Bautovich Alison, Katz Ivor, Smith Michelle, Loo Colleen K, Harvey Samuel B
School of Psychiatry, University of New South Wales, Sydney, Australia NSW Institute of Psychiatry, Westmead, Australia St George Hospital, Kogarah, Australia
St George Hospital, Kogarah, Australia Faculty of Medicine, University of New South Wales, Sydney, Australia.
Aust N Z J Psychiatry. 2014 Jun;48(6):530-41. doi: 10.1177/0004867414528589. Epub 2014 Mar 21.
To review the recent academic literature surrounding the prevalence, aetiopathology, associations and management of depression in chronic kidney disease (CKD), in order to provide a practical and up-to-date resource for clinicians.
We conducted electronic searches of the following databases: MEDLINE, EMBASE and PsycINFO. The main search terms were: depression, mood disorders, depressive disorder, mental illness, in combination with kidney disease, renal insufficiency, dialysis, kidney failure. Separate searches were conducted regarding antidepressant use in CKD.
A number of recent, large and well-conducted studies have confirmed markedly raised rates of depression amongst those with CKD, with meta-analysis suggesting the prevalence of interview-defined depression to be approximately 20%. The interactions between depression and CKD are complex, bidirectional and multifactorial. Depression in CKD has been shown to be associated with multiple poor outcomes, including increased mortality and hospitalisation rates, as well as poorer treatment compliance and quality of life. Clinical evaluation of depression in patients with CKD can be challenging; however, once a diagnosis is made, a range of treatment modalities can be considered.
Depression is common in CKD and is associated with a significant risk of adverse outcomes. Given the importance of this issue, there is now an urgent need for well-conducted randomised trials of interventions for depression in CKD in order to provide information on the safety and efficacy of treatments.
回顾近期围绕慢性肾脏病（CKD）中抑郁症的患病率、病因病理学、关联因素及管理的学术文献，以便为临床医生提供实用且最新的资料。
我们对以下数据库进行了电子检索：MEDLINE、EMBASE和PsycINFO。主要检索词为：抑郁症、心境障碍、抑郁障碍、精神疾病，与肾脏疾病、肾功能不全、透析、肾衰竭相结合。针对CKD中抗抑郁药的使用进行了单独检索。
近期多项大型且开展良好的研究证实，CKD患者中抑郁症的发病率显著升高，荟萃分析表明，经访谈定义的抑郁症患病率约为20%。抑郁症与CKD之间的相互作用复杂、双向且多因素。CKD中的抑郁症已被证明与多种不良结局相关，包括死亡率和住院率增加，以及治疗依从性和生活质量较差。对CKD患者进行抑郁症的临床评估可能具有挑战性；然而，一旦做出诊断，可考虑一系列治疗方式。
抑郁症在CKD中很常见，且与不良结局的重大风险相关。鉴于此问题的重要性，目前迫切需要开展针对CKD中抑郁症干预措施的高质量随机试验，以便提供有关治疗安全性和有效性的信息。
