Nadort Els, Schouten Robbert W, Witte Simon H S, Broekman Birit F P, Honig Adriaan, Siegert Carl E H, van Oppen Patricia
Department of Nephrology, OLVG hospital, Jan Tooropstraat 164, 1061 AE Amsterdam, the Netherlands; Department of Psychiatry, OLVG hospital, Jan Tooropstraat 164, 1061 AE Amsterdam, the Netherlands.
Department of Nephrology, OLVG hospital, Jan Tooropstraat 164, 1061 AE Amsterdam, the Netherlands.
Gen Hosp Psychiatry. 2020 Nov-Dec;67:26-34. doi: 10.1016/j.genhosppsych.2020.07.012. Epub 2020 Aug 5.
Symptoms of depression are highly prevalent and undertreated in dialysis patients. To aid clinicians in offering treatment to patients with depression, we conducted a systematic review and meta-analysis on the treatment of current depressive symptoms in dialysis patients.
Nine databases were searched on January 8th 2020 for randomized controlled trials on the treatment of depressive symptoms in dialysis patients. In contradiction to previous reviews, we only included studies who selected patients with a score above a defined cut-off for depressive symptoms and used an inactive control group, to investigate the effectiveness of treatments in currently depressed patients. All interventions aimed to treat depressive symptoms were accepted for inclusion. Standardized mean differences were calculated in a random effect meta-analysis.
Seventeen studies were included in the systematic review (1640 patients). Nine studies could be included in the meta-analysis. A pooled analysis of 7 studies on psychotherapy showed a standardized mean difference of -0.48 [-0.87; -0.08], with a moderate heterogeneity (I = 52%, X = 12.56, p = .05). All studies on psychotherapy performed a per protocol analysis and scored high on potential bias. A pooled analysis of two studies on SSRI's showed no statistically significant improvement of depressive symptoms (SMD -0.57 [-6.17; 5.02], I = 71%, X = 0.2474, p = .06).
Psychotherapy is a promising treatment for currently depressed dialysis patients, although quality of evidence is low. More evidence is needed regarding the efficacy of SSRI's, exercise therapy and dietary supplements in this population.
CRD42018073969.
抑郁症症状在透析患者中极为普遍且治疗不足。为帮助临床医生为抑郁症患者提供治疗，我们对透析患者当前抑郁症状的治疗进行了系统评价和荟萃分析。
2020年1月8日检索了九个数据库，以查找关于透析患者抑郁症状治疗的随机对照试验。与以往的综述不同，我们仅纳入那些选择抑郁症状评分高于既定临界值的患者且使用非活性对照组的研究，以调查当前抑郁患者治疗的有效性。所有旨在治疗抑郁症状的干预措施均被纳入。在随机效应荟萃分析中计算标准化均数差。
系统评价纳入了17项研究（1640例患者）。荟萃分析纳入了9项研究。对7项心理治疗研究的汇总分析显示标准化均数差为-0.48[-0.87；-0.08]，异质性中等（I=52%，X=12.56，p=0.05）。所有心理治疗研究均进行了符合方案分析，且潜在偏倚评分较高。对两项关于选择性5-羟色胺再摄取抑制剂（SSRI）研究的汇总分析显示，抑郁症状无统计学意义的改善（标准化均数差-0.57[-6.17；5.02]，I=71%，X=0.2474，p=0.06）。
心理治疗对当前抑郁的透析患者是一种有前景的治疗方法，尽管证据质量较低。关于SSRI、运动疗法和膳食补充剂在该人群中的疗效，还需要更多证据。
国际前瞻性系统评价注册库（PROSPERO）注册号：CRD42018073969。
