慢性肾病患者中的抑郁症与心血管疾病发病情况
Depression and incident cardiovascular disease among patients with chronic kidney disease.
作者信息
D'Oro Anthony, Patel Devansh Himanshu, Wass Sojin, Dolber Trygve, Nasir Khurram, Dobre Mirela, Rahman Mahboob, Al-Kindi Sadeer
机构信息
School of Medicine, Case Western Reserve University, Cleveland, OH, USA. This author Takes responsibility for all aspects of the reliability and freedom from bias of the data presented and Their discussed interpretation.
Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH, USA. This author Takes responsibility for all aspects of the reliability and freedom from bias of the data presented and Their discussed interpretation.
出版信息
Int J Cardiol Cardiovasc Risk Prev. 2023 Jul 18;18:200199. doi: 10.1016/j.ijcrp.2023.200199. eCollection 2023 Sep.
BACKGROUND
Depression is associated with an increased risk of cardiovascular disease (CVD) and is prevalent among patients with chronic kidney disease (CKD). We aimed to identify the association of depression with incident CVD.
METHODS
We studied patients with CKD stages 2-4 enrolled in the Chronic Renal Insufficiency Cohort (CRIC) and excluded participants with preexisting CVD. The Cox proportional hazard model was used to examine the association between baseline depression [Beck's Depression Inventory (BDI) score ≥11] and incidence of CVD (cerebrovascular accident, myocardial infarction, heart failure, or peripheral artery disease). Models were adjusted for age, sex, race, estimated glomerular filtration rate (eGFR), urine albumin-creatinine ratio (UACR), systolic and diastolic blood pressure, and 10-year estimated CVD risk.
RESULTS
Among 2585 CRIC study participants, 640 (25%) patients had depression at study baseline. Compared to patients without depression, patients with depression were more likely to be women (56% vs. 46%), non-White (68% vs. 53%), with household income <$20,000 (53% vs. 26%), without a high school degree (31% vs. 15%), uninsured (13% vs. 7%), with lower eGFR (42 vs. 46 ml/min/1.73 m (Palmer et al., 2013 Jul)22), and with higher UACR (90 vs. 33 mg/g). In multivariate analyses, depression was associated with a 29% increased risk of developing CVD (adjusted hazard ratio 1.29, 95% confidence interval 1.03-1.62, p = 0.03). BDI (as a continuous variable) was associated with CVD (adjusted hazard ratio 1.017, 95% confidence interval 1.004-1.030, p = 0.012).
CONCLUSIONS
Among patients with CKD stages 2-4 enrolled in CRIC without preexisting CVD, depression was associated with a 29% increased risk of incident CVD.
背景
抑郁症与心血管疾病（CVD）风险增加相关，且在慢性肾脏病（CKD）患者中普遍存在。我们旨在确定抑郁症与新发CVD之间的关联。
方法
我们研究了纳入慢性肾功能不全队列（CRIC）的2-4期CKD患者，并排除了已有CVD的参与者。采用Cox比例风险模型来检验基线抑郁症[贝克抑郁量表（BDI）评分≥11]与CVD（脑血管意外、心肌梗死、心力衰竭或外周动脉疾病）发病率之间的关联。模型对年龄、性别、种族、估计肾小球滤过率（eGFR）、尿白蛋白肌酐比值（UACR）、收缩压和舒张压以及10年估计CVD风险进行了校正。
结果
在2585名CRIC研究参与者中，640名（25%）患者在研究基线时有抑郁症。与无抑郁症的患者相比，有抑郁症的患者更可能为女性（56%对46%）、非白人（68%对53%）、家庭收入<$20,000（53%对26%）、没有高中学历（31%对15%）、未参保（13%对7%）、eGFR较低（42对46 ml/min/1.73 m²）以及UACR较高（90对33 mg/g）。在多变量分析中，抑郁症与发生CVD的风险增加29%相关（校正风险比1.29，95%置信区间1.03-1.62，p = 0.03）。BDI（作为连续变量）与CVD相关（校正风险比1.017，95%置信区间1.004-1.030，p = 0.012）。
结论
在纳入CRIC且无既往CVD的2-4期CKD患者中，抑郁症与新发CVD风险增加29%相关。
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