappearing thereafter. Among 9 prespecified subgroups, there was suggestion of heterogeneity with possible lack of association in patients with psychiatric comorbidity. Conclusion Exposure to a stress related disorder was associated with the long-term risk of CKD progression and the short-term risk of AKI. Studies are needed to better understand underlying mechanisms.