Geriatrics, Hôpital Ambroise-Paré, Assistance Publique des Hôpitaux de Paris (APHP), UVSQ, 9 Avenue Charles de Gaulle, F-92100 Boulogne-Billancourt, France.
Centre for Research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Inserm U1018, Paris-Saclay University, 12 Avenue Paul Vaillant Couturier, F-94800 Villejuif, France.
Toxins (Basel). 2024 Jul 22;16(7):326. doi: 10.3390/toxins16070326.
Depression is common in patients with chronic kidney disease (CKD). Experimental studies suggest the role of urea toxicity in depression. We assessed both the incidence of antidepressant prescriptions and depressive symptoms (measured by CESD (Center for Epidemiologic Depression) scale) in 2505 patients with CKD (Stage 3-4) followed up over 5 years in the Chronic Kidney Disease Renal Epidemiology and Information Network (CKD-REIN) cohort. We used a joint model to assess the association between the serum urea level and incident antidepressant prescriptions, and mixed models for the association between the baseline serum urea level and CESD score over the 5-year follow-up. Among the 2505 patients, 2331 were not taking antidepressants at baseline. Of the latter, 87 started taking one during a median follow-up of 4.6 years. After adjustment for confounding factors, the hazard ratio for incident antidepressant prescription associated with the serum urea level (1.28 [95%CI, 0.94,1.73] per 5 mmol/L increment) was not significant. After adjustment, the serum urea level was associated with the mean change in the CESD score (β = 0.26, [95%CI, 0.11,0.41] per 5 mmol/L increment). Depressive symptoms burden was associated with serum urea level unlike depression events. Further studies are needed to draw firm conclusions and better understand the mechanisms of depression in CKD.
慢性肾脏病（CKD）患者中普遍存在抑郁症状。实验研究表明尿素毒性在抑郁中的作用。我们评估了在慢性肾脏病肾流行病学和信息网络（CKD-REIN）队列中，2505 名 CKD（3-4 期）患者在 5 年内的抗抑郁药处方和抑郁症状（通过 CESD（流行病学研究中心抑郁量表）量表测量）的发生率。我们使用联合模型来评估血清尿素水平与新发抗抑郁药处方之间的关系，以及混合模型来评估基线血清尿素水平与 CESD 评分在 5 年随访期间的关系。在 2505 名患者中，2331 名患者在基线时未服用抗抑郁药。在后者中，有 87 名患者在中位数为 4.6 年的随访期间开始服用。调整混杂因素后，与血清尿素水平相关的新发抗抑郁药处方的风险比（每增加 5mmol/L 为 1.28 [95%CI，0.94,1.73]）无统计学意义。调整后，血清尿素水平与 CESD 评分的平均变化相关（β=0.26，[95%CI，0.11,0.41]每增加 5mmol/L）。与抑郁事件不同，抑郁症状负担与血清尿素水平相关。需要进一步研究以得出明确的结论并更好地理解 CKD 中抑郁的机制。
