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Depression severity was classified into four categories: normal (0\u201313), mild (14\u201319), moderate (20\u201328), and severe (\u2265\u200929). In Multivariable CPH models, ESKD risk showed a stepwise elevation in hazard ratios (HRs) without reaching statistical significance, whereas, mortality risk increased significantly in the moderate and severe group: HR 3.11 (95%CI 1.61\u20136.03) and 3.51 (1.40\u20138.80). Additionally, CPH models demonstrated a dose-dependent association between BDI-II categories and the incidence of both ESKD and mortality. CPH Models with penalized splines further revealed a gradual increase in ESKD risk, and a J-shaped association in mortality risk.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Depression severity showed dose-dependent associations with increased the incidence of ESKD and mortality in patients with CKD. Although mortality risk was significantly higher in the moderate and severe groups (BDI-II score\u2009\u2265\u200920), the stepwise elevation in ESKD risk did not reach statistical significance, and an optimal threshold for ESKD risk could not be identified.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10157-026-02908-8","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T11:16:28Z","timestamp":1785842188000},"page":"1530-1538","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Dose-dependent association of depression with incidence of end-stage kidney disease and all-cause mortality, CKD-JAC study: a retrospective cohort study"],"prefix":"10.1007","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7739-893X","authenticated-orcid":false,"given":"Maki","family":"Shinzawa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenta","family":"Murotani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takahiro","family":"Imaizumi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryohei","family":"Yamamoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshitaka","family":"Isaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Wada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shoichi","family":"Maruyama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,4]]},"reference":[{"issue":"6","key":"2908_CR1","doi-asserted-by":"publisher","first-page":"2089","DOI":"10.1111\/j.1523-1755.2005.00365.x","volume":"67","author":"AS Levey","year":"2005","unstructured":"Levey AS, Eckardt KU, Tsukamoto Y, Levin A, Coresh J, Rossert J, et al. 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Risk factors for unplanned dialysis initiation: a systematic review of the literature. 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The sponsor had no involvement in the design of the study, data collection, analysis, interpretation, or the decision to publish the findings.Cumulative probabilities of\n                      a\n                      end-stage kidney disease (ESKD) and\n                      b\n                      mortality across BDI-II categories\u2014normal (0\u201313), mild (14\u201319), moderate (20\u201328), and severe (\u2265\u200929)\u2014were compared using the log-rank trend test.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}}]}}