Postgraduate in Health Sciences Program, Universidade de Pernambuco, Av. Gov. Agamenon Magalhães, S/N - Santo Amaro, Recife, PE, 50100-010, Brazil.
Qual Life Res. 2020 Jul;29(7):1829-1838. doi: 10.1007/s11136-020-02445-1. Epub 2020 Feb 15.
Depression and impairment of quality of life (QoL) reduce the survival of individual on hemodialysis (HD). However, few studies evaluated the impact of these conditions on the survival of older patients undergoing HD.
A retrospective cohort study was performed including patients aged ≥ 60 years on HD in Recife, Brazil, assessed in 2013 and monitored until 2017. Depression was evaluated with the Mini-International Neuropsychiatric Interview and QoL with the Control, Autonomy, Self-realization, and Pleasure Questionnaire (CASP-16). Survival differences according to the depression and QoL status were measured by Kaplan-Meier analysis and Cox regression. Death Certificates were analyzed to assess the cause of death.
A total of 171 patients were included (mean age 68.7 ± 6.9 years). The mean follow-up time was 3 years (maximum 4.5 years) and there were 98 deaths (57.3% of the sample). In a multivariate model that included depression and QoL, only QoL impairment was associated with a higher risk of death (HR 1.62, p = 0.035). Among CASP domains, only "Control" was associated with survival (HR 0.90, p = 0.014). Depression was unrelated to the cause of death, but there was a trend for death by endocrine diseases if QoL was impaired (p = 0.057).
QoL impairment is a key predictor of prognosis in older patients on HD and may be more important than depression. It is important that teams dealing with this population include in protocols an assessment of QoL, in order to offer a range of care according to the needs of these patients.
抑郁和生活质量（QoL）受损会降低接受血液透析（HD）个体的生存率。然而，很少有研究评估这些情况对接受 HD 的老年患者生存的影响。
本回顾性队列研究纳入了巴西累西腓年龄≥60 岁的 HD 患者，于 2013 年进行评估并随访至 2017 年。采用迷你国际神经精神访谈评估抑郁，采用控制、自主、自我实现和愉悦问卷（CASP-16）评估 QoL。采用 Kaplan-Meier 分析和 Cox 回归评估抑郁和 QoL 状态与生存率的差异。分析死亡证明以评估死因。
共纳入 171 例患者（平均年龄 68.7±6.9 岁）。平均随访时间为 3 年（最长 4.5 年），有 98 例死亡（占样本的 57.3%）。在纳入抑郁和 QoL 的多变量模型中，仅 QoL 受损与死亡风险增加相关（HR 1.62，p=0.035）。在 CASP 各领域中，仅“控制”与生存相关（HR 0.90，p=0.014）。抑郁与死因无关，但如果 QoL 受损，内分泌疾病死亡有趋势（p=0.057）。
QoL 受损是 HD 老年患者预后的关键预测因素，可能比抑郁更重要。处理该人群的团队在方案中纳入 QoL 评估非常重要，以便根据这些患者的需求提供一系列护理。
