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Peer-reviewedCC BY-NCClinical kidney journal

Selective serotonin reuptake inhibitors and tricyclic antidepressants differentially affect heart failure risk in patients with kidney failure.

  • Yun Seob Jung1
  • Byoung Geun Han2
  • Yoonjong Bae3
  • Dong Hui Shin2
  • Tae Sic Lee4
  • Sang Won Hwang5
  • Semi Hwang6
  • Seung-Kuy Cha7,8,9
  • Jun Young Lee2,8,10
  • Jinhee Lee11
11 affiliations
  1. 1Department of Pharmacology, Yonsei University Wonju College of Medicine, Wonju, Korea.
  2. 2Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju, Korea.
  3. 3Department of Data Science, Hanmi Pharm. Co., Ltd, Seoul, Korea.
  4. 4Department of Family Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
  5. 5Department of Precision Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
  6. 6Yonsei University Wonju Health System, Wonju, Korea.
  7. 7Department of Physiology, Yonsei University Wonju College of Medicine, Wonju, Korea.
  8. 8Organelle Medical Research Center, Yonsei University Wonju College of Medicine, Wonju, Korea.
  9. 9Department of Global Medical Science, Yonsei University Wonju College of Medicine, Wonju, Korea.
  10. 10Department of Nephrology, Comprehensive Kidney Disease Research Institute, Wonju, Korea.
  11. 11Department of Psychiatry, Yonsei University Wonju College of Medicine, Wonju, Korea.
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Abstract

Background

Although selective serotonin reuptake inhibitors (SSRIs) are the treatment of choice for dialysis patients, tricyclic antidepressants (TCAs) are still frequently prescribed in clinical practice. No studies have compared the cardiovascular outcomes of patients with kidney failure (KF) and depression prescribed SSRIs and those of patients with KF and depression prescribed TCAs.Methods

Data of patients who were diagnosed with depression after being diagnosed with KF between January 2003 and December 2022 were extracted from the Korean National Health Institute Database System. The primary outcome was incident heart failure. Secondary outcomes included all-cause mortality and other cardiovascular outcomes.Results

We extracted the data of 3096 patients who were prescribed a single type of antidepressant that was continued throughout the follow-up period. Among these patients, 2169 were prescribed TCAs (mean age, 59.3 years; 57.4% were male), and 927 were prescribed SSRIs (mean age, 60.5 years; 48.8% were male) after KF was diagnosed. After 1:1 propensity score matching, 844 patients remained in each group, and no significant difference in all-cause mortality was observed between patients prescribed TCAs and those prescribed SSRIs. However, the risk of incident heart failure associated with TCA use was higher than that associated with SSRI use [adjusted hazard ratio (HR) 1.21, 95% confidence interval (CI) 1.07-1.36]. This result was consistent with those indicated by the unmatched multivariate adjusted analysis and landmark analysis.Conclusions

Among patients who were diagnosed with depression after being diagnosed with KF, SSRI use was associated with a lower risk of incident heart failure than TCA use. Individualized antidepressant treatment strategies should be considered for patients at high risk.

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Cite

BibTeXRIS
BibTeX
@article{jung2026selective,
  title = {{Selective serotonin reuptake inhibitors and tricyclic antidepressants differentially affect heart failure risk in patients with kidney failure.}},
  author = {Yun Seob Jung and Byoung Geun Han and Yoonjong Bae and Dong Hui Shin and Tae Sic Lee and Sang Won Hwang and Semi Hwang and Seung-Kuy Cha and Jun Young Lee and Jinhee Lee},
  journal = {Clinical kidney journal},
  year = {2026},
  month = aug,
  doi = {10.1093/ckj/sfag255},
  url = {https://europepmc.org/article/MED/42909902},
  note = {CC BY-NC},
}
RIS
TY  - JOUR
TI  - Selective serotonin reuptake inhibitors and tricyclic antidepressants differentially affect heart failure risk in patients with kidney failure.
AU  - Yun Seob Jung
AU  - Byoung Geun Han
AU  - Yoonjong Bae
AU  - Dong Hui Shin
AU  - Tae Sic Lee
AU  - Sang Won Hwang
AU  - Semi Hwang
AU  - Seung-Kuy Cha
AU  - Jun Young Lee
AU  - Jinhee Lee
PY  - 2026
DA  - 2026/08/11
JO  - Clinical kidney journal
DO  - 10.1093/ckj/sfag255
UR  - https://europepmc.org/article/MED/42909902
AB  - Background  Although selective serotonin reuptake inhibitors (SSRIs) are the treatment of choice for dialysis patients, tricyclic antidepressants (TCAs) are still frequently prescribed in clinical practice. No studies have compared the cardiovascular outcomes of patients with kidney failure (KF) and depression prescribed SSRIs and those of patients with KF and depression prescribed TCAs.Methods  Data of patients who were diagnosed with depression after being diagnosed with KF between January 2003 and December 2022 were extracted from the Korean National Health Institute Database System. The primary outcome was incident heart failure. Secondary outcomes included all-cause mortality and other cardiovascular outcomes.Results  We extracted the data of 3096 patients who were prescribed a single type of antidepressant that was continued throughout the follow-up period. Among these patients, 2169 were prescribed TCAs (mean age, 59.3 years; 57.4% were male), and 927 were prescribed SSRIs (mean age, 60.5 years; 48.8% were male) after KF was diagnosed. After 1:1 propensity score matching, 844 patients remained in each group, and no significant difference in all-cause mortality was observed between patients prescribed TCAs and those prescribed SSRIs. However, the risk of incident heart failure associated with TCA use was higher than that associated with SSRI use [adjusted hazard ratio (HR) 1.21, 95% confidence interval (CI) 1.07-1.36]. This result was consistent with those indicated by the unmatched multivariate adjusted analysis and landmark analysis.Conclusions  Among patients who were diagnosed with depression after being diagnosed with KF, SSRI use was associated with a lower risk of incident heart failure than TCA use. Individualized antidepressant treatment strategies should be considered for patients at high risk.
SN  - 2048-8505
SN  - 2048-8513
ER  -