Virani Anuj, Shah Rushi P, Haneef Goher, Khan Asma T, Dias Caroline C, Pereira Kristal N, Gupta Siddharth, Sharma Prerna
Family Medicine, Windsor University School of Medicine, Cayon, KNA.
Medicine, Byramjee Jeejeebhoy Medical College, Ahmedabad, Rajkot, IND.
Cureus. 2021 Jun 29;13(6):e16017. doi: 10.7759/cureus.16017. eCollection 2021 Jun.
Objectives To evaluate the difference in demographics and clinical correlates during hospitalization for chronic kidney disease (CKD) between patients with depression and those without depression, and its impact on the severity of illness and in-hospital mortality. Methods We conducted a case-control study and included 2,296 adult inpatients (age ≥18 years) with a primary discharge diagnosis of CKD using the nationwide inpatient sample (NIS). We used propensity score matching to extract the cases i.e., CKD inpatients with depression (N = 1,264) and the controls i.e. CKD inpatients without depression (N = 1,032). The matching was done based on demographic characteristics of age at admission, sex, race, and median household income. Our outcomes of interest are the severity of illness and all-cause in-hospital mortality. All patient refined drg (APR-DRG) are allocated using health information systems software by the NIS and the severity of illness within each base APR-DRG was classified into minor, moderate, or major loss of body functions. Binomial logistic regression analysis was conducted to find the odds ratio (OR) of association for major loss of function in CKD inpatients with depression, and this model was adjusted for potential confounders of congestive heart failure (CHF), coronary artery disease (CAD), diabetes, hypertension, obesity, and tobacco abuse, and utilization of hemodialysis. Results A higher proportion of CKD inpatients with depression had a statistically significant higher prevalence of major loss of function (49.8% vs. 40.3% in non-depressed). There was a statistically significant difference with higher utilization of hemodialysis in CKD inpatients with depression (76.2% vs. 70.7% in non-depressed). The all-cause in-hospital mortality rate was lower in CKD inpatients with depression (2.1% vs. 3.5% in non-depressed). After controlling the logistic regression model for potential comorbidities and utilization of hemodialysis, depression was associated with increased odds (OR 1.46; 95% CI 1.227 - 1.734) for major loss of function versus in non-depressed CKD inpatients Conclusion Comorbid depression increases the likelihood of major loss of functioning in CKD inpatients by 46%. Treating depression can allow patients to better cope emotionally and physically with CKD and other comorbidities and significantly improve the patient's quality of life (QoL) and health outcome.
目的 评估慢性肾脏病（CKD）住院患者中伴有抑郁与不伴有抑郁者在人口统计学和临床相关因素方面的差异，及其对疾病严重程度和院内死亡率的影响。方法 我们进行了一项病例对照研究，使用全国住院患者样本（NIS）纳入了2296例主要出院诊断为CKD的成年住院患者（年龄≥18岁）。我们采用倾向评分匹配法选取病例，即伴有抑郁的CKD住院患者（N = 1264）和对照，即不伴有抑郁的CKD住院患者（N = 1032）。匹配基于入院年龄、性别、种族和家庭收入中位数等人口统计学特征进行。我们感兴趣的结局是疾病严重程度和全因院内死亡率。所有患者的改良诊断相关分组（APR-DRG）由NIS使用健康信息系统软件进行分配，每个基础APR-DRG内的疾病严重程度分为轻度、中度或重度身体功能丧失。进行二项逻辑回归分析以确定伴有抑郁的CKD住院患者出现重度功能丧失的关联比值比（OR），该模型针对充血性心力衰竭（CHF）、冠状动脉疾病（CAD）、糖尿病、高血压、肥胖、烟草滥用以及血液透析的使用等潜在混杂因素进行了调整。结果 伴有抑郁的CKD住院患者中，重度功能丧失的患病率在统计学上显著更高（49.8% 对非抑郁患者的40.3%）。伴有抑郁的CKD住院患者血液透析使用率更高，存在统计学显著差异（76.2% 对非抑郁患者的70.7%）。伴有抑郁的CKD住院患者全因院内死亡率更低（2.1% 对非抑郁患者的3.5%）。在对潜在合并症和血液透析使用情况进行逻辑回归模型控制后，与非抑郁的CKD住院患者相比，抑郁与重度功能丧失的比值增加相关（OR 1.46；95% CI 1.227 - 1.734）。结论 合并抑郁使CKD住院患者出现重度功能丧失的可能性增加46%。治疗抑郁可使患者在情感和身体上更好地应对CKD及其他合并症，并显著改善患者的生活质量（QoL）和健康结局。
