Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
Int J Clin Pract. 2013 Apr;67(4):363-8. doi: 10.1111/ijcp.12020.
Although depression and anxiety are the most common psychological problems among dialysis patients, little is known about the association between depression, anxiety and quality of life (QOL) in patients with predialysis chronic kidney disease (CKD). Therefore, we assessed the prevalence of depression and anxiety, and their association with QOL in patients with predialysis CKD.
Two hundred and eight predialysis patients (male 61.1%) with a mean age of 55.7 ± 13.7 years and an estimated glomerular filtration rate < 60 ml/min/1.73 m(2) were enrolled. Depression and anxiety were assessed with the Hospital Anxiety and Depression Scale. Patients with anxiety and depression scores ≥ 8 were diagnosed with anxiety and depression disorders respectively. The WHOQOL-BREF questionnaire was used to assess patient QOL.
The prevalence of depression (47.1%) and anxiety (27.6%) did not differ across CKD stages. Depression correlated positively with age, employment, income, education, comorbidity index, haemoglobin level, albumin concentration and anxiety score, and negatively with all WHOQOL-BREF domain scores. Anxiety correlated significantly with QOL, but not with socioeconomic factors. In a multiple regression analysis, haemoglobin level, anxiety and QOL were independent factors associated with depression. In a linear regression analysis, depression and anxiety independently correlated with QOL after we adjusted for age, alcohol use, employment, income, education, haemoglobin level and albumin concentration.
Patients with predialysis CKD have a high prevalence of depression and anxiety, which are associated with reduced QOL. Early detection of depression and anxiety and active interventions should be considered to improve the QOL of these patients.
尽管抑郁和焦虑是透析患者中最常见的心理问题，但对于透析前慢性肾脏病（CKD）患者中抑郁、焦虑与生活质量（QOL）的关系知之甚少。因此，我们评估了透析前 CKD 患者抑郁和焦虑的发生率及其与 QOL 的关系。
共纳入 208 例透析前患者（男性占 61.1%），平均年龄为 55.7±13.7 岁，估算肾小球滤过率<60ml/min/1.73m2。采用医院焦虑抑郁量表评估抑郁和焦虑。焦虑和抑郁评分≥8 分的患者分别被诊断为焦虑和抑郁障碍。采用世界卫生组织生活质量简表（WHOQOL-BREF）评估患者的 QOL。
CKD 各期患者的抑郁（47.1%）和焦虑（27.6%）发生率无差异。抑郁与年龄、就业、收入、教育程度、合并症指数、血红蛋白水平、白蛋白浓度和焦虑评分呈正相关，与所有 WHOQOL-BREF 领域评分呈负相关。焦虑与 QOL 显著相关，但与社会经济因素无关。多元回归分析显示，血红蛋白水平、焦虑和 QOL 是与抑郁相关的独立因素。线性回归分析显示，在校正年龄、饮酒、就业、收入、教育程度、血红蛋白水平和白蛋白浓度后，抑郁和焦虑与 QOL 独立相关。
透析前 CKD 患者抑郁和焦虑的发生率较高，与 QOL 降低有关。应早期发现抑郁和焦虑，并积极干预，以改善这些患者的 QOL。
