Chilcot Joseph, Wellsted David, Vilar Enric, Farrington Ken
Renal Unit Lister Hospital, Stevenage, UK.
Nephron Clin Pract. 2009;113(2):c117-24. doi: 10.1159/000229019. Epub 2009 Jul 21.
The loss of residual renal function (RRF) and subsequent urine volume among haemodialysis (HD) patients may influence affect. Although RRF has been associated with improved patient outcome, its relationship with depression symptomatology is unknown.
106 HD patients completed the Beck Depression Inventory (BDI). The BDI is a depression symptom screening tool, with a score of >or=16 indicating possible clinical depression. Clinical parameters, including RRF (urea clearance, KRU [ml/min]) and interdialytic urine volume, were averaged over the 3-month pre-assessment including the month of the BDI assessment.
BDI scores correlated negatively with KRU and interdialytic urine volume. Patients with a KRU <1 had significantly higher BDI scores compared to those with a KRU >or=1. In logistic regression, KRU significantly predicted a BDI score >or=16, after controlling for a range of clinical parameters including urea, dialysis vintage and treatment time. A history of depressive illness was the only other predictive factor.
We have demonstrated an association between RRF and depression symptoms in HD patients. The perception of loss associated with low RRF and urine volume may increase depressive vulnerability. Longitudinal assessment is required in order to validate this finding and to determine causality.
血液透析（HD）患者残余肾功能（RRF）的丧失及随后尿量的变化可能会产生影响。尽管RRF与患者预后改善相关，但其与抑郁症状的关系尚不清楚。
106例HD患者完成了贝克抑郁量表（BDI）测评。BDI是一种抑郁症状筛查工具，得分≥16分表明可能存在临床抑郁。临床参数，包括RRF（尿素清除率，KRU[毫升/分钟]）和透析间期尿量，在包括BDI测评月份在内的3个月预评估期间进行平均。
BDI得分与KRU和透析间期尿量呈负相关。KRU<1的患者与KRU≥1的患者相比，BDI得分显著更高。在逻辑回归分析中，在控制了包括尿素、透析龄和治疗时间等一系列临床参数后，KRU显著预测BDI得分≥16分。抑郁病史是唯一的其他预测因素。
我们已经证明HD患者的RRF与抑郁症状之间存在关联。与低RRF和尿量相关的丧失感可能会增加抑郁易感性。需要进行纵向评估以验证这一发现并确定因果关系。
