Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Nephrol Dial Transplant. 2012 Jan;27(1):299-303. doi: 10.1093/ndt/gfr305. Epub 2011 May 30.
Non-dialysis-dependent chronic kidney disease (CKD) and dialysis-dependent Stage 5 CKD (CKD5) are associated with a significant physical and psychosocial burden. Little is known, however, about the impact of stressful life events on CKD and CKD5 patients. This study aimed to determine the prevalence of stressful life events in CKD and CKD5 patients and identify the factors correlated with high levels of event-related distress.
This cross-sectional study's sample consisted of 181 patients (91 with non-dialysis-dependent CKD Stages 4 and 5, 90 with CKD5) who filled out the Impact of Event Scale (IES), which measures subjective distress related to stressful life events. Other measures included scores from the Medical Outcomes Study Short Form-36, Patient Health Questionnaire-9 (PHQ-9) and Dialysis Symptom Index (DSI).
One hundred and three subjects reported stressors on the IES. Almost half the stressors (49.5%) related to personal health; the rest fell into other categories. There were significant differences between the no stressor, low event-related distress and high event-related distress groups in age (P < 0.001), PHQ-9 score (P < 0.001) and DSI score (P = 0.002). After adjustment, PHQ-9 score was associated with high event-related distress [odds ratio (OR) 1.20, 95% confidence interval (CI) 1.10-1.32], as was DSI score (OR 1.04, 95% CI 1.02-1.07) in a separate model.
Event-related distress is common in CKD and CKD5 patients. High event-related distress is associated with worse depressive symptoms and greater somatic and emotional symptom burden, even with adjustments for age and gender. The renal practitioner may need to address patients' event-related distress in order to provide optimal care.
非透析依赖型慢性肾脏病（CKD）和透析依赖型 5 期 CKD（CKD5）与显著的身体和心理社会负担有关。然而，对于应激性生活事件对 CKD 和 CKD5 患者的影响知之甚少。本研究旨在确定 CKD 和 CKD5 患者应激性生活事件的发生率，并确定与事件相关的困扰程度高相关的因素。
本横断面研究的样本包括 181 名患者（91 名非透析依赖型 CKD 4 期和 5 期，90 名 CKD5 期），他们填写了事件影响量表（IES），该量表衡量与应激性生活事件相关的主观困扰。其他措施包括医疗结果研究短表单-36、患者健康问卷-9（PHQ-9）和透析症状指数（DSI）的分数。
103 名受试者在 IES 上报告了应激源。近一半的应激源（49.5%）与个人健康有关；其余的则属于其他类别。在无应激源、低事件相关困扰和高事件相关困扰组之间，年龄（P<0.001）、PHQ-9 评分（P<0.001）和 DSI 评分（P=0.002）存在显著差异。调整后，PHQ-9 评分与高事件相关困扰相关[比值比（OR）1.20，95%置信区间（CI）1.10-1.32]，DSI 评分也是如此（OR 1.04，95%CI 1.02-1.07），在另一个模型中。
事件相关困扰在 CKD 和 CKD5 患者中很常见。高事件相关困扰与更严重的抑郁症状和更大的躯体和情绪症状负担相关，即使在调整了年龄和性别后也是如此。肾脏医生可能需要解决患者的事件相关困扰，以提供最佳护理。
