Chiang Hsin-Hung, Guo How-Ran, Livneh Hanoch, Lu Ming-Chi, Yen Mei-Ling, Tsai Tzung-Yi
Department of Nursing, Dalin Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, Chiayi, Taiwan; College of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan.
Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
J Psychosom Res. 2015 Sep;79(3):228-32. doi: 10.1016/j.jpsychores.2015.01.009. Epub 2015 Jan 28.
Comorbid depressive symptoms are common and undertreated in patients with renal diseases. It remains uncertain whether it is an independent risk factor for poor clinical outcome in patients with chronic kidney disease (CKD). This 3-year study investigated the association of depressive symptoms with long-term outcomes, including initiation of dialysis and all-cause mortality, in a population of CKD patients from Taiwan.
This prospective cohort study enrolled 262 CKD subjects, none of whom were undergoing dialysis, from a hospital in Taiwan during 2010-2011 and followed them for 3years. At enrollment, all subjects underwent a structured interview with the Taiwan Depression Questionnaire to ascertain the baseline presence of depressive symptoms. Primary end points were initiation of dialysis and all-cause mortality.
A total of 21.4% of enrolled patients (56/262) reported the presence of depressive symptoms at baseline. After 3-year follow-up, the risk of composite events (dialysis or death) was significantly higher in CKD patients with depressive symptoms than in those without depressive symptoms (adjusted hazard ratio [AHR]=2.95, 95% confidence interval [CI]: 1.86-4.72). Depressive symptoms at baseline could independently predict the risk of initiation of dialysis (AHR=2.25, 95% CI: 1.27-4.98) or all-cause mortality (AHR=3.08, 95% CI: 1.69-7.06).
Depressive symptoms at baseline were independently associated with increased risk of poor clinical outcomes in CKD patients, which suggested that the prompt provision of appropriate psycho-social care may improve the holistic clinical outcomes for CKD patients.
合并抑郁症状在肾病患者中很常见且治疗不足。慢性肾脏病（CKD）患者中，抑郁症状是否为临床预后不良的独立危险因素仍不确定。这项为期3年的研究调查了台湾CKD患者人群中抑郁症状与长期预后（包括开始透析和全因死亡率）之间的关联。
这项前瞻性队列研究在2010年至2011年期间从台湾一家医院招募了262名未接受透析的CKD受试者，并对他们进行了3年的随访。入组时，所有受试者均接受了台湾抑郁问卷的结构化访谈，以确定基线时是否存在抑郁症状。主要终点是开始透析和全因死亡率。
共有21.4%的入组患者（56/262）在基线时报告存在抑郁症状。经过3年的随访，有抑郁症状的CKD患者发生复合事件（透析或死亡）的风险显著高于无抑郁症状的患者（调整后风险比[AHR]=2.95，95%置信区间[CI]：1.86-4.72）。基线时的抑郁症状可独立预测开始透析的风险（AHR=2.25，95%CI：1.27-4.98）或全因死亡率（AHR=3.08，95%CI：1.69-7.06）。
基线时的抑郁症状与CKD患者临床预后不良风险增加独立相关，这表明及时提供适当的心理社会护理可能改善CKD患者的整体临床预后。
