心理社会压力对肾功能下降速度的影响。
Effect of Psychosocial Distress on the Rate of Kidney Function Decline.
机构信息
Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea.
Division of Nephrology, Department of Internal Medicine, Myongji Hospital, Goyang, Gyeonggi-do, Republic of Korea.
出版信息
J Gen Intern Med. 2021 Oct;36(10):2966-2974. doi: 10.1007/s11606-020-06573-9. Epub 2021 Jan 19.
BACKGROUNDS
Chronic kidney disease is a growing global health problem. Psychosocial stress has been found to induce changes in biological processes and behavioral patterns that increase risks of cardiovascular and metabolic diseases. However, the association between psychosocial stress and kidney function is not well understood.
OBJECTIVE
To evaluate the association between psychosocial stress and kidney function decline.
DESIGN
In this prospective cohort study, psychosocial distress was assessed using the psychosocial well-being index short-form (PWI-SF).
PARTICIPANTS
Data of a total of 7246 participants were retrieved from a community-based cohort (Korean Genome and Epidemiology Study).
MAIN MEASURES
The rate of estimated glomerular filtration rate (eGFR) decline was calculated for each individual. Rapid eGFR decline was defined as a decrease of ≥ 3 mL/min/1.73 m per year. The presence of kidney disease was defined as eGFR < 60 mL/min/1.73 m at baseline or proteinuria of higher than trace levels from two consecutive urine test results.
KEY RESULTS
A total of 7246 participants were analyzed. The mean eGFR was 92.1 ± 14.0 mL/min/1.73 m. Rapid eGFR decline was observed in 941 (13.0%) participants during a median follow-up of 11.7 years. When the participants were categorized into tertiles according to PWI-SF score, rapid eGFR decline was more prevalent in the group with the highest PWI-SF score (15.8%) than in the group with the lowest score (12.2%). Multivariate logistic regression analysis revealed that the risk of rapid eGFR decline was significantly increased in the tertile group with the highest PWI-SF score compared to the lowest group (odds ratio, 1.35; 95% confidence interval, 1.15-1.59). This association was maintained even after adjusting for confounding variables and excluding participants with kidney disease.
CONCLUSIONS
Higher levels of psychosocial distress were closely associated with an increased risk of rapid kidney function decline.
背景
慢性肾脏病是一个日益严重的全球健康问题。社会心理压力已被发现会导致生物过程和行为模式的变化，从而增加心血管和代谢疾病的风险。然而，社会心理压力与肾功能之间的关系尚不清楚。
目的
评估社会心理压力与肾功能下降之间的关系。
设计
在这项前瞻性队列研究中，使用社会心理幸福感指数短表（PWI-SF）评估社会心理困扰。
参与者
从一个基于社区的队列（韩国基因组和流行病学研究）中检索到总共 7246 名参与者的数据。
主要测量指标
为每个个体计算估算肾小球滤过率（eGFR）下降的速度。快速 eGFR 下降定义为每年下降≥3mL/min/1.73m。肾脏疾病的存在定义为基线时 eGFR<60mL/min/1.73m 或两次连续尿液检测结果中蛋白尿高于痕量水平。
主要结果
共分析了 7246 名参与者。平均 eGFR 为 92.1±14.0mL/min/1.73m。在中位随访 11.7 年期间，7246 名参与者中有 941 名（13.0%）出现快速 eGFR 下降。当根据 PWI-SF 评分将参与者分为三分位时，最高 PWI-SF 评分组（15.8%）快速 eGFR 下降的发生率高于最低评分组（12.2%）。多变量逻辑回归分析显示，与最低评分组相比，最高评分组发生快速 eGFR 下降的风险显著增加（比值比，1.35；95%置信区间，1.15-1.59）。即使在校正了混杂变量并排除了患有肾脏疾病的参与者后，这种关联仍然存在。
结论
较高水平的社会心理压力与快速肾功能下降的风险增加密切相关。
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