Renal-Electrolyte Division, Section of Palliative Care and Medical Ethics, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA; Mid-Atlantic Renal Coalition, Richmond, VA; Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Renal-Electrolyte Division, Section of Palliative Care and Medical Ethics, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA; Mid-Atlantic Renal Coalition, Richmond, VA; Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Adv Chronic Kidney Dis. 2014 Jul;21(4):385-91. doi: 10.1053/j.ackd.2014.03.012.
Depression and depressive symptoms are common in advanced kidney disease and are associated with poor outcomes. For those with CKD not on dialysis, depression may influence how patients cope and prepare for their disease and its management, including decisions about dialysis treatment. Patient self-reported scales exist to better identify depression; how to incorporate these scales into clinical practice and assist with treatment decision-making is less clear. We present a case-based discussion of depressive symptoms in patients with advanced kidney disease not on dialysis. We highlight the contribution of underlying somatic and psychosocial factors in the assessment and management of depression. We further define the role of the interdisciplinary care team, including palliative care and hospice medicine, to assist with symptom management and end-of-life care for CKD patients with depression.
抑郁和抑郁症状在晚期肾病中很常见，并且与不良结局相关。对于未接受透析治疗的慢性肾脏病患者，抑郁可能会影响患者应对和准备疾病及其管理的方式，包括关于透析治疗的决策。存在用于更好地识别抑郁的患者自报告量表；如何将这些量表纳入临床实践并协助治疗决策不太清楚。我们提出了一个基于病例的讨论，内容是关于未接受透析治疗的晚期肾病患者的抑郁症状。我们强调了潜在的躯体和心理社会因素在评估和管理抑郁中的作用。我们进一步定义了多学科护理团队的作用，包括姑息治疗和临终关怀医学，以协助管理抑郁的慢性肾脏病患者的症状和终末期护理。
