Duke-NUS Medical School, Singapore, 8 College Road, 169857, Singapore.
Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore, Outram Rd, 169608, Singapore; SingHealth Duke-NUS Family Medicine Academic Clinical Program, Outram Rd, 169608, Singapore; Outram Community Hospital, SingHealth Community Hospitals, 10 Hospital Boulevard, 168582, Singapore; SingHealth Regional Health System PULSES Centre, Singapore Health Services, Singapore, Outram Rd, 169608, Singapore.
Gen Hosp Psychiatry. 2021 Mar-Apr;69:27-40. doi: 10.1016/j.genhosppsych.2020.12.003. Epub 2020 Dec 15.
Anxiety is associated with poor health outcomes among chronic kidney disease (CKD) patients. This review summarizes the prevalence and risk factors associated with elevated anxiety symptoms and disorders among CKD patients.
Articles evaluating the prevalence and risk factors associated with elevated anxiety symptoms and disorders among CKD patients, as diagnosed via DSM 4th or 5th edition criteria, clinical interviews or validated questionnaires, were searched in Medline®, Embase®, PsychINFO® and CINAHL®. Using random-effects meta-analyses, the prevalence of elevated anxiety symptoms and disorders were estimated. A narrative review on the risk factors associated with elevated anxiety symptoms and disorders was presented.
From 4941 articles, 61 studies were included. The pooled prevalence of anxiety disorders (9 studies, n = 1071) among CKD patients across studies was 19% while that of elevated anxiety symptoms (52 studies, n = 10,739) was 43%. Across continents, prevalence of elevated anxiety symptoms was highest in Europe and Asia. Between pre-dialysis and dialysis patients, the prevalence of elevated anxiety symptoms was not statistically different at 31% and 42% respectively. Common risk factors associated with elevated anxiety symptoms included concomitant depression, lower parathyroid hormone levels, increased comorbidities, increased duration of hospitalization, reduced perceived quality of life, and decreased vitality levels.
Given the high prevalence of anxiety disorders and elevated anxiety symptoms, more studies are required to assess the role and outcomes of anxiety screening among CKD patients. This could facilitate early identification of at-risk patients and potentially improve their clinical outcomes.
焦虑与慢性肾脏病（CKD）患者的健康状况不佳有关。本综述总结了 CKD 患者焦虑症状和障碍的患病率及相关风险因素。
检索 Medline ® 、Embase ® 、PsychINFO ® 和 CINAHL ® ，评估通过 DSM 第 4 或 5 版标准、临床访谈或经过验证的问卷诊断为 CKD 患者的焦虑症状和障碍的患病率及相关风险因素。采用随机效应荟萃分析估计焦虑症状和障碍的患病率。呈现了与焦虑症状和障碍相关的风险因素的叙述性综述。
从 4941 篇文章中，纳入了 61 项研究。在这些研究中，CKD 患者焦虑障碍（9 项研究，n=1071）的总患病率为 19%，而焦虑症状升高（52 项研究，n=10739）的患病率为 43%。在各大洲中，欧洲和亚洲的焦虑症状升高患病率最高。在透析前和透析患者中，焦虑症状升高的患病率分别为 31%和 42%，差异无统计学意义。常见的与焦虑症状升高相关的风险因素包括合并抑郁、甲状旁腺激素水平降低、合并症增加、住院时间延长、生活质量感知降低和活力水平降低。
鉴于焦虑障碍和焦虑症状升高的高患病率，需要更多的研究来评估 CKD 患者焦虑筛查的作用和结果。这可以促进识别高危患者，并有可能改善他们的临床结局。
