Yu Margaret K, Weiss Noel S, Ding Xiaobo, Katon Wayne J, Zhou Xiao-Hua, Young Bessie A
Health Services Research and Development and, ††Epidemiologic Research and Information Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington;, †Division of Nephrology, Department of Medicine,, §Kidney Research Institute, and, *Department of Psychiatry and Behavioral Sciences, University of Washington-School of Medicine, Seattle, Washington;, Departments of ‡Epidemiology,, ‖Biostatistics, and, ‡‡Health Services, University of Washington-School of Public Health, Seattle, Washington, ¶Academy of Mathematics and Systems Science, Chinese Academy of Sciences, Beijing, China.
Clin J Am Soc Nephrol. 2014 May;9(5):920-8. doi: 10.2215/CJN.08670813. Epub 2014 Mar 27.
Comorbid major depression is associated with adverse health outcomes in patients with diabetes, but little is known regarding its associations with long-term renal outcomes in this population. Furthermore, the impact of minor depression on renal outcomes is not known. This study evaluated associations between depressive symptoms and risk of incident ESRD in a diabetic cohort.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In this prospective, observational cohort study, 3886 ambulatory adults with diabetes were recruited from primary care clinics of a large health maintenance organization in the state of Washington. Demographics, laboratory data, depressive symptoms (based on the Patient Health Questionnaire-9), and patterns of diabetes self-care were collected. Participants were considered depressed if they had the required number of depressive symptoms (≥ 5 for major or 2-4 for minor depressive symptoms), including depressed mood or anhedonia, >50% of the time for ≥ 2 weeks and a Patient Health Questionnaire-9 score ≥ 10 for major and ≥ 5 for minor depressive symptoms. Risk of incident ESRD was estimated using Cox proportional hazards regression, with predialysis death as a competing risk.
During a median follow-up of 8.8 years, 87 patients (2.2%) developed ESRD. Major depressive symptoms were associated with a higher risk of incident ESRD (hazard ratio, 1.85; 95% confidence interval, 1.02 to 3.33) after adjusting for age, sex, race/ethnicity, marital status, education, smoking, body mass index, diabetes duration, hemoglobin A1c, baseline kidney function, microalbuminuria, hypertension, renin-angiotensin system blockers, and adherence to diabetes self-care. Minor depressive symptoms were not significantly associated with incident ESRD (hazard ratio, 1.08; 95% confidence interval, 0.52 to 2.25).
Major depressive symptoms, but not minor depressive symptoms, were associated with a higher risk of incident ESRD over 10 years. Additional studies are needed to determine whether treatment for depression can improve renal outcomes in patients with diabetes.
共病的重度抑郁症与糖尿病患者的不良健康结局相关，但对于其与该人群长期肾脏结局的关联知之甚少。此外，轻度抑郁症对肾脏结局的影响尚不清楚。本研究评估了糖尿病队列中抑郁症状与新发终末期肾病（ESRD）风险之间的关联。
设计、地点、参与者及测量方法：在这项前瞻性观察性队列研究中，从华盛顿州一家大型健康维护组织的初级保健诊所招募了3886名非卧床成年糖尿病患者。收集了人口统计学资料、实验室数据、抑郁症状（基于患者健康问卷-9）以及糖尿病自我管理模式。如果参与者出现所需数量的抑郁症状（重度抑郁症状≥5条或轻度抑郁症状2-4条），包括情绪低落或快感缺失，持续时间超过50%且持续≥2周，并且患者健康问卷-9评分重度抑郁症状≥10分、轻度抑郁症状≥5分，则被认为患有抑郁症。采用Cox比例风险回归估计新发ESRD的风险，并将透析前死亡作为竞争风险。
在中位随访8.8年期间，87名患者（2.2%）发生了ESRD。在调整年龄、性别、种族/民族、婚姻状况、教育程度、吸烟、体重指数、糖尿病病程、糖化血红蛋白、基线肾功能、微量白蛋白尿、高血压、肾素-血管紧张素系统阻滞剂以及糖尿病自我管理依从性后，重度抑郁症状与新发ESRD的风险较高相关（风险比，1.85；95%置信区间，1.02至3.33）。轻度抑郁症状与新发ESRD无显著关联（风险比，1.08；95%置信区间，0.52至2.25）。
重度抑郁症状而非轻度抑郁症状与10年内新发ESRD的较高风险相关。需要进一步研究以确定抑郁症治疗是否能改善糖尿病患者的肾脏结局。
