Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas.
Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, Kansas.
Kidney360. 2024 Sep 1;5(9):1350-1358. doi: 10.34067/KID.0000000000000538. Epub 2024 Aug 6.
Depression and health-related quality of life improve with kidney transplantation and is sustained beyond the immediate post-transplant period. The improvement in health-related quality of life, especially the physical component, differs by age and is higher in younger patients. Depression improves in all kidney transplantation recipients, irrespective of their age.
Depression and diminished health-related quality of life (HRQOL) are common in kidney failure. In this study, we investigate whether kidney transplantation (KT), the treatment of choice for kidney failure, improves depression and HRQOL across lifespan and whether this effect is sustained.
In this longitudinal observational cohort study, we assessed depression and HRQOL in patients on the KT waitlist and again at 3 months and 1 year after KT. We measured depression using the Beck Depression Inventory-II (BDI-II) and HRQOL using the Kidney Disease Quality of Life Short Form Version 1.3 physical health composite score (PCS) and mental health composite score (MCS). We used linear mixed-effects models with random intercepts for patients to evaluate the effect of time, age, and KT status on BDI-II score, PCS, and MCS. For models with significant age interactions, we estimated this effect for baseline age groups.
We analyzed 239 longitudinal BDI-II assessments completed by 99 patients and 143 Kidney Disease Quality of Life Short Form Version 1.3 assessments completed by 59 patients (16% Black, 79% White). The BDI-II scores improved pre- to post-KT (10 pre-KT versus five post-KT, < 0.001). PCS improved pre- to post-KT in younger patients, but the magnitude of change was lower with older age ( for interaction=0.01). In the subgroup analysis by age, there was improvement in PCS post-KT in patients younger than 60 years ( = 0.003 for 30–39, = 0.007 for 40–49, = 0.03 for 50–59). The MCS also improved from 47 pre-KT to 51 post-KT ( < 0.001), and the magnitude of improvement was again lower with older age ( for interaction=0.03).
Depression and HRQOL improve with KT. While depression improves in all ages, the improvement in HRQOL, especially PCS, is more evident in younger patients. This improvement in depression and HRQOL is sustained until at least 1 year post-KT. These data help frame expectations for patients and transplant teams.
This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/K360/2024_09_26_KID0000000000000538.mp3
肾移植可改善抑郁和与健康相关的生活质量，并在移植后即刻持续改善。与健康相关的生活质量的改善，特别是身体成分，因年龄而异，在年轻患者中更高。所有接受肾移植的患者的抑郁状况都有所改善，与年龄无关。
在肾衰竭患者中，抑郁和与健康相关的生活质量（HRQOL）下降很常见。在这项研究中，我们研究了肾移植（KT）——肾衰竭的首选治疗方法——是否会改善整个生命周期的抑郁和 HRQOL，以及这种效果是否可持续。
在这项纵向观察队列研究中，我们评估了等待肾移植患者的抑郁和 HRQOL，并在肾移植后 3 个月和 1 年再次进行评估。我们使用贝克抑郁量表第二版（BDI-II）评估抑郁，使用肾脏病生活质量简表 1.3 版评估身体健康综合评分（PCS）和心理健康综合评分（MCS）。我们使用线性混合效应模型，为患者建立随机截距，以评估时间、年龄和 KT 状态对 BDI-II 评分、PCS 和 MCS 的影响。对于具有显著年龄交互作用的模型，我们估计了基线年龄组的这种影响。
我们分析了 99 名患者的 239 次纵向 BDI-II 评估和 59 名患者的 143 次肾脏病生活质量简表 1.3 评估（16%为黑人，79%为白人）。BDI-II 评分在肾移植前到后有所改善（10 分肾移植前，5 分肾移植后， < 0.001）。年轻患者的 PCS 在肾移植前到后有所改善，但随着年龄的增长，变化幅度较小（交互作用=0.01）。在按年龄的亚组分析中，60 岁以下患者的 PCS 在肾移植后有所改善（30-39 岁=0.003，40-49 岁=0.007，50-59 岁=0.03）。PCS 也从肾移植前的 47 分提高到了肾移植后的 51 分（ < 0.001），而且年龄越大，改善幅度越小（交互作用=0.03）。
肾移植可改善抑郁和与健康相关的生活质量。虽然所有年龄的抑郁状况都有所改善，但 HRQOL 的改善，特别是 PCS，在年轻患者中更为明显。这种抑郁和 HRQOL 的改善至少可持续到肾移植后 1 年。这些数据有助于为患者和移植团队设定预期。
