Qammar Asfia, Azeem Bazil, Kumar Sateesh, Kumari Madhurta, Hassan Farhad, Khurram Laiba, Kumar Sumet, Fasih Abdul, Khan Arwa, Basit Azeem Muhammad, Sadiq Nimra, Dibaj Ramsha, Sharma Varsha
Baylor Scott & White Heart and Vascular Hospital, Dallas, TX, USA.
Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan.
Ann Med Surg (Lond). 2024 Oct 22;86(12):7082-7093. doi: 10.1097/MS9.0000000000002677. eCollection 2024 Dec.
Depression is prevalent among patients with end-stage renal disease (ESRD) undergoing dialysis, with significant implications for their quality of life and treatment compliance. Traditional treatments for depression, including various therapies and pharmacological interventions, have limitations due to their adverse effects. Sertraline, a selective serotonin re-uptake inhibitor (SSRI), offers a promising alternative, but its efficacy and safety in this population require thorough evaluation.
This meta-analysis aims to assess the effectiveness and adverse effects of sertraline in treating depressive episodes in dialysis patients compared to placebo.
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the authors conducted a comprehensive search of databases, including PubMed, Cochrane Library, and Science Direct, up to 20 June 2024. The authors included randomized controlled trials (RCTs) that compared sertraline with placebo in dialysis patients with depression. Two researchers independently performed data extraction and risk of bias assessment. Statistical analysis was conducted using ReviewManager 5.4.1, employing a random effects model.
Four RCTs involving 468 participants were included. Sertraline significantly reduced depressive symptoms, as measured by the Quick Inventory of Depressive Symptomatology (QIDS) and Beck Depression Inventory-II (BDI-II) scores, at 6 and 12 weeks compared to placebo. Improvements in kidney disease-specific quality of life (KDQOL-36) scores were also noted. However, sertraline was associated with a higher risk of adverse events compared to placebo.
Sertraline effectively reduces depressive symptoms and improves the quality of life in dialysis patients with ESRD. Despite the increased risk of adverse events, the overall benefits make sertraline a viable treatment option for this population. Larger, more comprehensive studies are needed to confirm these findings and optimize sertraline use in clinical practice.
抑郁症在接受透析的终末期肾病（ESRD）患者中普遍存在，对他们的生活质量和治疗依从性有重大影响。抑郁症的传统治疗方法，包括各种疗法和药物干预，由于其不良反应而存在局限性。舍曲林是一种选择性5-羟色胺再摄取抑制剂（SSRI），提供了一种有前景的替代方案，但其在该人群中的疗效和安全性需要全面评估。
本荟萃分析旨在评估与安慰剂相比，舍曲林治疗透析患者抑郁发作的有效性和不良反应。
作者按照系统评价和荟萃分析的首选报告项目（PRISMA）指南，对截至2024年6月20日的数据库进行了全面检索，包括PubMed、Cochrane图书馆和Science Direct。作者纳入了比较舍曲林与安慰剂治疗抑郁症透析患者的随机对照试验（RCT）。两名研究人员独立进行数据提取和偏倚风险评估。使用ReviewManager 5.4.1进行统计分析，采用随机效应模型。
纳入了四项涉及468名参与者的RCT。与安慰剂相比，在6周和12周时，通过抑郁症状快速量表（QIDS）和贝克抑郁量表第二版（BDI-II）评分测量，舍曲林显著减轻了抑郁症状。还注意到肾病特异性生活质量（KDQOL-36）评分有所改善。然而，与安慰剂相比，舍曲林与更高的不良事件风险相关。
舍曲林可有效减轻ESRD透析患者的抑郁症状并改善生活质量。尽管不良事件风险增加，但总体益处使舍曲林成为该人群可行的治疗选择。需要更大规模、更全面的研究来证实这些发现，并在临床实践中优化舍曲林的使用。
