Baseline anxiety disorders are associated with progression of diabetic kidney disease in type 2 diabetes

Figures & data

Table 1. Characteristics of participants by anxiety disorders.

Characteristics	All	No anxiety diagnosis	Anxiety diagnosis	p Value
n	2040 (−)	1637 (80.2)	403 (19.8)
Female (%)	936 (45.8)	671 (41.0)	265 (65.8)	<0.001
Age (years)	60.2 ± 6.9	60.7 ± 6.5	58.1 ± 8.1	<0.001
BMI (kg/m^2)	29.7 ± 14.9	29.1 ± 15.7	31.9 ± 11.2	0.001
Married/life partner (%)	1800 (88.2)	1451 (88.6)	349 (86.6)	0.255
Current smoking (%)	493 (24.2)	392 (23.9)	101 (25.1)	0.639
Hypertension (%)	945 (46.3)	746 (45.6)	199 (49.4)	0.170
Diabetes duration (years)	10.5 ± 2.8	10.0 ± 2.7	12.4 ± 2.2	<0.001
Total cholesterol (mmol/l)	5.06 ± 0.23	5.06 ± 0.23	5.05 ± 0.24	0.341
HDL cholesterol (mmol/l)	1.52 ± 0.49	1.52 ± 0.47	1.55 ± 0.56	0.177
Triglyceride (mmol/l)	1.88 ± 1.21	1.89 ± 1.28	1.85 ± 0.91	0.538
LDL cholesterol (mmol/l)	2.57 ± 0.85	2.56 ± 0.82	2.61 ± 0.96	0.289
HbA1c (%)	7.7 ± 0.9	7.7 ± 0.8	7.8 ± 1.0	0.003
HbA1c (mmol/mol)	59.8 ± 10.6	59.1 ± 10.2	62.8 ± 11.8	<0.001
AER (mg/24 h)	44 (23–91)	43 (25–89)	168 (56–224)	<0.001
eGFR (ml/min/1.73 m^2)	79.6 ± 25.5	79.8 ± 25.3	78.7 ± 26.5	0.476
SBP (mmHg)	139.9 ± 8.5	138.9 ± 7.8	144.2 ± 9.5	<0.001
DBP (mmHg)	84.7 ± 7.0	84.6 ± 6.5	85.2 ± 8.5	0.149
RAS inhibitor (%)	851 (41.7)	692 (42.3)	159 (39.5)	0.304
Statin (%)	754 (37.0)	610 (37.3)	144 (35.7)	0.568
Diagnosed depression (%)	250 (12.3)	143 (8.7)	107 (26.6)	<0.001

Quantitative values are presented as mean ± SD, and qualitative values are presented as number of participants/percentage. BMI: body mass index; AER: albumin excretion rate; eGFR: estimated glomerular filtration rate; SBP: systolic blood pressure; DBP: diastolic blood pressure; RAS: renin angiotensin system; SD: standard deviation.

Figure 1. Cumulative event-free survival (Kaplan–Meyer curves) for progression of DKD. Significant difference was shown in estimated mean time free of DKD progression by anxiety status (log rank p < 0.001). DKD: diabetic kidney disease.

Table 2. Characteristics of participants by progression of diabetic nephropathy.

Characteristics	Non-progressors	Progressors	p Value
n	1700 (83.3%)	340 (16.7%)
Female (%)	816 (48.0)	120 (35.3)	<0.001
Age (years)	60.0 ± 7.0	61.1 ± 7.2	0.006
BMI (kg/m^2)	29.6 ± 14.4	30.0 ± 17.6	0.668
Married/life partner (%)	1502 (88.4)	295 (86.8)	0.409
Current smoking (%)	405 (23.8)	88 (25.9)	0.418
Hypertension (%)	765 (45.0)	180 (52.9)	0.007
Diabetes duration (years)	10.4 ± 2.7	10.8 ± 3.4	0.008
Follow-up time (years)	3.0 (2.1–3.2)	2.1 (0.9–3.2)	<0.001
Total cholesterol (mmol/l)	5.05 ± 0.23	5.09 ± 0.24	0.004
HDL cholesterol (mmol/l)	1.53 ± 0.49	1.51 ± 0.47	0.678
Triglyceride (mmol/l)	1.89 ± 1.26	1.87 ± 0.96	0.859
LDL cholesterol (mmol/l)	2.57 ± 0.86	2.58 ± 0.80	0.788
HbA1c (%)	7.6 ± 1.0	7.7 ± 0.92	0.250
HbA1c (mmol/mol)	59.7 ± 10.7	60.5 ± 10.1	0.250
eGFR (ml/min/1.73 m^2)	79.9 ± 25.9	77.8 ± 23.5	0.168
SBP (mmHg)	139.3 ± 7.5	142.9 ± 11.3	<0.001
DBP (mmHg)	84.8 ± 7.0	84.7 ± 7.0	0.870
RAS inhibitor (%)	733 (43.1)	119 (35.0)	0.006
Statin (%)	648 (38.1)	106 (31.2)	0.015
Anxiety disorders (%)	305 (17.9)	98 (28.8)	<0.001
Depression (%)	189 (11.1)	61 (17.9)	<0.001

Quantitative values are presented as mean ± SD or median (IQR), and qualitative values are presented as number of participants/percentage. BMI: body mass index; eGFR: estimated glomerular filtration rate; SBP: systolic blood pressure; DBP: diastolic blood pressure; RAS: renin angiotensin system; SD: standard deviation.

Table 3. Association between anxiety and progression of diabetic nephropathy in type 2 diabetes.

	HR	95% CI	p Value
Univariate model	1.652	1.278–2.136	<0.001
Multivariate-adjusted model
Model 1*	1.553	1.122–2.150	0.008
Model 2^†	1.539	1.130–2.095	0.006

*Model 1 is adjusted for age, sex, BMI, marital status, smoking, hypertension, duration of diabetes, use of renin-angiotensin system blocker and statin, HbA_1c, eGFR, total cholesterol, HDL cholesterol, triglyceride, LDL cholesterol, blood pressure, and an anxiety × depression interaction term. ^†Model 2 is adjusted additionally for depression. BMI: body mass index; eGFR: estimated glomerular filtration rate; HR: hazard ratios; CI: confidence intervals.

Data availability statement

The datasets during and/or analyzed during the present study are available from the corresponding author on reasonable request.