Anxiety, Depression Highly Prevalent in Patients with Lupus Nephritis

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"Lupus nephritis (LN) patients might suffer from mental disorders which further prolong the LN treatment duration and affect patients' quality of life.”

Linked to aging, inflammation, alopecia, and severe renal involvement, patients with lupus nephritis (LN) are more prone to anxiety and depression, according to a study published in Immunity, Inflammation and Disease.1

“Currently, the treatment of LN mainly includes induction therapy of cyclophosphamide, mycophenolate mofetil/mycophenolate acid (MMF/MPA), and calcineurin inhibitors (CNI), as well as subsequent maintenance therapy by MMF/MPA, azathioprine (AZA), and so forth,” investigators stated. “However, despite the advance in treatment approaches in decades, the kidney failure risk still remains unacceptably high; notably, approximately 30% of LN patients would finally develop end-stage renal disease (ESRD). Apart from that, the LN patients might also suffer from mental disorders (such as anxiety, depression, suicidality, etc), which further prolong the LN treatment duration and affect patients' quality of life.”

A total of 50 patients with LN, 50 non-LN systemic lupus erythematosus (SLE) patients, and 50 healthy controls (HCs) were enrolled in the case-control study between May 2018 and March 2021. Eligible patients were aged 18 years or older, diagnosed with LN according to American College of Rheumatology criteria, and volunteered to participate. Clinical characteristics, which included age, gender, disease duration, clinical manifestations, systemic lupus erythematous disease activity index (SLEDAI) score, LN activity index, LN chronicity indexes, biochemical indexes, and LN classification were collected. The Hospital Anxiety and Depression Scale (HADS) was utilized to evaluate both anxiety (HADS-A) and depression (HADS-D).

The mean age of patients with LN was 46.3 years, 86% were female, and the median disease duration was 55.5 months. Anxiety, as measured by the HADS-A score, was highest in patients with LN (median 7.0, interquartile range [IQR]: 6.0–10.0), followed by non-LN SLE patients (median 6.0, IQR: 5.0–8.0). Anxiety rates were highest in the LN cohort (38%), followed by non-LN SLE patients (28%), and least common in HCs (12%).

The HADS-D score indicated that depression was highest in LN patients (median 7.5, IQR: 6.0–11.0), followed by non-LN SLE patients (median 6.0, IQR: 5.0–8.3), and lowest in HCs (median 4.0, IQR: 2.0–6.3) (p < .001). Depression rates were most common in patients with LN (50%), followed by non-LN SLE patients (30%), and the rarest in HCs (10%) (p < .001). Patients with LN ranked lowest in HCs (median 5.0, IQR: 3.0–7.0) (p < .001).

Risk factors for anxiety included age (p = .009), LN activity index (p = .020), alopecia (p = .023), 24 h proteinuria (p = .044), and C-reactive protein (p = .049). Depression risk was independently correlated with age (p = .001) and LN activity index (p = .009).

Limitations included the single-centered nature of the study, as well as the small sample size, which may hinder generalizability. HADS scores were based on a subjective, self-assessment, which may create assessment bias. Lastly, the study did not evaluate the underlying pathogenesis of anxiety and depression in patients with LN.

“In the current study, LN patients had higher anxiety and depression scores compared with non-LN SLE patients and HCs,” investigators concluded. “Meanwhile, LN patients had higher anxiety and depression rates compared with non-LN SLE patients and HCs. Possible explanations could be that: (1) LN patients might face several bleaker events such as pain, disability, discrimination, fear of mortality, and social stress, which might result in psychological problems. (2) The occurrence of LN is accompanied by the recruitment of proinflammation cytokines, which are reported to be closely related to anxiety and depression, subsequently, anxiety and depression have high frequencies in LN patients.”


Hu Y, Zhan G. Anxiety and depression prevalence and their risk factors in lupus nephritis patients: A case-control study. Immun Inflamm Dis. 2022;10(9):e689. doi:10.1002/iid3.689