Knapp Christopher D, Horak Kayla, Roetker Nicholas S, Fink Abigail, Gao Allan, Johansen Kirsten L, Murray Anne, Hart Allyson
Division of Nephrology, Department of Medicine, Hennepin Healthcare System, Minneapolis, Minnesota.
Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota.
Kidney360. 2025 Apr 1;6(4):627-635. doi: 10.34067/KID.0000000670. Epub 2024 Dec 3.
In a cohort of individuals with CKD and a high prevalence of depression and antidepressant use, depression symptoms did not worsen over time. This finding was consistent across all levels of eGFR impairment, including those who initiated dialysis. There were no differences in changes in depressive symptoms over time between individuals with CKD of any stage and those without CKD.
The prevalence of depression is high in the CKD (20%–40%) and dialysis (30%–50%) populations. Less is known about how depressive symptoms change over time in patients with CKD.
Participants in the Brain in Kidney Disease cohort study completed a depressive symptom questionnaire (Patient Health Questionnaire-9 [PHQ-9]) and serum creatinine testing annually. We used linear mixed-effects models to examine changes in PHQ-9 scores over time and compared rates of change between participants with different ranges of eGFR impairment and those with normal eGFR.
At baseline, 147 participants had normal eGFR, 424 had impaired eGFR without dialysis dependence, and 31% reported a diagnosis of depression, with a mean baseline PHQ-9 score of 4.3. Participants were followed for up to 5 years. After adjustment for factors associated with depression, mean PHQ-9 scores decreased (improved) by 0.25 points per year (95% confidence interval [CI], 0.07 to 0.42) among participants with normal eGFR (>60 ml/min per 1.73 m) and by 0.35 points (95% CI, 0.14 to 0.56), 0.30 points (95% CI, 0.13 to 0.46), and 0.42 points (95% CI, 0.06 to 0.77) among participants with eGFR 45–59 ml/min per 1.73 m, with eGFR 30–44 ml/min per 1.73 m, and who developed dialysis dependence, respectively. PHQ-9 scores among participants with eGFR <30 ml/min per 1.73 m did not change significantly. We did not observe any statistically significant differences in mean change in PHQ-9 scores between participants with any degree of eGFR impairment and those with normal eGFR, nor between participants with dialysis dependence and those with eGFR of ≤15 ml/min per 1.73 m. Participants with a PHQ-9 score ≥5 had 80% greater odds of immediate study attrition than participants with a PHQ-9 score of 0–4.
The mean PHQ-9 scores of participants were largely stable over time, and we observed no differences in change in PHQ-9 scores between those with impaired eGFR and those with normal eGFR.
在患有慢性肾脏病且抑郁症患病率和抗抑郁药使用率较高的队列中，抑郁症状并未随时间恶化。这一发现在所有估算肾小球滤过率（eGFR）损害水平中均一致，包括开始透析的患者。各个阶段慢性肾脏病患者与无慢性肾脏病患者的抑郁症状随时间的变化并无差异。
慢性肾脏病（20% - 40%）和透析（30% - 50%）人群中抑郁症患病率较高。关于慢性肾脏病患者抑郁症状随时间如何变化的了解较少。
“肾脏病中的脑”队列研究的参与者每年完成一份抑郁症状问卷（患者健康问卷 - 9 [PHQ - 9]）和血清肌酐检测。我们使用线性混合效应模型来研究PHQ - 9评分随时间的变化，并比较不同eGFR损害范围参与者与eGFR正常参与者的变化率。
基线时，147名参与者eGFR正常，424名参与者eGFR受损但不依赖透析，31%的参与者报告有抑郁症诊断，基线时PHQ - 9平均评分为4.3。参与者随访长达5年。在调整与抑郁症相关的因素后，eGFR正常（>60 ml/min per 1.73 m²）的参与者中，PHQ - 9平均评分每年下降（改善）0.25分（95%置信区间[CI]，0.07至0.42）；eGFR为45 - 59 ml/min per 1.73 m²、30 - 44 ml/min per 1.73 m²以及开始依赖透析的参与者中，PHQ - 9评分分别每年下降0.35分（95% CI，0.14至0.56）、0.30分（95% CI，0.13至0.46）和0.42分（95% CI，0.06至0.77）。eGFR <30 ml/min per 1.73 m²的参与者中PHQ - 9评分无显著变化。我们未观察到任何程度eGFR损害的参与者与eGFR正常的参与者之间，以及依赖透析的参与者与eGFR≤15 ml/min per 1.73 m²的参与者之间，PHQ - 9评分的平均变化有任何统计学上的显著差异。PHQ - 9评分≥5的参与者立即退出研究的几率比PHQ - 9评分为0 - 4的参与者高80%。
参与者的PHQ - 9平均评分随时间基本稳定，我们未观察到eGFR受损者与eGFR正常者在PHQ - 9评分变化上的差异。
