Prevalence, incidence, indication, and choice of antidepressants in patients with and without chronic kidney disease: a matched cohort study in UK Clinical Practice Research Datalink

Masao Iwagami, Laurie A. Tomlinson, Kathryn E. Mansfield, Helen I. McDonald, Liam Smeeth, Dorothea Nitsch

Research output: Contribution to journalArticlepeer-review

14 Citations (SciVal)


Purpose: People with chronic kidney disease (CKD) have an increased prevalence of depression, anxiety, and neuropathic pain. We examined prevalence, incidence, indication for, and choice of antidepressants among patients with and without CKD. Methods: Using the UK Clinical Practice Research Datalink, we identified patients with CKD (two measurements of estimated glomerular filtration rate < 60 mL/min/1.73m2 for ≥3 months) between April 2004 and March 2014. We compared those with CKD to a general population cohort without CKD (matched on age, sex, general practice, and calendar time [index date]). We identified any antidepressant prescribing in the six months prior to index date (prevalence), the first prescription after index date among non-prevalent users (incidence), and recorded diagnoses (indication). We compared antidepressant choice between patients with and without CKD among patients with a diagnosis of depression. Results: There were 242 349 matched patients (median age 76 [interquartile range 70–82], male 39.3%) with and without CKD. Prevalence of antidepressant prescribing was 16.3 and 11.9%, and incidence was 57.2 and 42.4/1000 person-years, in patients with and without CKD, respectively. After adjusting for confounders, CKD remained associated with higher prevalence and incidence of antidepressant prescription. Regardless of CKD status, selective serotonin reuptake inhibitors were predominantly prescribed for depression or anxiety, while tricyclic antidepressants were prescribed for neuropathic pain or other reasons. Antidepressant choice was similar in depressed patients with and without CKD. Conclusions: The rate of antidepressant prescribing was nearly one and a half times higher among people with CKD than in the general population.

Original languageEnglish
Pages (from-to)792-801
Number of pages10
JournalPharmacoepidemiology and Drug Safety
Issue number7
Publication statusPublished - 11 Apr 2017
Externally publishedYes

Bibliographical note

Funding Information:
This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. At an individual level, Dr Masao Iwagami is funded by Honjo International Scholarship Foundation, Dr Laurie Tomlinson is funded by a Wellcome Trust Intermediate Clinical Fellowship [WT101143MA], and Dr Helen McDonald was funded by a Kidney Research UK studentship [ST2/2011]. The funders had no role in the execution of this study or interpretation of results.

Publisher Copyright:
© 2017 The Authors. Pharmacoepidemiology & Drug Safety Published by John Wiley & Sons Ltd


  • antidepressants
  • chronic kidney disease
  • depression
  • incidence
  • prevalence

ASJC Scopus subject areas

  • Epidemiology
  • Pharmacology (medical)


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