Kistler Brandon M, Khubchandani Jagdish, Bennett Paul, Wilund Kenneth R, Sosnoff Jacob
Brandon M. Kistler, PhD, RD, Department of Nutrition and Health Science, Ball State University, Muncie, IN, USA.
Jagdish Khubchandani, MBBS, PhD, Department of Public Health Sciences, New Mexico State University, Las Cruces, NM, USA.
J Am Psychiatr Nurses Assoc. 2022 May-Jun;28(3):235-240. doi: 10.1177/1078390320970648. Epub 2020 Nov 5.
People with chronic kidney disease (CKD) are at increased risk for falls and fall-related injuries. Depressive disorders (DEP) are common in individuals with CKD and may increase the risk of falls and fall-related injuries. However, not much is known about the relationship between DEP and falls in people with CKD. The purpose of this study was to determine the influence of DEP on the relationship between CKD, falls, and fall-related injuries.
Using the Behavioral Risk Factor Surveillance System, we identified 16,574 adults with CKD. Patients with CKD were stratified by history of self-reported DEP (SRDEP), and multivariate logistic regression was conducted to determine the odds for falls and fall-related injuries among those with and without SRDEP.
In unadjusted regression analysis, falls (OR = 2.40, 95% CI = 2.08-2.76) and fall-related injuries (OR = 2.12, 95% CI = 1.72-2.59) were higher in individuals with CKD and history of SRDEP compared to those with CKD and no history of SRDEP. Adjustment for confounders had little effect on the relationship between a history of SRDEP and either falls (AOR = 1.87, 95% CI = 1.60-2.19) or fall-related injuries (AOR = 1.58, 95% CI = 1.26-1.97).
People with CKD and DEP are at increased odds for falls and fall-related injuries even after adjustment for sociodemographic, lifestyle factors, and comorbidities. Prospective studies are warranted to further understand this relationship, but it may be prudent for clinicians, in particular nurses, to consider fall risk when treating DEP in patients with CKD.
慢性肾脏病（CKD）患者跌倒及跌倒相关损伤的风险增加。抑郁症（DEP）在CKD患者中很常见，可能会增加跌倒及跌倒相关损伤的风险。然而，关于CKD患者中DEP与跌倒之间的关系，人们了解得并不多。本研究的目的是确定DEP对CKD、跌倒及跌倒相关损伤之间关系的影响。
利用行为危险因素监测系统，我们识别出16574名患有CKD的成年人。CKD患者根据自我报告的DEP病史（SRDEP）进行分层，并进行多因素逻辑回归分析，以确定有或无SRDEP患者跌倒及跌倒相关损伤的几率。
在未调整的回归分析中，与无SRDEP病史的CKD患者相比，有SRDEP病史的CKD患者跌倒（比值比[OR]=2.40，95%置信区间[CI]=2.08-2.76）及跌倒相关损伤（OR=2.12，95%CI=1.72-2.59）的发生率更高。对混杂因素进行调整后，SRDEP病史与跌倒（调整后OR[AOR]=1.87，95%CI=1.60-2.19）或跌倒相关损伤（AOR=1.58，95%CI=1.26-1.97）之间的关系影响不大。
即使在对社会人口学、生活方式因素和合并症进行调整之后，患有CKD和DEP的患者跌倒及跌倒相关损伤的几率仍然增加。有必要进行前瞻性研究以进一步了解这种关系，但临床医生，尤其是护士，在治疗CKD患者的DEP时考虑跌倒风险可能是谨慎的做法。
