Investigating the Association of Posttraumatic Stress Disorder (PTSD) with Chronic Kidney Disease (CKD) in World Trade Center (WTC) Responders

Details

• Personal Author:
  Koraishy FM
• Description:
  Background: Chronic kidney disease (CKD) is a prevalent and costly condition with high mortality rates. Identifying new risk factors for eGFR decline and CKD onset is crucial. Posttraumatic stress disorder (PTSD), a common diagnosis among World Trade Center (WTC) responders, may contribute to kidney function decline. This study aimed to establish PTSD as a new risk factor for eGFR decline and CKD development and examine how PTSD severity impacts kidney function using both clinical and genetic data. Methods: First Study: Examined WTC responders with multiple eGFR measurements. PTSD severity was categorized using the PTSD Checklist (PCL), and multinomial logistic regression assessed associations between PTSD and eGFR changes. Second Study: Analyzed 640 older adults with cardiovascular disease, hypertension, and diabetes over a 5-year period. The study explored the link between PTSD and eGFR decline using generalized estimating equations and logistic regression, adjusting for demographics, medical conditions, and psychiatric factors. Third Study: Investigated genetic influences on kidney function decline in 1,601 WTC responders with European ancestry. Polygenic risk scores (PRS) from the largest genome-wide association study of CKD progression assessed associations between genetic predisposition and kidney function decline. Fourth Study: Tracked PTSD symptoms in WTC responders over 20 years to explore their relationship with rapid eGFR decline. Models adjusted for demographics, comorbidities, and genetic factors assessed whether PTSD symptom changes were linked to kidney function decline. Results: First Study: Found that PTSD (16.5% of participants) was associated with greater risk of both eGFR decline and rise. "Hyperarousal" PTSD symptoms showed the strongest link to GFR decline, especially in individuals over 50. Second Study: PTSD was associated with a greater decline in eGFR (2.97 vs. 2.11 ml/min/1.73 m² per year, p = .022). PTSD increased the likelihood of rapid eGFR decline by 91%, even after controlling for demographic and medical factors. Third Study: Lower baseline eGFR and increased risk of CKD progression were linked to polygenic risk scores. PRS was associated with lower eGFR, higher CKD stages, and a higher likelihood of eGFR decline. Fourth Study: In a cohort of 7,509 WTC responders, PTSD symptoms over 20 years were significantly associated with rapid eGFR decline. This association remained even after adjusting for genetic risk factors, suggesting PTSD is an independent risk factor for kidney function decline. Conclusions: These studies indicate that PTSD is a significant risk factor for accelerated kidney function decline in both younger, relatively healthy WTC responders and older adults with existing health conditions. The findings persist even after accounting for traditional CKD risk factors. Additionally, genetic variants were linked to eGFR decline in middle-aged WTC responders with low comorbidity. The longest study tracking PTSD symptoms confirmed that worsening PTSD trajectories are independently associated with rapid GFR decline, regardless of traditional kidney disease risk factors or genetic predisposition. [Description provided by NIOSH]
• Subjects:
  Emergency Responders Occupational Health Safety September 11 Terrorist Attacks
• Keywords:
  First Responders Genetic Factors Kidney Disorders Kidney Function Nephrological Disorders Post-traumatic Stress Disorder PTSD World Trade Center WTC
• Series:
  Grant Final Reports
• Publisher:
  National Institute for Occupational Safety and Health
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Final Grant Report
• Place as Subject:
  New York ; New York City Region [OSHA]
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  OEP - Office of Extramural Programs
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  1-14
• NIOSHTIC Number:
  nn:20070835
• Citation:
  Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, R21-OH-012237, 2025 Mar; :1-14
• Email:
  Farrukh.Koraishy@stonybrookmedicine.edu
• Federal Fiscal Year:
  2025
• Performing Organization:
  State University New York Stony Brook
• Peer Reviewed:
  False
• Start Date:
  20210701
• Source Full Name:
  National Institute for Occupational Safety and Health
• End Date:
  20230630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:9ecc010ea918f8ff7da33bf3c28c2c57e543567935c4c94611d5e7231b2bc96397ef2842ae61902ac07f8e63528ac66501253600b01714a3ca15bf4abe7c8872
• Download URL:
  https://stacks.cdc.gov/view/cdc/219287/cdc_219287_DS1.pdf
• File Type:
  [PDF - 339.46 KB ]