Sy John, McCulloch Charles E, Johansen Kirsten L
Division of Nephrology, Tibor Rubin Veterans Affairs Medical Center, Long Beach, California, USA.
Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA.
Hemodial Int. 2019 Apr;23(2):239-246. doi: 10.1111/hdi.12747. Epub 2019 Mar 1.
Frailty and depression are highly prevalent in the dialysis population, but the association between them, the risk factors for their development, and their independent associations with mortality have not been studied.
We examined 771 patients enrolled in the ACTIVE/ADIPOSE prevalent dialysis cohort study. Fried's frailty phenotype and the Center for Epidemiologic Studies Depression score were used to determine frailty and presence of depressive symptoms, respectively. We assessed the baseline association between frailty and depressive symptoms, whether one entity is a risk factor for development of the other, and associations between frailty and depressive symptoms with mortality.
At baseline, 13.1% of our population screened positive for depressive symptoms, 21.8% met criteria for frailty, and 10.0% met criteria for both. During follow-up, 26.6% of our population developed frailty and 12.7% developed depressive symptoms. Using multivariable logistic regression, baseline depressive symptoms were associated with 2.14-fold higher odds of being frail at baseline (95% confidence interval [CI] 1.45-3.17) and with a 2.16-fold higher odds of incident frailty during follow-up (95% CI 1.22-3.82). However, baseline frailty was not associated with incident depressive symptoms. Frailty and depressive symptoms were independent predictors of mortality in time-varying survival analysis (meeting frailty criteria: hazard ratio [HR] 1.53, 95% CI 1.05-2.23; depressive symptoms: HR 2.21, 95% CI 1.50-3.25).
Frailty and depressive symptoms remained highly prevalent over time and were strongly associated with one another and independently associated with mortality among dialysis patients. Future studies should investigate whether interventions for depression could potentially mitigate the appearance of frailty and its associated poor outcomes.
衰弱和抑郁在透析人群中极为普遍，但它们之间的关联、发展的危险因素以及与死亡率的独立关联尚未得到研究。
我们对771名参加ACTIVE/ADIPOSE现患透析队列研究的患者进行了检查。分别采用弗里德衰弱表型和流行病学研究中心抑郁评分来确定衰弱和抑郁症状的存在情况。我们评估了衰弱与抑郁症状之间的基线关联、一个因素是否是另一个因素发展的危险因素，以及衰弱和抑郁症状与死亡率之间的关联。
在基线时，我们的研究人群中有13.1%的人抑郁症状筛查呈阳性，21.8%的人符合衰弱标准，10.0%的人两者都符合标准。在随访期间，我们的研究人群中有26.6%的人出现了衰弱，12.7%的人出现了抑郁症状。使用多变量逻辑回归分析，基线时的抑郁症状与基线时衰弱几率高2.14倍相关（95%置信区间[CI]1.45 - 3.17），与随访期间发生衰弱的几率高2.16倍相关（95%CI 1.22 - 3.82）。然而，基线时的衰弱与新发抑郁症状无关。在时变生存分析中，衰弱和抑郁症状是死亡率的独立预测因素（符合衰弱标准：风险比[HR]1.53，95%CI 1.05 - 2.23；抑郁症状：HR 2.21，95%CI 1.50 - 3.25）。
随着时间的推移，衰弱和抑郁症状仍然极为普遍，并且在透析患者中彼此密切相关且与死亡率独立相关。未来的研究应调查针对抑郁的干预措施是否有可能减轻衰弱的出现及其相关的不良后果。
