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Association of mental health-related patient reported outcomes with blood pressure in adults and children with primary proteinuric glomerulopathies

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Abstract

Introduction

The prevalence of mental health disorders including anxiety and depression is increasing and is linked to hypertension in healthy individuals. However, the relationship of psychosocial patient-reported outcomes on blood pressure (BP) in primary proteinuric glomerulopathies is not well characterized. This study explored longitudinal relationships between psychosocial patient-reported outcomes and BP status among individuals with proteinuric glomerulopathies.

Methods

An observational cohort study was performed using data from 745 adults and children enrolled in the Nephrotic Syndrome Study Network (NEPTUNE). General Estimating Equations for linear regression and binary logistic analysis for odds ratios were performed to analyze relationships between the exposures, longitudinal Patient-Reported Outcome Measurement Information System (PROMIS) measures and BP and hypertension status as outcomes.

Results

In adults, more anxiety was longitudinally associated with higher systolic and hypertensive BP. In children, fatigue was longitudinally associated with increased odds of hypertensive BP regardless of the PROMIS report method. More stress, anxiety, and depression were longitudinally associated with higher systolic BP index, higher diastolic BP index, and increased odds of hypertensive BP index in children with parent-proxy patient-reported outcomes.

Discussion/conclusion

Chronically poor psychosocial patient-reported outcomes may be significantly associated with higher BP and hypertension in adults and children with primary proteinuric glomerulopathies. This interaction appears strong in children but should be interpreted with caution, as multiple confounders related to glomerular disease may influence both mental health and BP independently. That said, access to mental health resources may help control BP, and proper disease and BP management may improve overall mental health.

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Data availability

All data generated or analyzed during this study are included in this article. Further enquiries can be directed to the corresponding author.

