晚期慢性肾脏病患者的健康相关生活质量、抑郁症状与肾移植可及性：慢性肾功能不全队列（CRIC）研究结果
Health-Related Quality of Life, Depressive Symptoms, and Kidney Transplant Access in Advanced CKD: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study.
作者信息
Harhay Meera Nair, Yang Wei, Sha Daohang, Roy Jason, Chai Boyang, Fischer Michael J, Hamm L Lee, Hart Peter D, Hsu Chi-Yuan, Huan Yonghong, Huml Anne M, Kallem Radhakrishna Reddy, Tamura Manjula Kurella, Porter Anna C, Ricardo Ana C, Slaven Anne, Rosas Sylvia E, Townsend Raymond R, Reese Peter P, Lash James P, Akkina Sanjeev
机构信息
Department of Medicine, Drexel University College of Medicine, Philadelphia, PA.
Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA.
出版信息
Kidney Med. 2020 Aug 11;2(5):600-609.e1. doi: 10.1016/j.xkme.2020.06.010. eCollection 2020 Sep-Oct.
RATIONALE & OBJECTIVE: Among individuals with chronic kidney disease (CKD), poor self-reported health is associated with adverse outcomes including hospitalization and death. We sought to examine the association between health-related quality-of-life (HRQoL) and depressive symptoms in advanced CKD and subsequent access to the kidney transplant waiting list.
STUDY DESIGN
Prospective cohort study.
SETTING & POPULATION: 1,676 Chronic Renal Insufficiency Cohort (CRIC) study participants with estimated glomerular filtration rates ≤ 30 mL/min/1.73 m at study entry or during follow-up.
EXPOSURES
HRQoL ascertained by 5 scales of the Kidney Disease Quality of Life-36 Survey (Physical Component Summary [PCS], Mental Component Summary, Symptoms, Burdens, and Effects), with higher scores indicating better HRQoL, and depressive symptoms ascertained using the Beck Depression Inventory.
OUTCOMES
Time to kidney transplant wait-listing and time to pre-emptive wait-listing.
ANALYTIC APPROACH
Time-to-event analysis using Cox proportional hazards regression.
RESULTS
During a median follow-up of 5.1 years, 652 (39%) participants were wait-listed, of whom 304 were preemptively wait-listed. Adjusted for demographics, comorbid conditions, estimated glomerular filtration rate slope, and cognitive function, participants with the highest scores on the Burden and Effects scales, respectively, had lower rates of wait-listing than those with the lowest scores on the Burden (wait-listing adjusted hazard ratio [aHR], 0.70; 95% CI, 0.57-0.85; < 0.001) and Effects scales (wait-listing aHR, 0.74; 95% CI, 0.59-0.92; = 0.007). Participants with fewer depressive symptoms (ie, Beck Depression Inventory score < 14) had lower wait-listing rates than those with more depressive symptoms (aHR, 0.81; 95% CI, 0.66-0.99; = 0.04). Participants with lower Burden and Effects scale scores and those with higher Symptoms and PCS scores had higher pre-emptive wait-listing rates (aHR in highest tertile of PCS relative to lowest tertile, 1.58; 95% CI, 1.12-2.23; = 0.01).
LIMITATIONS
Unmeasured confounders.
CONCLUSIONS
Self-reported health in late-stage CKD may influence the timing of kidney transplantation.
原理与目的
在慢性肾脏病（CKD）患者中，自我报告的健康状况不佳与包括住院和死亡在内的不良结局相关。我们试图研究晚期CKD患者的健康相关生活质量（HRQoL）与抑郁症状之间的关联，以及随后进入肾脏移植等待名单的情况。
研究设计
前瞻性队列研究。
设置与人群
1676名慢性肾功能不全队列（CRIC）研究参与者，在研究开始时或随访期间估计肾小球滤过率≤30 mL/min/1.73 m²。
暴露因素
通过肾脏病生活质量-36调查的5个量表确定HRQoL（身体成分总结[PCS]、心理成分总结、症状、负担和影响），得分越高表明HRQoL越好，使用贝克抑郁量表确定抑郁症状。
结局
进入肾脏移植等待名单的时间和抢先进入等待名单的时间。
分析方法
使用Cox比例风险回归进行事件发生时间分析。
结果
在中位随访5.1年期间，652名（39%）参与者进入了等待名单，其中3名4被抢先列入等待名单。在对人口统计学、合并症、估计肾小球滤过率斜率和认知功能进行调整后，负担量表和影响量表得分最高的参与者进入等待名单的比例分别低于负担量表得分最低的参与者（进入等待名单的调整后风险比[aHR]，0.70；95%CI，0.57-0.85；P<0.001）和影响量表得分最低的参与者（进入等待名单的aHR，0.74；95%CI，0.59-0.92；P=0.007）。抑郁症状较少（即贝克抑郁量表得分<14）的参与者进入等待名单的比例低于抑郁症状较多的参与者（aHR，0.81；95%CI，0.66-0.99；P=0.04）。负担量表和影响量表得分较低以及症状量表和PCS得分较高的参与者抢先进入等待名单的比例较高（PCS最高三分位数相对于最低三分位数的aHR，1.58；95%CI，1.12-2.23；P=0.01）。
局限性
未测量的混杂因素。
结论
晚期CKD患者自我报告的健康状况可能会影响肾脏移植的时机。
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