Aggarwal H K, Jain Deepak, Dabas Geeta, Yadav R K
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Pril (Makedon Akad Nauk Umet Odd Med Nauki). 2017 Sep 1;38(2):35-44. doi: 10.1515/prilozi-2017-0020.
Chronic kidney disease (CKD) is an emerging health problem in both developed and developing countries. Depression, anxiety and sleep disturbances are highly prevalent in patients with chronic disease, but remain undertreated despite significant negative consequences on patients' health. Assessment of key components of mental health early in disease course will help to identify high risk subjects in whom modifying these predictors will help in providing active and healthy life in CKD patients.
We did a cross sectional study in 200 patients of CKD stage III to V-D fulfilling the eligibility criteria who were on follow up in a single tertiary care center in the state of Haryana, India. We assessed the prevalence of anxiety, depression and insomnia and their correlation with demographic variables in these patients. The structured questionnaire used in this study gathered information on respondent demographic and disease characteristics, and information obtained from the HADS and PSQI questionnaire. Factors associated with anxiety, depression and insomnia were examined by a multiple logistic regression analysis.
The prevalence of anxiety, depression and insomnia were found to be 71%, 69% and 86.5% respectively. As the CKD stage advanced, the prevalence as well as severity of these parameters increased. Anxiety, depression and sleep quality were found to be significantly correlated to unemployment, low income, low education, urban residence and presence of co-morbidities. The anxiety, depression and insomnia scores were found to have a strong negative correlation with eGFR, hemoglobin, serum calcium (p <0.01) and a positive correlation with TLC, blood urea, serum creatinine and serum phosphate (p <0.05).
We observed a high prevalence of anxiety, depression and insomnia in CKD patients. There is a need to develop strategies to accurately identify "high risk" subjects who may benefit from preventive measures before complications occur. By identifying CKD patients with high risk of developing these mental health related issues, healthcare provider may be better able to ensure the provision of appropriate rehabilitation to this population.
慢性肾脏病（CKD）在发达国家和发展中国家都是一个日益突出的健康问题。抑郁、焦虑和睡眠障碍在慢性病患者中极为普遍，但尽管对患者健康有重大负面影响，却仍未得到充分治疗。在疾病进程早期评估心理健康的关键组成部分，将有助于识别高危人群，改变这些预测因素将有助于慢性肾脏病患者过上积极健康的生活。
我们在印度哈里亚纳邦一家三级医疗中心对200例符合入选标准的CKD III至V - D期患者进行了横断面研究。我们评估了这些患者中焦虑、抑郁和失眠的患病率及其与人口统计学变量的相关性。本研究中使用的结构化问卷收集了受访者的人口统计学和疾病特征信息，以及从医院焦虑抑郁量表（HADS）和匹兹堡睡眠质量指数（PSQI）问卷中获得的信息。通过多元逻辑回归分析检查与焦虑、抑郁和失眠相关的因素。
焦虑、抑郁和失眠的患病率分别为71%、69%和86.5%。随着CKD分期的进展，这些参数的患病率和严重程度均有所增加。焦虑、抑郁和睡眠质量与失业、低收入、低教育程度、城市居住以及合并症的存在显著相关。焦虑、抑郁和失眠评分与估算肾小球滤过率（eGFR）、血红蛋白、血清钙（p<0.01）呈强烈负相关，与白细胞计数（TLC）、血尿素、血清肌酐和血清磷呈正相关（p<0.05）。
我们观察到CKD患者中焦虑、抑郁和失眠的患病率很高。有必要制定策略，准确识别可能从并发症发生前的预防措施中获益的“高危”人群。通过识别有发生这些心理健康相关问题高风险的CKD患者，医疗服务提供者可能能够更好地确保为这一人群提供适当的康复治疗。
