Nguyen Hoang Anh, Anderson Cheryl A M, Miracle Cynthia M, Rifkin Dena E
Department of Nephrology and Hypertension, UCSD Medical Center, San Diego, CA, USA.
Nephron. 2017;136(2):127-135. doi: 10.1159/000455750. Epub 2017 Mar 2.
Depression is the most common mental health disorder among those with end-stage renal disease (ESRD), with prevalence of 15-40%. However, the association between chronic kidney disease (CKD) and depression is more variable. We examined the associations of CKD with depression, perceived health status, and quality of life in the National Health and Nutrition Examination Survey (NHANES) 2011-2012.
This study included 4,075 adults. Depression was defined as a condition when a Patient Health Questionnaire score was ≥10, or when there was reported antidepressant use. Reduced quality of life was defined by the number of days having poor mental and physical health, or feeling anxious. We calculated ORs for associations between CKD and depression and self-perceived health status, and used linear regression to examine associations between CKD and the number of days of poor health or anxiety.
The prevalence of CKD was 7.0% and that of depression was 19.1%. Those with CKD were not more likely to be depressed versus those without CKD after multivariate adjustment. Although they were 2.2 times more likely to have fair/poor health status after adjusting for demographic characteristics, this was attenuated by adjustment for confounders. Those with CKD reported one more day of being inactive due to poor health in the past month (p < 0.05), after multivariate adjustment. No differences were found for self-reported anxiety.
Our findings suggest that NHANES participants with CKD have more days of poor health but are not more likely to be depressed or anxious. This may reflect differences between clinical CKD populations and community-based samples.
抑郁症是终末期肾病（ESRD）患者中最常见的心理健康障碍，患病率为15%-40%。然而，慢性肾脏病（CKD）与抑郁症之间的关联更具变异性。我们在2011-2012年美国国家健康与营养检查调查（NHANES）中研究了CKD与抑郁症、自我感知健康状况及生活质量之间的关联。
本研究纳入4075名成年人。抑郁症定义为患者健康问卷得分≥10或有使用抗抑郁药记录的情况。生活质量下降由身心健康状况差或感到焦虑的天数来定义。我们计算了CKD与抑郁症及自我感知健康状况之间关联的比值比（OR），并使用线性回归分析CKD与健康状况差或焦虑天数之间的关联。
CKD的患病率为7.0%，抑郁症的患病率为19.1%。多因素调整后，与无CKD者相比，CKD患者患抑郁症的可能性并无增加。尽管在调整人口统计学特征后，他们健康状况为一般/较差的可能性高出2.2倍，但在调整混杂因素后这一差异有所减弱。多因素调整后，CKD患者报告过去一个月因健康状况差而活动减少的天数多一天（p<0.05）。自我报告的焦虑方面未发现差异。
我们的研究结果表明，NHANES中患有CKD的参与者健康状况差的天数更多，但患抑郁症或焦虑症的可能性并未增加。这可能反映了临床CKD人群与社区样本之间的差异。
