Medicine, Jesse Brown VA Medical Center and University of Illinois Medical Center, Chicago, USA.
Am J Kidney Dis. 2012 Jul;60(1):27-38. doi: 10.1053/j.ajkd.2011.12.033. Epub 2012 Apr 11.
Depressive symptoms are correlated with poor health outcomes in adults with chronic kidney disease (CKD). The prevalence, severity, and treatment of depressive symptoms and potential risk factors, including level of kidney function, in diverse populations with CKD have not been well studied.
Cross-sectional analysis.
SETTINGS & PARTICIPANTS: Participants at enrollment into the Chronic Renal Insufficiency Cohort (CRIC) and Hispanic-CRIC (H-CRIC) Studies. CRIC enrolled Hispanics and non-Hispanics at 7 centers in 2003-2007, and H-CRIC enrolled Hispanics at the University of Illinois in 2005-2008.
Depressive symptoms measured by Beck Depression Inventory (BDI).
Demographic and clinical factors.
Elevated depressive symptoms (BDI score ≥11) and antidepressant medication use.
Of 3,853 participants, 27.4% had evidence of elevated depressive symptoms and 18.2% were using antidepressant medications; 31.0% of persons with elevated depressive symptoms were using antidepressants. The prevalence of elevated depressive symptoms varied by level of kidney function: 23.6% for participants with estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m(2) and 33.8% of those with eGFR <30 mL/min/1.73 m(2). Lower eGFR (OR per 10-mL/min/1.73 m(2) decrease, 1.10; 95% CI, 1.04-1.17), and non-Hispanic black race (OR, 1.42; 95% CI, 1.16-1.74) were each associated with increased odds of elevated depressive symptoms after controlling for other factors. In regression analyses incorporating BDI score, whereas female sex was associated with greater odds of antidepressant use, Hispanic ethnicity, non-Hispanic black race, and higher urine albumin levels were associated with decreased odds of antidepressant use (P < 0.05 for each).
Absence of clinical diagnosis of depression and use of nonpharmacologic treatments.
Although elevated depressive symptoms were common in individuals with CKD, use of antidepressant medications is low. Individuals of racial and ethnic minority background and with more advanced CKD had a greater burden of elevated depressive symptoms and lower use of antidepressant medications.
抑郁症状与慢性肾脏病（CKD）成人的不良健康结局相关。在不同的 CKD 人群中，抑郁症状的患病率、严重程度和治疗情况，以及包括肾功能水平在内的潜在危险因素，尚未得到充分研究。
横断面分析。
慢性肾功能不全队列（CRIC）和西班牙裔-CRIC（H-CRIC）研究的入组参与者。CRIC 于 2003-2007 年在 7 个中心招募了西班牙裔和非西班牙裔人群，而 H-CRIC 于 2005-2008 年在伊利诺伊大学招募了西班牙裔人群。
贝克抑郁量表（BDI）测量抑郁症状。
人口统计学和临床因素。
在 3853 名参与者中，有 27.4%存在抑郁症状升高，18.2%使用抗抑郁药物；31.0%的抑郁症状升高者正在使用抗抑郁药物。抑郁症状升高的患病率因肾功能水平而异：肾小球滤过率（eGFR）≥60mL/min/1.73m2的参与者为 23.6%，eGFR<30mL/min/1.73m2的参与者为 33.8%。较低的 eGFR（每 10mL/min/1.73m2 降低的比值比，1.10；95%可信区间，1.04-1.17）和非西班牙裔黑人种族（比值比，1.42；95%可信区间，1.16-1.74）在控制其他因素后，与抑郁症状升高的几率增加相关。在纳入 BDI 评分的回归分析中，女性性别与使用抗抑郁药物的几率增加相关，而西班牙裔种族、非西班牙裔黑人种族和更高的尿白蛋白水平与使用抗抑郁药物的几率降低相关（P<0.05）。
缺乏抑郁的临床诊断和非药物治疗的使用。
尽管 CKD 个体中常见抑郁症状升高，但使用抗抑郁药物的情况较低。少数族裔背景和 CKD 更严重的个体中，抑郁症状升高的负担更大，使用抗抑郁药物的情况也更低。
