Iwagami Masao, Tomlinson Laurie A, Mansfield Kathryn E, McDonald Helen I, Smeeth Liam, Nitsch Dorothea
Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
Pharmacoepidemiol Drug Saf. 2017 Jul;26(7):792-801. doi: 10.1002/pds.4212. Epub 2017 Apr 11.
People with chronic kidney disease (CKD) have an increased prevalence of depression, anxiety, and neuropathic pain. We examined prevalence, incidence, indication for, and choice of antidepressants among patients with and without CKD.
Using the UK Clinical Practice Research Datalink, we identified patients with CKD (two measurements of estimated glomerular filtration rate < 60 mL/min/1.73m for ≥3 months) between April 2004 and March 2014. We compared those with CKD to a general population cohort without CKD (matched on age, sex, general practice, and calendar time [index date]). We identified any antidepressant prescribing in the six months prior to index date (prevalence), the first prescription after index date among non-prevalent users (incidence), and recorded diagnoses (indication). We compared antidepressant choice between patients with and without CKD among patients with a diagnosis of depression.
There were 242 349 matched patients (median age 76 [interquartile range 70-82], male 39.3%) with and without CKD. Prevalence of antidepressant prescribing was 16.3 and 11.9%, and incidence was 57.2 and 42.4/1000 person-years, in patients with and without CKD, respectively. After adjusting for confounders, CKD remained associated with higher prevalence and incidence of antidepressant prescription. Regardless of CKD status, selective serotonin reuptake inhibitors were predominantly prescribed for depression or anxiety, while tricyclic antidepressants were prescribed for neuropathic pain or other reasons. Antidepressant choice was similar in depressed patients with and without CKD.
The rate of antidepressant prescribing was nearly one and a half times higher among people with CKD than in the general population. © 2017 The Authors. Pharmacoepidemiology & Drug Safety Published by John Wiley & Sons Ltd.
慢性肾脏病（CKD）患者中抑郁症、焦虑症和神经性疼痛的患病率增加。我们研究了患有和未患有CKD的患者中抗抑郁药的患病率、发病率、使用指征及选择情况。
利用英国临床实践研究数据链，我们确定了2004年4月至2014年3月期间患有CKD（估算肾小球滤过率两次测量值<60 mL/min/1.73m²且持续≥3个月）的患者。我们将这些患有CKD的患者与无CKD的普通人群队列（根据年龄、性别、全科医疗和日历时间[索引日期]匹配）进行比较。我们确定了索引日期前六个月内的任何抗抑郁药处方（患病率）、非患病使用者中索引日期后的首张处方（发病率），并记录诊断情况（使用指征）。我们比较了诊断为抑郁症的患者中患有和未患有CKD的患者之间的抗抑郁药选择情况。
共有242349名匹配的患者（年龄中位数76岁[四分位间距70 - 82岁]，男性占39.3%），其中有CKD患者和无CKD患者。患有和未患有CKD的患者中，抗抑郁药处方的患病率分别为16.3%和11.9%，发病率分别为57.2/1000人年和42.4/1000人年。在对混杂因素进行校正后，CKD仍然与抗抑郁药处方的较高患病率和发病率相关。无论CKD状态如何，选择性5-羟色胺再摄取抑制剂主要用于治疗抑郁症或焦虑症，而三环类抗抑郁药则用于治疗神经性疼痛或其他原因。患有和未患有CKD的抑郁症患者的抗抑郁药选择相似。
CKD患者中抗抑郁药的处方率比普通人群高出近一倍半。© 2017作者。药物流行病学与药物安全由John Wiley & Sons Ltd出版。
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