Department of Medicine, University of Chicago, Chicago, IL 60637, USA.
Am J Kidney Dis. 2013 Sep;62(3):541-8. doi: 10.1053/j.ajkd.2013.03.039. Epub 2013 Jun 5.
Although chronic kidney disease (CKD) is a highly prevalent condition among older adults with diabetes, the associations between health-related quality of life (HRQoL) and severity of CKD in this population are not well understood. The objective of this study was to assess HRQoL and depressive symptoms across estimated glomerular filtration rate (eGFR) stages.
Cross-sectional.
SETTING & PARTICIPANTS: 5,805 members of Kaiser Permanente Northern California, 60 years or older with diabetes, from the 2005-2006 Diabetes Study of Northern California (DISTANCE) survey.
eGFR categories were defined as ≥90 (referent category), 75-89, 60-74, 45-59, 30-44, or ≤29 mL/min/1.73 m(2).
HRQoL was measured using the modified Short Form-8 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. Depressive symptoms were measured using the Patient Health Questionnaire-8.
In unadjusted linear regression analyses, physical (PCS) and mental (MCS) HRQoL scores were significantly lower with worsening eGFR level. However, after adjustment for sociodemographics, diabetes duration, obesity, and cardiovascular comorbid conditions and taking into account interactions with proteinuria, none of the eGFR categories was significantly or substantively associated with PCS or MCS score. In both unadjusted and adjusted analyses, higher risk of depressive symptoms was observed in respondents with eGFR ≤29 mL/min/1.73 m(2) (relative risk, 2.02; 95% CI, 1.10-3.71; P < 0.05) compared with the referent group. However, this eGFR-depression relationship was no longer significant after adjusting for hemoglobin level.
Participants are part of a single health care delivery system.
Our findings suggest the need for greater attention to and potential interventions for depression in patients with reduced eGFR.
虽然慢性肾脏病（CKD）在老年糖尿病患者中是一种高发疾病，但该人群的健康相关生活质量（HRQoL）与 CKD 严重程度之间的关联尚不清楚。本研究的目的是评估肾小球滤过率（eGFR）各分期的 HRQoL 和抑郁症状。
横断面研究。
来自加利福尼亚州北部 Kaiser Permanente 的 5805 名成员，年龄在 60 岁及以上，患有糖尿病，来自 2005-2006 年加利福尼亚州北部糖尿病研究（DISTANCE）调查。
eGFR 类别定义为≥90（参考类别）、75-89、60-74、45-59、30-44 或≤29 mL/min/1.73 m(2)。
在未经调整的线性回归分析中，随着 eGFR 水平的恶化，身体（PCS）和精神（MCS）HRQoL 评分显著降低。然而，在调整了社会人口统计学、糖尿病持续时间、肥胖和心血管合并症，并考虑到与蛋白尿的相互作用后，eGFR 的所有类别与 PCS 或 MCS 评分均无显著或实质性关联。在未调整和调整分析中，与参考组相比，eGFR≤29 mL/min/1.73 m(2)（相对风险，2.02；95%置信区间，1.10-3.71；P<0.05）的受访者发生抑郁症状的风险更高。然而，在校正血红蛋白水平后，这种 eGFR-抑郁关系不再显著。
参与者是单一医疗保健系统的一部分。
我们的研究结果表明，需要更加关注和潜在干预 eGFR 降低患者的抑郁问题。