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Acknowledgements

We would like to express our deepest gratitude to all the patients and families who generously participated in this study. We would also like to extend our thanks to the members of the NEPTUNE consortium listed below: Members of the Nephrotic Syndrome Study Network (NEPTUNE). NEPTUNE Enrolling Centers: Atrium Health Levine Children’s Hospital, Charlotte, SC: S Massengill (Principal Investigator), L Lo (Study Coordinator); Cleveland Clinic, Cleveland, OH: K Dell (Co-investigator), J Sedor (Co-investigator), B Martin (Study Coordinator); Children’s Hospital, Los Angeles, CA: K Lemley (Principal Investigator), C Fajardo (Principal Investigator), S Sharma (Study Coordinator); Children’s Mercy Hospital, Kansas City, MO: T Srivastava (Principal Investigator), K Markus (Study Coordinator); Cohen Children’s Hospital, New Hyde Park, NY: C Sethna (Principal Investigator), S Vento (Study Coordinator); Columbia University, New York, NY: P Canetta (Principal Investigator), A Pradhan (Study Coordinator); Duke University Medical Center, Durham, NC: R Gbadegesin (Principal Investigator), O Olabisi (Co-investigator), M Smith (Study Coordinator); Emory University, Atlanta, GA: L Greenbaum (Principal Investigator), CS Wang (Co-investigator), E Yun (Study Coordinator); The Lundquist Institute, Torrence, CA: S Adler (Principal Investigator), J LaPage (Study Coordinator); John H Stroger Cook County Hospital, Chicago, IL: A Amarah (Principal Investigator), M Itteera (Study Coordinator); Johns Hopkins Medicine, Baltimore, MD: M Atkinson (Principal Investigator), M Williams (Study Coordinator); Mayo Clinic, Rochester, MN: F Fervenza (Principal Investigator), M Hogan (Co-investigator), J Lieske (Principal Investigator; Study Coordinator); Medical University of South Carolina, D Selewski (Principal Investigator), C Alston (Study Coordinator); Montefiore Medical Center, Bronx, NY: F Kaskel (Principal Investigator), M Ross (Principal Investigator), P Flynn (Study Coordinator); NIDDK Intramural, Bethesda MD: J Kopp (Principal Investigator); New York University Medical Center, New York, NY: L Malaga-Dieguez (Principal Investigator), O Zhdanova (Co-investigator), LJ Pehrson (Study Coordinator); The Ohio State University College of Medicine, Columbus, OH: S Almaani (Principal Investigator), L Roberts (Study Coordinator); Stanford University, Stanford, CA: R Lafayette (Principal Investigator), S Dave (Study Coordinator); Temple University, Philadelphia, PA: I Lee (Principal Investigator), Z Pfeffer (Study Coordinator); Texas Children’s Hospital at Baylor College of Medicine, Houston, TX: S Shah (Principal Investigator), A Deslandes (Study Coordinator); University Health Network Toronto: H Reich (Principal Investigator), M Hladunewich (Co-investigator), P Ling (Study Coordinator), M Romano (Study Coordinator); University of California at San Francisco, San Francisco, CA: P Brakeman (Principal Investigator); University of Colorado Anschutz Medical Campus, Aurora, CO: A Podoll (Principal Investigator), N Rogers (Study Coordinator); University of Kansas Medical Center, Kansas City, KS: E McCarthy (Principal Investigator), E Landry (Study Coordinator); University of Miami, Miami, FL: A Fornoni (Principal Investigator), C Bidot (Study Coordinator); University of Michigan, Ann Arbor, MI: M Kretzler (Principal Investigator), D Gipson (Principal Investigator), A Williams (Study Coordinator), M Stelzer (Study Coordinator); University of Minnesota, Minneapolis, MN: P Nachman (Principal Investigator), M Rheault (Co-investigator), V Rao (Study Coordinator); University of North Carolina, Chapel Hill, NC: V Derebail (Principal Investigator), K Gibson (Principal Investigator), A Froment (Study Coordinator), F Ochoa-Toro (Study Coordinator); University of Pennsylvania, Philadelphia, PA: L Holzman (Principal Investigator), K Meyers (Co-investigator), K Kallem (Study Coordinator), A Swenson (Study Coordinator); University of Texas San Antonio, San Antonio, TX: K Sharma (Principal Investigator); University of Texas Southwestern, Dallas, TX: K Sambandam (Principal Investigator), E Robles (Study Coordinator), M Turk (Study Coordinator); University of Washington, Seattle, WA: A Jefferson (Principal Investigator), S Hingorani (Co-investigator), K Tuttle (Co-investigator) (Providence Medical Research Center, Spokane, WA), L Manahan (Study Coordinator), E Pao (Study Coordinator), K Kuykendall K (Providence Medical Research Center, Spokane, WA); Wake Forest University Baptist Health, Winston-Salem, NC: JJ Lin (Principal Investigator) no coordinators identified; Washington University in St. Louis, St. Louis, MO: E Cody (Principal Investigator) no coordinators identified. Data Analysis and Coordinating Center: Matthias Kretzler (Principal Investigator), Laura Barisoni (Co-investigator), Crystal Gadegbeku (Co-investigator), Brenda Gillespie (Co-investigator), Lawrence Holzman (Co-investigator), Laura Mariani (Co-investigator), Zubin Modi (Co-investigator), Matthew G Sampson (Co-investigator), Eloise Salmon (Co-investigator), John Sedor (Co-investigator), Abigail Smith (Co-investigator), Howard Trachtman (Co-investigator), Jarcy Zee (Co-investigator), Gabrielle Alter, Hailey Desmond, Sean Eddy, Damian Fermin, Wenjun Ju, Maria Larkina, Shengqian Li, Shannon Li, Chrysta Lienczewski, Tina Mainieri, Rebecca Scherr, Johnathan Troost, Amanda Williams. Digital Pathology Committee: Carmen Avila-Casado (University Health Network, Toronto), Serena Bagnasco (Johns Hopkins University), Clarissa Cassol (Arakana), Lihong Bu (Mayo Clinic), Shelley Caltharp (Emory University), Dawit Demeke (University of Michigan), Brenda Gillespie (University of Michigan), Jared Hassler (Temple University), Leal Herlitz (Cleveland Clinic), Stephen Hewitt (National Cancer Institute), Jeff Hodgin (University of Michigan), Danni Holanda (Arkana), Neeraja Kambham (Stanford University), Kevin Lemley (Children’s Hospital of Los Angeles), Laura Mariani (University of Michigan), Nidia Messias (Washington University), Alexei Mikhailov (Wake Forest), Behzad Najafian (University of Washington), Matthew Palmer (University of Pennsylvania), Avi Rosenberg (Johns Hopkins University), Virginie Royal (University of Montreal), Barry Stokes (Columbia University), David Thomas (Duke University), Michifumi Yamashita (Cedar Sinai), Hong Yin (Emory University) Jarcy Zee (University of Pennsylvania), Yiqin Zuo (University of Miami), Co-Chairs: Laura Barisoni (Duke University) and Cynthia Nast (Cedar Sinai). Last Update: 17 May 2023.

