Núcleo de Epidemiologia Clínica e Medicina Baseada em Evidências, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil.
Nephron Clin Pract. 2010;115(1):c35-40. doi: 10.1159/000286348. Epub 2010 Feb 19.
BACKGROUND/AIMS: The reasons for lower health-related quality of life (HRQOL) scores in women compared to men on maintenance hemodialysis (MHD) are unknown. We investigated whether depression accounts for gender differences in HRQOL.
Cross-sectional study of 868 (40.9% women) Brazilian MHD patients (PROHEMO Study). We used the Kidney Disease Quality of Life Short Form to assess HRQOL and the Center for Epidemiological Studies Depression (CES-D) scale (scores from 0-60) to assess depression with scores >or=18 indicating high depression probability.
Higher depression scores were associated with lower HRQOL in both sexes. Women had higher depression scores; 51.8% of women versus 38.2% of men (p < 0.001) had CES-D scores >or=18. Women scored lower on all 9 assessed HRQOL scales. The female-to-male differences in HRQOL were slightly reduced with inclusion of Kt/V and comorbidities in regression models. Substantial additional reductions in female-to-male differences in all HRQOL scales were observed after including depression scores in the models, by 50.9% for symptoms/problems related to renal failure, by 71.6% for mental health and by 87.1% for energy/vitality.
Lower HRQOL among women was largely explained by depression symptoms. Results support greater emphasis on treating depression to improve HRQOL in MHD patients, particularly women.
背景/目的：在维持性血液透析（MHD）患者中，女性的健康相关生活质量（HRQOL）评分低于男性，其原因尚不清楚。我们研究了抑郁是否是导致 HRQOL 性别差异的原因。
这是一项对 868 名（40.9%为女性）巴西 MHD 患者（PROHEMO 研究）进行的横断面研究。我们使用肾脏病生活质量简表评估 HRQOL，使用流行病学研究抑郁量表（CES-D）（评分范围为 0-60）评估抑郁，得分≥18 表示高度抑郁的可能性。
在两性中，更高的抑郁评分与更低的 HRQOL 相关。女性的抑郁评分更高；51.8%的女性与 38.2%的男性（p<0.001）的 CES-D 评分≥18。女性在所有 9 项评估的 HRQOL 量表中得分均较低。在回归模型中纳入 Kt/V 和合并症后，HRQOL 的性别差异略有缩小。在模型中纳入抑郁评分后，所有 HRQOL 量表中女性与男性的差异均有显著减少，与肾衰竭相关的症状/问题减少 50.9%，心理健康减少 71.6%，活力/精力减少 87.1%。
女性较低的 HRQOL 主要归因于抑郁症状。结果支持更加重视治疗抑郁以改善 MHD 患者，尤其是女性的 HRQOL。
