McDougall Kathryn A, Larkin John W, Wingard Rebecca L, Jiao Yue, Rosen Sophia, Ma Lin, Usvyat Len A, Maddux Franklin W
Clinical Innovation Initiatives, Fresenius Medical Care North America, Waltham, MA 02451.
Integrated Care Analytics, Fresenius Medical Care North America, Waltham, MA 02451.
Clin Kidney J. 2018 Feb;11(1):123-129. doi: 10.1093/ckj/sfx054. Epub 2017 Jul 11.
The prevalence of depressive affect is not well defined in the incident hemodialysis (HD) population. We investigated the prevalence of and associated risk factors and hospitalization rates for depressive affect in incident HD patients.
We performed a prospective investigation using the Patient Health Questionnaire 2 (PHQ2) depressive affect assessment. From January to July of 2013 at 108 in-center clinics randomly selected across tertiles of baseline quality measures, we contacted 577 and 543 patients by telephone for depressive affect screening. PHQ2 test scores range from 0 to 6 (scores ≥3 suggest the presence of depressive affect). The prevalence of depressive affect was measured at 1-30 and 121-150 days after initiating HD; depressive affect risk factors and hospitalization rates by depressive affect status at 1-30 days after starting HD were computed.
Of 1120 contacted patients, 340 completed the PHQ2. In patients screened at 1-30 or 121-150 days after starting HD, depressive affect prevalence was 20.2% and 18.5%, respectively (unpaired -test, P = 0.7). In 35 patients screened at both time points, there were trends for lower prevalence of depressive affect at the end of incident HD, with 20.0% and 5.7% of patients positive for depressive affect at 1-30 and 121-150 days, respectively (paired -test, P = 0.1). Hospitalization rates were higher in patients with depressive affect during the first 30 days, exhibiting 1.5 more admissions (P < 0.001) and 10.5 additional hospital days (P = 0.008) per patient-year. Females were at higher risk for depressive affect at 1-30 days (P = 0.01).
The prevalence of depressive affect in HD patients is high throughout the incident period. Rates of hospital admissions and hospital days are increased in incident HD patients with depressive affect.
在初次接受血液透析（HD）的患者群体中，抑郁情绪的患病率尚不明确。我们调查了初次接受HD治疗的患者抑郁情绪的患病率、相关危险因素及住院率。
我们采用患者健康问卷2（PHQ2）抑郁情绪评估方法进行前瞻性研究。2013年1月至7月期间，在根据基线质量指标三分位数随机选取的108家中心诊所中，我们通过电话联系了577名和543名患者进行抑郁情绪筛查。PHQ2测试分数范围为0至6分（分数≥3分表明存在抑郁情绪）。在开始HD治疗后的1至30天以及121至150天测量抑郁情绪的患病率；计算开始HD治疗后1至30天抑郁情绪状态的抑郁情绪危险因素及住院率。
在1120名被联系的患者中，340名完成了PHQ2测试。在开始HD治疗后1至30天或121至150天接受筛查的患者中，抑郁情绪患病率分别为20.2%和18.5%（未配对t检验，P = 0.7）。在两个时间点均接受筛查的35名患者中，初次HD治疗结束时抑郁情绪患病率有降低趋势，在1至30天和121至150天，分别有20.0%和5.7%的患者抑郁情绪呈阳性（配对t检验，P = 0.1）。在最初30天内，有抑郁情绪的患者住院率更高，每名患者每年多住院1.5次（P < 0.001），多住院10.5天（P = 0.008）。女性在1至30天患抑郁情绪的风险更高（P = 0.01）。
在初次HD治疗期间，HD患者抑郁情绪的患病率较高。初次接受HD治疗且有抑郁情绪的患者住院次数和住院天数增加。
