Psychological and Neurocognitive Dimensions of Kidney Disease: Mental Health Impacts of Chronic Hypertension and Systemic Illness

Abstract

Background:
Hypertension and chronic kidney disease are now considered systemic disorders associated with vascular, metabolic, and inflammatory dysfunction, which may also cause depressive symptoms and cognitive impairment in the elderly. In this study, the researchers assessed how kidney disease indicators, hypertension status, depressive symptoms and neurocognitive performance were related in a nationally representative ageing population.

Methods:
Secondary analysis was performed based on the 2013-2014 National Health and Nutrition Examination Survey. The key inclusion criteria were participants aged 60 to 80 years and full data on blood pressure, estimated glomerular filtration rate, urine albumin-to-creatinine ratio, and depressive symptoms measured by the Patient Health Questionnaire-9 and standardized cognitive tests. Associations between kidney markers, hypertension status, depressive symptoms and cognitive outcomes were investigated using multivariable linear regression models after adjusting for age and sex.

Results:
The poorer cognitive performance was linked to higher albuminuria, especially in the processing speed and executive ability. Estimated glomerular filtration rate was not independently associated with cognitive outcomes after adjustment. Greater depressive symptom burden was consistently associated with lower cognitive scores across all domains. Both lower estimated glomerular filtration rate and higher albuminuria were associated with increased depressive symptoms. Hypertension status demonstrated domain-specific associations with cognitive performance.

Conclusions:
Albuminuria and depressive symptoms are independently associated with neurocognitive performance in older adults, highlighting the importance of integrated renal, mental health, and cognitive screening strategies in aging populations.