Gerontological Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of PsychologicalMedicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Am J Geriatr Psychiatry. 2013 Jun;21(6):570-9. doi: 10.1016/j.jagp.2012.12.020. Epub 2013 Jan 18.
Among patients with chronic kidney disease (CKD), we investigated the prevalence of depressive symptoms, their impact on mortality and quality of life, and correlates of depressive symptoms.
Prospective cohort study, followed up to 4 years.
General community.
A total of 362 older adults with CKD (Stages 3 and 4 assessed from estimated glomerular filtration rate [eGFR]) drawn from the Singapore Longitudinal Aging Study cohort.
Scores on the Geriatric Depression Scale (GDS) and the prevalence of depressive symptoms (GDS ≥5) and other variables were assessed at baseline, and SF-12 quality of life (QOL) (at 2 years) and mortality determined from 4 years of follow-up.
Depressive symptoms were present in 13% of the participants at baseline, and were associated with poorer SF-12 QOL scores (up to 30 percentage point differences). There was a significant association between depressive symptoms and increased mortality risk (odds ratio: 3.17; 95% confidence interval: 1.17-8.61; χ(2) = 5.11; df = 1; p = 0.023), which was statistically significant in unadjusted analysis, but not in multivariate analysis that accounted for covariates (odds ratio: 2.62; 95% confidence interval: 0.77-8.89; χ(2) = 2.37; df = 1; p = 0.13). Baseline cognitive impairment, functional disability, and other chronic illness were significantly associated with both increasing GDS scores and depressive symptoms. No relationship between eGFR and depressive symptoms was observed.
Depression among individuals with CKD was significantly associated with poorer quality of life, but not with increased mortality in predialysis CKD patients. More prospective studies are needed to establish the effects of depression on adverse CKD outcomes in predialysis CKD patients.
在患有慢性肾脏病（CKD）的患者中，我们调查了抑郁症状的患病率、它们对死亡率和生活质量的影响，以及抑郁症状的相关因素。
前瞻性队列研究，随访 4 年。
一般社区。
来自新加坡纵向老龄化研究队列的 362 名患有 CKD（根据估计肾小球滤过率 [eGFR] 评估为 3 期和 4 期）的老年人。
基线时评估老年抑郁量表（GDS）评分和抑郁症状的患病率（GDS≥5）以及其他变量，通过 4 年的随访确定 SF-12 生活质量（QOL）（在 2 年时）和死亡率。
基线时，13%的参与者存在抑郁症状，与 SF-12 QOL 评分较差相关（相差高达 30 个百分点）。抑郁症状与死亡率升高显著相关（优势比：3.17；95%置信区间：1.17-8.61；χ(2) = 5.11；df = 1；p = 0.023），在未调整分析中具有统计学意义，但在考虑协变量的多变量分析中不具有统计学意义（优势比：2.62；95%置信区间：0.77-8.89；χ(2) = 2.37；df = 1；p = 0.13）。基线认知障碍、功能障碍和其他慢性疾病与 GDS 评分升高和抑郁症状均显著相关。未观察到 eGFR 与抑郁症状之间存在关系。
在接受透析前 CKD 患者中，CKD 患者的抑郁与生活质量较差显著相关，但与死亡率增加无关。需要更多的前瞻性研究来确定抑郁对接受透析前 CKD 患者不良 CKD 结局的影响。
