Hernandez Rosalba, Xie Dawei, Wang Xue, Jordan Neil, Ricardo Ana C, Anderson Amanda H, Diamantidis Clarissa J, Kusek John W, Yaffe Kristine, Lash James P, Fischer Michael J
College of Nursing, University of Illinois Chicago, Chicago, Illinois.
Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Kidney Med. 2024 Feb 9;6(4):100790. doi: 10.1016/j.xkme.2024.100790. eCollection 2024 Apr.
RATIONALE & OBJECTIVE: The extent to which depression affects the progression of chronic kidney disease (CKD) and leads to adverse clinical outcomes remains inadequately understood. We examined the association of depressive symptoms (DS) and antidepressant medication use on clinical outcomes in 4,839 adults with nondialysis CKD.
Observational cohort study.
Adults with mild to moderate CKD who participated in the multicenter Chronic Renal Insufficiency Cohort Study (CRIC).
The Beck Depression Inventory (BDI) was used to quantify DS. Antidepressant use was identified from medication bottles and prescription lists. Individual effects of DS and antidepressants were examined along with categorization as follows: (1) BDI <11 and no antidepressant use, (2) BDI <11 with antidepressant use, (3) BDI ≥11 and no antidepressant use, and (4) BDI ≥11 with antidepressant use.
CKD progression, incident cardiovascular disease composite, all-cause hospitalizations, and mortality.
Cox regression models were fitted for outcomes of CKD progression, incident cardiovascular disease, and all-cause mortality, whereas hospitalizations used Poisson regression.
At baseline, 27.3% of participants had elevated DS, and 19.7% used antidepressants. Elevated DS at baseline were associated with significantly greater risk for an incident cardiovascular disease event, hospitalization, and all-cause mortality, but not CKD progression, adjusted for antidepressants. Antidepressant use was associated with higher risk for all-cause mortality and hospitalizations, after adjusting for DS. Compared to participants without elevated DS and not using antidepressants, the remaining groups (BDI <11 with antidepressants; BDI ≥11 and no antidepressants; BDI ≥11 with antidepressants) showed higher risks of hospitalization and all-cause mortality.
Inability to infer causality among depressive symptoms, antidepressants, and outcomes. Additionally, the absence of nonpharmacological data, and required exploration of generalizability and alternative analytical approaches.
Elevated DS increased adverse outcome risk in nondialysis CKD, unattenuated by antidepressants. Additionally, investigation into the utilization and counterproductivity of antidepressants in this population is warranted.
抑郁症对慢性肾脏病（CKD）进展的影响程度以及导致不良临床结局的情况仍未得到充分了解。我们研究了4839例非透析CKD成人患者的抑郁症状（DS）及抗抑郁药物使用与临床结局之间的关联。
观察性队列研究。
参与多中心慢性肾功能不全队列研究（CRIC）的轻至中度CKD成人患者。
使用贝克抑郁量表（BDI）对DS进行量化。从药瓶和处方清单中确定抗抑郁药物的使用情况。对DS和抗抑郁药物的个体效应进行了检查，并进行了如下分类：（1）BDI<11且未使用抗抑郁药物；（2）BDI<11且使用抗抑郁药物；（3）BDI≥11且未使用抗抑郁药物；（4）BDI≥11且使用抗抑郁药物。
CKD进展、心血管疾病复合事件、全因住院率和死亡率。
采用Cox回归模型分析CKD进展、心血管疾病发病和全因死亡率的结局，而住院率采用Poisson回归分析。
在基线时，27.3%的参与者DS升高，19.7%使用抗抑郁药物。在调整抗抑郁药物后，基线时DS升高与心血管疾病事件、住院和全因死亡率的风险显著增加相关，但与CKD进展无关。在调整DS后，抗抑郁药物的使用与全因死亡率和住院率的风险较高相关。与DS未升高且未使用抗抑郁药物的参与者相比，其余组（BDI<11且使用抗抑郁药物；BDI≥11且未使用抗抑郁药物；BDI≥11且使用抗抑郁药物）的住院和全因死亡风险更高。
无法推断抑郁症状、抗抑郁药物和结局之间的因果关系。此外，缺乏非药物治疗数据，需要探索普遍性和替代分析方法。
DS升高增加了非透析CKD患者的不良结局风险，抗抑郁药物无法减轻这种风险。此外，有必要对该人群中抗抑郁药物的使用及其负面作用进行研究。
