Department of Nephrology, University of Groningen, University Medical Center Groningen, The Netherlands.
Transplantation. 2012 Nov 27;94(10):1033-40. doi: 10.1097/TP.0b013e31826bc3c8.
Renal transplantation is the treatment of choice for end stage renal disease. Although there is more depression in wait-listed versus transplant patients, depression persists after transplantation. We investigated the determinants of depression in renal transplantation recipients (RTRs) and the association with cardiovascular (CV) and all-cause-mortality and graft failure.
RTR were investigated between 2001 and 2003. Depression was assessed using the Depression Subscale of the Symptom Checklist (SCL-90). Mortality and graft failure were recorded until May 2009.
A total of 527 RTR (age, 51±12 years; 55% men) were studied; 31% of the RTR were indicated with depression. Independent variables associated with depression were medically unfit for work, proteinuria, lower physical activity level, and longer dialysis duration. During follow-up for 7.0 (6.2-7.5) years, 114 RTR (59 CV) died. In Cox regression analyses, depression was strongly associated with increased risk for CV (HR=2.12 [1.27-3.53], P=0.004) and all-cause mortality (HR=1.96 [1.36-2.84], P<0.001). Adjustments for confounders did not materially change these associations. The association with graft failure (HR=1.77 [1.01-3.10]. P=0.047) disappeared after adjustment for kidney function (P=0.6).
Although our study has several limitations, including the lack of pretransplant depression status, we identified medically unfit for work, proteinuria, lower physical activity level, and longer dialysis duration as independent variables associated with depression. We furthermore found that depression is associated with CV and all-cause mortality in RTR.
肾移植是治疗终末期肾病的首选方法。尽管等待移植的患者比移植患者更容易出现抑郁，但移植后仍会持续存在抑郁。我们研究了肾移植受者（RTR）抑郁的决定因素，以及与心血管（CV）和全因死亡率以及移植物衰竭的关联。
RTR 在 2001 年至 2003 年间进行了研究。使用症状清单（SCL-90）的抑郁分项来评估抑郁。记录了死亡率和移植物衰竭情况，直至 2009 年 5 月。
共有 527 名 RTR（年龄 51±12 岁；55%为男性）接受了研究；31%的 RTR 有抑郁症状。与抑郁相关的独立变量包括因病无法工作、蛋白尿、较低的身体活动水平和更长的透析时间。在 7.0（6.2-7.5）年的随访期间，114 名 RTR（59 例 CV）死亡。在 Cox 回归分析中，抑郁与 CV 风险增加强烈相关（HR=2.12 [1.27-3.53]，P=0.004）和全因死亡率（HR=1.96 [1.36-2.84]，P<0.001）。调整混杂因素后，这些关联并未发生实质性变化。在调整肾功能后（P=0.6），与移植物衰竭（HR=1.77 [1.01-3.10]，P=0.047）的关联消失。
尽管我们的研究存在一些局限性，包括缺乏移植前的抑郁状态，但我们确定因病无法工作、蛋白尿、较低的身体活动水平和更长的透析时间是与抑郁相关的独立变量。我们还发现，抑郁与 RTR 的 CV 和全因死亡率相关。
