Department of Medical Psychology and Neuropsychology, Center for Research on Psychology in Somatic diseases, Tilburg University, P.O. Box 90153, 5000 LE Tilburg, The Netherlands.
Clin J Am Soc Nephrol. 2011 Apr;6(4):834-44. doi: 10.2215/CJN.03840510. Epub 2011 Mar 10.
Depression is a risk indicator for adverse outcomes in dialysis patients, but its prognostic impact in individuals who are not yet on dialysis is unknown. This study examines whether depressive symptoms are longitudinally associated with renal function decline, new-onset chronic kidney disease (CKD), ESRD, or hospitalization with acute kidney injury (AKI).
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Depressive symptoms were measured in a longitudinal cohort study with the 10-item Centers for Epidemiologic Studies Depression scale using a previously validated cut-off value (≥8). CKD at study entry and during follow-up was defined as an estimated GFR (eGFR) < 60 ml/min per m(2). Outcomes were rapid decline in eGFR (>3 ml/min per m(2) per year), new-onset CKD, ESRD (U.S. Renal Data System-based), and AKI (based on adjudicated medical record review). The median follow-up duration was 10.5 years.
Depressed participants (21.2%) showed a higher prevalence of CKD at baseline compared with nondepressed participants in multivariable analysis. Depression was associated with a subsequent risk of rapid decline in eGFR, incident ESRD, and AKI, but not incident CKD in unadjusted models. In multivariable analyses, only associations of depressive symptoms with AKI remained significant.
Elevated depressive symptoms are associated with subsequent adverse renal disease outcomes. The depression-related elevated risk of AKI was independent of traditional renal disease risk factors and may in part be explained by the predictive value of depression for acute coronary syndromes and heart failure hospitalizations that can be complicated by AKI.
抑郁症是透析患者不良预后的一个风险指标，但它在尚未透析的患者中的预后影响尚不清楚。本研究旨在探讨抑郁症状是否与肾功能下降、新发慢性肾脏病（CKD）、终末期肾病（ESRD）或伴有急性肾损伤（AKI）的住院呈纵向相关。
设计、地点、参与者和测量：使用先前验证的临界值（≥8），通过 10 项流行病学研究中心抑郁量表（Centers for Epidemiologic Studies Depression scale）对一项纵向队列研究中的抑郁症状进行了测量。研究开始时和随访期间的 CKD 定义为估计肾小球滤过率（eGFR）<60ml/min/1.73m2。结果为 eGFR 快速下降（>3ml/min/1.73m2/年）、新发 CKD、ESRD（基于美国肾脏数据系统）和 AKI（基于经过审查的医疗记录）。中位随访时间为 10.5 年。
在多变量分析中，与无抑郁症状的参与者相比，抑郁症状患者（21.2%）在基线时 CKD 的患病率更高。在未调整模型中，抑郁与 eGFR 快速下降、新发 ESRD 和 AKI 的风险增加相关，但与新发 CKD 无关。在多变量分析中，抑郁症状与 AKI 的相关性仍然显著。
升高的抑郁症状与随后发生的肾脏疾病不良结局相关。抑郁相关的 AKI 风险增加独立于传统的肾脏疾病危险因素，部分原因可能是抑郁对急性冠状动脉综合征和心力衰竭住院的预测价值，这些疾病可能并发 AKI。
