抑郁症与慢性肾脏病及充血性心力衰竭住院患者死亡率之间的关联。

The association between depression and chronic kidney disease and mortality among patients hospitalized with congestive heart failure.

作者信息

Hedayati S Susan, Jiang Wei, O'Connor Christopher M, Kuchibhatla Maragatha, Krishnan K Ranga, Cuffe Michael S, Blazing Michael A, Szczech Lynda A

机构信息

Department of Medicine, Division of Nephrology, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27705, USA.

出版信息

Am J Kidney Dis. 2004 Aug;44(2):207-15. doi: 10.1053/j.ajkd.2004.04.025.

DOI:10.1053/j.ajkd.2004.04.025

PMID:15264178

Abstract

BACKGROUND

The point prevalence of depression and its relationship to poor outcomes among patients with chronic kidney disease (CKD) has not been fully characterized.

METHODS

We performed a secondary analysis of a prospective cohort of 374 patients admitted with congestive heart failure between March 1, 1997 and June 30, 1998, to investigate the point prevalence of depression among patients with CKD and its association with mortality. The Beck Depression Inventory (BDI) was administered to all patients. Those who scored 10 or higher were administered the National Institute of Mental Health Diagnostic Interview Schedule (DIS). Logistic regression was used to examine the association between severe CKD, corresponding to a creatinine clearance less than 30 mL/min/72 kg (<0.50 mL/s/72 kg), depression, and mortality at 1 year.

RESULTS

Point prevalences of depressive symptoms by BDI and major depression by DIS were 54.8% and 21.6% if severe CKD was present and 32.8% and 13.0% if severe CKD was absent, respectively. After controlling for important clinical factors, severe CKD was associated with depressive symptoms by BDI (odds ratio, 2.89; 95% confidence interval, 1.39 to 5.99). Both depression by DIS and severe CKD were significant predictors of mortality. The increased mortality risk associated with depression did not decline with decreasing kidney function.

CONCLUSION

Depression was more prevalent among patients with than without severe CKD and had at least as strong an association with mortality as compared with depression in patients with no or less severe CKD. The point prevalence of depression decreased when the DIS interview was used, perhaps related to the presence of somatic measures on the BDI reflecting uremia. Studies assessing the efficacy of antidepressants among patients with CKD are needed to determine whether, in addition to treating depression, pharmacotherapy impacts mortality.

摘要

背景

慢性肾脏病（CKD）患者中抑郁症的时点患病率及其与不良结局的关系尚未完全明确。

方法

我们对1997年3月1日至1998年6月30日期间因充血性心力衰竭入院的374例患者的前瞻性队列进行了二次分析，以调查CKD患者中抑郁症的时点患病率及其与死亡率的关联。对所有患者进行贝克抑郁量表（BDI）测评。得分10分及以上者接受美国国立精神卫生研究所诊断访谈表（DIS）测评。采用逻辑回归分析来检验重度CKD（肌酐清除率小于30 mL/min/72 kg[<0.50 mL/s/72 kg]）、抑郁症与1年死亡率之间的关联。

结果

若存在重度CKD，BDI评定的抑郁症状时点患病率和DIS评定的重度抑郁症时点患病率分别为54.8%和21.6%；若不存在重度CKD，则分别为32.8%和13.0%。在控制了重要临床因素后，重度CKD与BDI评定的抑郁症状相关（比值比为2.89；95%置信区间为1.39至5.99）。DIS评定的抑郁症和重度CKD均为死亡率的显著预测因素。与抑郁症相关的死亡风险增加并未随肾功能下降而降低。

结论

与无重度CKD的患者相比，抑郁症在重度CKD患者中更为普遍，并且与死亡率的关联至少与无或轻度CKD患者中的抑郁症一样强。使用DIS访谈时抑郁症的时点患病率降低，这可能与BDI上反映尿毒症的躯体测量项目有关。需要开展评估抗抑郁药对CKD患者疗效的研究，以确定药物治疗除了治疗抑郁症外是否还会影响死亡率。