The Association of Post-Traumatic Stress Disorder with longitudinal change in Glomerular Filtration Rate in World Trade Center responders.

OBJECTIVE High levels of psychological distress increase the risk of a wide range of medical diseases. We investigated the association between posttraumatic stress disorder (PTSD) and kidney disease in this study. METHODS World Trade Center (WTC) responders were included if they had ≥2 measures of estimated glomerular filtration rate (eGFR). The PTSD checklist (PCL) was used to define no PTSD (PCL < 40), 'mild' PTSD (40 ≤ PCL <50) and 'severe' PTSD (PCL ≥50). Subtypes of PTSD by symptom clusters were analyzed.. Multinomial logistic regression was used to estimate the association of PTSD with two GFR change outcomes (decline or increase) compared to the stable GFR outcome. RESULTS In 2,266 participants, the mean age was 53.1 years, 8.2% female, and 89.1% were White. Individuals with PTSD (N = 373; 16.5%) did not differ in mean baseline GFR from individuals without PTSD (89.73 vs. 90.56 ml/min/1.73 m2); p = 0.29). Over a 2.01 years mean follow-up,a mean GFR decline of -1.51 ml/min/1.73m2 per year was noted. In multivariable-adjusted models, PTSD was associated with GFR decline (aRR = 1.74 [1.32-2.30], p < 0.001) compared to stable GFR, with 'Hyperarousal' symptoms showing the strongest association aRR =2.11 [1.40-3.19]; p < 0.001).. Dose-response effects were evident when comparing mild to severe PTSD and comparing PTSD with versus without depression. PTSD was also associated with GFR rise (aRR = 1.47 [1.10-1.97], p < 0.009). The association between PTSD and GFR change was stronger in participants <50 years of age. CONCLUSIONS PTSD may be a novel risk factor for exaggerated longitudinal GFR change in young, healthy adults. These findings need to be validated in other cohorts.