Kang Min Seok, Kim Dong Young, Kim Sung Hwa, Kim Jae Seok, Yang Jae Won, Han Byoung Geun, Kang Dae Ryong, Lee Jinhee, Lee Jun Young
Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
Department of Biostatistics, Yonsei University Wonju College of Medicine, Wonju, Korea.
Clin Transplant Res. 2024 Jun 30;38(2):98-105. doi: 10.4285/ctr.24.0004. Epub 2024 Jun 19.
Kidney transplantation (KT) improves physical and psychological prognoses for patients with end-stage kidney disease (ESKD). However, few comparative studies have examined depression and suicide rates among patients with ESKD treated with dialysis versus KT.
Data on 21,809 patients with ESKD were extracted from the Korean National Health Insurance Service database, extending from January 2002 to December 2018. These patients exhibited no history of depression or insomnia before starting renal replacement therapy. Outcomes were compared between dialysis and KT recipients using 1:2 propensity score matching (PSM).
Of the patients, 17,649 received dialysis (hemodialysis, 15,537; peritoneal dialysis, 2,112), while 4,160 underwent KT. Of those on dialysis, 45.04% (7,949) experienced insomnia, compared to 25.72% (1,070) of KT recipients (P<0.001). Depression was more frequent among dialysis recipients (22.77%, 4,019) than KT recipients (8.61%, 358; P<0.001). Additionally, those on dialysis had a higher incidence of suicide (0.19%, 33) than recipients of KT (0.12%, 5; P=0.047). After PSM, the hazard ratio (HR) for depression in patients on dialysis compared to KT recipients was 1.76 (95% confidence interval [CI], 1.56-1.99). In subgroup analysis, the relative likelihood of depression among dialysis recipients was particularly high for residents of urban areas (HR, 2.10; 95% CI, 1.80-2.44) and patients under 65 years old (HR, 1.82; 95% CI, 1.62-2.09).
KT recipients exhibit a lower suicide rate than patients on dialysis. Furthermore, KT is associated with a lower prevalence of depression among Korean patients with ESKD, particularly urban residents and individuals under 65 years old.
肾移植（KT）可改善终末期肾病（ESKD）患者的身体和心理预后。然而，很少有比较研究考察接受透析治疗与接受肾移植的ESKD患者的抑郁和自杀率。
从韩国国民健康保险服务数据库中提取了2002年1月至2018年12月期间21809例ESKD患者的数据。这些患者在开始肾脏替代治疗前无抑郁或失眠病史。采用1:2倾向评分匹配（PSM）比较透析患者和肾移植受者的结局。
患者中，17649例接受透析（血液透析15537例；腹膜透析2112例），4160例接受肾移植。透析患者中45.04%（7949例）出现失眠，而肾移植受者中为25.72%（1070例）（P<0.001）。透析患者中抑郁更为常见（22.77%，4019例），高于肾移植受者（8.61%，358例；P<0.001）。此外，透析患者的自杀发生率（0.19%，33例）高于肾移植受者（0.12%，5例；P=0.047）。PSM后，透析患者抑郁的风险比（HR）与肾移植受者相比为1.76（95%置信区间[CI]，1.56 - 1.99）。在亚组分析中，透析患者中抑郁的相对可能性在城市地区居民（HR，2.10；95%CI，1.80 - 2.44）和65岁以下患者（HR，1.82；95%CI，1.62 - 2.09）中尤其高。
肾移植受者的自杀率低于透析患者。此外，肾移植与韩国ESKD患者中较低的抑郁患病率相关，尤其是城市居民和65岁以下个体。