Funding

The Nephrotic Syndrome Study Network (NEPTUNE) is part of the Rare Diseases Clinical Research Network (RDCRN), which is funded by the National Institutes of Health (NIH) and led by the National Center for Advancing Translational Sciences (NCATS) through its Division of Rare Diseases Research Innovation (DRDRI). NEPTUNE is funded under grant number U54DK083912 as a collaboration between NCATS and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Additional funding and/or programmatic support is provided by the University of Michigan, NephCure Kidney International and the Halpin Foundation. RDCRN consortia are supported by the RDCRN Data Management and Coordinating Center (DMCC), funded by NCATS and the National Institute of Neurological Disorders and Stroke (NINDS) under U2CTR002818. C. Sethna is supported by NIH/NHLBI 1R01HL162912-01A1 and NIH/NIDDK R01DK131091. K.R. Tuttle is supported by NIH research grants R01MD014712, U2CDK114886, UL1TR002319, U54DK083912, U01DK100846, OT2HL161847, UM1AI109568, CDC project number 75D301-21-P-12254. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author information

Authors and Affiliations

  1. Northwell, Cohen Children’s Medical Center, Division of Pediatric Nephrology, New Hyde Park, NY, USA

    Matthew Schuchman & Christine B. Sethna

  2. Division of Pediatric Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Tammy M. Brady

  3. Division of Nephrology and Hypertension, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Dorey A. Glenn

  4. Providence Medical Research Center, Providence Inland Northwest Health, Spokane, WA, USA

    Katherine R. Tuttle

  5. Division of Nephrology, University of Washington School of Medicine, Spokane, WA, USA

    Katherine R. Tuttle

  6. Section of Pediatric Nephrology, Children’s Hospital Colorado, University of Colorado, Aurora, CO, USA

    Gabriel Cara-Fuentes

  7. Division of Nephrology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA

    Rebecca V. Levy

  8. Division of Pediatric Nephrology, Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA

    Rebecca V. Levy

  9. Department of Physiology and Biophysics, Case Western Reserve University School of Medicine, Cleveland, OH, USA

    Agustin Gonzalez-Vicente

  10. Department of Internal Medicine, Nephrology Division, University of Michigan, Ann Arbor, MI, USA

    Fadhl M. Alakwaa

  11. Pediatric Nephrology, Children’s Mercy Hospital, Kansas City, MO, USA

    Tarak Srivastava

  12. Feinstein Institutes for Medical Research, Manhasset, NY, USA

    Christine B. Sethna

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  1. Matthew Schuchman
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  4. Katherine R. Tuttle
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Contributions

M.S. and C.B.S. conceptualized the overall research questions and designed the subanalysis of the NEPTUNE study. M.S. conducted the statistical analyses. Original draft preparation was performed by M.S. and C.B.S., and all authors (M.S., T.M.B, D.A.G., K.R.T., G.C-F., R.V.L., A.G-V., F.M.A., T.S., C.B.S.) contributed to editing and reviewing the manuscript. Overriding supervision: C.B.S.

Corresponding author

Correspondence to Christine B. Sethna.

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Conflicts of interest

A.G-V has no conflict of interest to report. C.Sethna was on an advisory board for Travere Therapeutics. K.R. Tuttle reports support from Eli Lilly; personal fees and other support from Boehringer Ingelheim; personal fees and other support from AstraZeneca; grants, personal fees and other support from Bayer AG; grants, personal fees and other support from Novo Nordisk; grants and other support from Goldfinch Bio; other support from Gilead; and grants from Travere outside the submitted work.

Ethical approval

The NEPTUNE study was approved by the Institutional Review Board (IRB) at each of the 29 participating sites. The NEPTUNE study protocol was reviewed and approved by University of Michigan Medical School (IRBMED), Approval Number HUM00158219.

Human and animal rights

All procedures were approved by the University of Michigan Institutional Review Board.

Informed consent

Written informed consent and/or assent was obtained from each participant and/or caregiver before joining the study.

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Schuchman, M., Brady, T.M., Glenn, D.A. et al. Association of mental health-related patient reported outcomes with blood pressure in adults and children with primary proteinuric glomerulopathies. J Nephrol (2024). https://doi.org/10.1007/s40620-024-01919-6

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