Kang Shin Chan, Koh Hee Byung, Kim Hyung Woo, Joo Young Su, Han Seung Hyeok, Yoo Tae-Hyun, Kang Shin-Wook, Park Jung Tak
Department of Internal Medicine and Institute of Kidney Disease, Yonsei University College of Medicine, Seoul, Republic of Korea.
Division of Nephrology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea.
Kidney Res Clin Pract. 2022 Nov;41(6):753-763. doi: 10.23876/j.krcp.21.311. Epub 2022 Sep 8.
Alzheimer disease (AD) and depressive disorder (DD) are prevalent among elderly end-stage kidney disease (ESKD) patients. However, whether preexisting mental health disorders increase the risk of ESKD is not well understood. The risk of incident ESKD in patients with or without underlying AD or DD was evaluated in a nationwide cohort of elderly people in Republic of Korea.
This study used data from the National Health Insurance Service-Senior cohort in Republic of Korea. Among the 558,147 total subjects, 49,634 and 54,231 were diagnosed with AD (AD group) or DD (DD group), respectively, during the follow-up period. Propensity score matching was conducted to create non-AD and non-DD groups of subjects. AD and DD diagnoses were analyzed as time-varying exposures, and the study outcome was development of ESKD.
The incidence rates of ESKD were 0.36 and 1.17 per 1,000 person-years in the non-AD and AD groups, respectively. After adjustment for clinical variables and competing risks of death, the risk of incident ESKD was higher in the AD group than in the nonAD group (hazard ratio [HR], 1.67; 95% confidence interval [CI], 1.34-2.08). The incidence rates of ESKD in the non-DD and DD groups were 0.36 and 0.91 per 1,000 person-years, respectively. The risk of ESKD development was also higher in the DD group than the non-DD group (HR, 1.44; 95% CI, 1.19-1.76).
The risk of ESKD development was higher in subjects diagnosed with AD or DD, suggesting that central nervous system diseases can adversely affect kidney function in elderly people.
阿尔茨海默病（AD）和抑郁症（DD）在老年终末期肾病（ESKD）患者中很常见。然而，既往存在的心理健康障碍是否会增加ESKD的风险尚不清楚。在韩国的一个全国性老年人群队列中，评估了患有或未患有潜在AD或DD的患者发生ESKD的风险。
本研究使用了韩国国民健康保险服务-老年队列的数据。在总共558,147名受试者中，49,634名和54,231名在随访期间分别被诊断为AD（AD组）或DD（DD组）。进行倾向得分匹配以创建非AD和非DD的受试者组。将AD和DD诊断作为随时间变化的暴露因素进行分析，研究结局为ESKD的发生。
非AD组和AD组的ESKD发病率分别为每1000人年0.36例和1.17例。在调整临床变量和死亡竞争风险后，AD组发生ESKD的风险高于非AD组（风险比[HR]，1.67；95%置信区间[CI]，1.34 - 2.08）。非DD组和DD组的ESKD发病率分别为每1000人年0.36例和0.91例。DD组发生ESKD的风险也高于非DD组（HR，1.44；95% CI，1.19 - 1.76）。
被诊断患有AD或DD的受试者发生ESKD的风险更高，这表明中枢神经系统疾病会对老年人的肾功能产生不利影响。
