Tuot Delphine S, Lin Feng, Norris Keith, Gassman Jennifer, Smogorzewski Miroslaw, Ku Elaine
Division of Nephrology, University of California, San Francisco; San Francisco, California, USA.
Center for Vulnerable Populations at Priscilla Chan and Mark Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA.
Kidney Int Rep. 2018 Oct 9;4(2):222-230. doi: 10.1016/j.ekir.2018.10.001. eCollection 2019 Feb.
Depression is common but underrecognized in patients with chronic kidney disease (CKD), especially among racial/ethnic minorities. We examined the association between depressive symptoms and all-cause mortality (including deaths before and after end-stage renal disease [ESRD]) and whether antidepressant use impacts this association, overall, and by race/ethnicity.
We ascertained whether the presence of depressive symptoms, defined by a Beck Depression Inventory II (BDI) score of >14 at cohort enrollment, was associated with all-cause mortality (before or after ESRD) among study participants of the Chronic Renal Insufficient Cohort (CRIC) overall and by race/ethnicity. Models were adjusted for socioeconomic factors, baseline CKD severity, time-updated comorbid conditions, and time-updated antidepressant use. Confirmatory analyses were performed among African American Study of Kidney Disease and Hypertension (AASK) participants.
Among 3739 CRIC participants, 16.3% had a baseline BDI of >14; 18.2% reported antidepressant use. Crude mortality rate was 3.16 per 100 person-years during 6.8 years of median follow-up. Baseline BDI >14 was independently associated with higher risk of all-cause mortality (adjusted hazard ratio [aHR]: 1.27; 95% confidence interval: 1.07-1.52) without attenuation by antidepressant use. Differences among white and black individuals were noted (P= 0.02) but not among white versus Hispanic individuals (P = 0.43) or black versus Hispanic individuals (P = 0.22). Depressive symptoms were associated with higher mortality among white individuals (aHR: 1.66; 1.21-2.28), but not Hispanic individuals (aHR: 1.47; 0.95-2.28) or black individuals (aHR: 1.06; 0.82-1.37). Similar results were noted among 611 AASK participants (aHR: 0.99; 0.69-1.42).
The presence of depressive symptoms is a risk factor for all-cause mortality among patients with mild-moderate CKD, particularly among white individuals. Further studies are needed to understand the heterogeneity in the response to the presence of depressive symptoms by race.
抑郁症在慢性肾脏病（CKD）患者中很常见，但却未得到充分认识，在种族/族裔少数群体中尤其如此。我们研究了抑郁症状与全因死亡率（包括终末期肾病[ESRD]之前和之后的死亡）之间的关联，以及使用抗抑郁药是否会影响这种关联，总体情况以及按种族/族裔划分的情况。
我们确定在慢性肾功能不全队列研究（CRIC）的研究参与者中，以队列入组时贝克抑郁量表II（BDI）得分>14定义的抑郁症状的存在是否与全因死亡率（ESRD之前或之后）相关，总体情况以及按种族/族裔划分的情况。模型针对社会经济因素、基线CKD严重程度、随时间更新的合并症以及随时间更新的抗抑郁药使用情况进行了调整。在非裔美国人肾病与高血压研究（AASK）参与者中进行了验证性分析。
在3739名CRIC参与者中，16.3%的人基线BDI>14；18.2%的人报告使用了抗抑郁药。在中位随访6.8年期间，粗死亡率为每100人年3.16例。基线BDI>14与全因死亡率较高独立相关（调整后的风险比[aHR]：1.27；95%置信区间：1.07 - 1.52），且未因使用抗抑郁药而减弱。白人和黑人之间存在差异（P = 0.02），但白人与西班牙裔个体之间（P = 0.43）或黑人与西班牙裔个体之间（P = 0.22）不存在差异。抑郁症状与白人个体的较高死亡率相关（aHR：1.66；1.21 - 2.28），但与西班牙裔个体（aHR：1.47；0.95 - 2.28）或黑人个体（aHR：1.06；0.82 - 1.37）无关。在611名AASK参与者中也观察到了类似结果（aHR：0.99；0.69 - 1.42）。
抑郁症状的存在是轻度至中度CKD患者全因死亡率的危险因素，尤其是在白人个体中。需要进一步研究以了解种族对抑郁症状反应的异质性。
