Li Xin, Zhang Kun, Guo Qi, Ding Wei, Niu Jianying, Zhao Junli, Zhang Liming, Qi Hualin, Zhang Suhua, Yu Chen
Department of Nephrology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.
Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China.
Kidney Dis (Basel). 2024 Sep 23;10(6):468-478. doi: 10.1159/000540683. eCollection 2024 Dec.
Depression is a common psychiatric problem in maintenance hemodialysis (MHD) patients. Recent studies have begun to explore the relationship between body composition and depression. Phase angle (PhA), a core parameter for assessing body composition, has been observed to be associated with frailty and cognitive dysfunction. The aim of this study was to investigate the association between PhA and depression in MHD patients.
This multicenter, cross-sectional study included 843 MHD patients from seven dialysis centers in Shanghai, China. Depressive symptoms were evaluated using the Patient Health Questionnaire (PHQ-9), with a score of ≥10 indicating depression. PhA was measured by bioelectrical impedance analysis. Nutritional status was assessed by malnutrition inflammation score (MIS). Multivariable logistic regression models were used to investigate the association between PhA and depression. Restricted cubic spline (RCS) analysis was utilized to examine the association. Receiver operating characteristic curve was used to identify the cut-off value of PhA for depression.
A total of 15.2% of patients (62.8% male, median age 66 years) had depression. Median PhA level (interquartile range) of depressed patients was 4.4° (3.9-4.9°) for males and 3.9° (3.2-4.7°) for females. There was a significant decrease in the prevalence of depression with increasing quartiles of PhA levels. In multivariable logistic regression analyses, after adjusting for age, sex, education level, spKt/V, dialysis vintage, Charlson comorbidity index, hemoglobin, and serum albumin, lower PhA levels (lowest quartile group) were significantly associated with depressive symptoms (adjusted odds ratio, 2.19; 95% confidence interval, 1.07 to 4.48), compared to higher PhA levels (highest quartile group). RCS analysis showed a relatively inverse linear association between PhA and depression. The optimal cut-off value of PhA for depression was 4.9° for males and 3.5° for females. Subgroup analyses validated the findings across patient characteristics, including age, sex, diabetes, education, and malnutrition.
Our findings indicated an inverse association between PhA and depressive symptoms in Chinese MHD patients, suggesting that PhA could serve as a valuable indicator for assessing the risk of depression in this population. Further studies are needed to explore the potential of PhA as a prognostic tool and its implications for intervention strategies.
抑郁症是维持性血液透析（MHD）患者中常见的精神问题。最近的研究开始探索身体成分与抑郁症之间的关系。相位角（PhA）是评估身体成分的核心参数，已被观察到与虚弱和认知功能障碍有关。本研究的目的是调查MHD患者中PhA与抑郁症之间的关联。
这项多中心横断面研究纳入了来自中国上海七个透析中心的843例MHD患者。使用患者健康问卷（PHQ-9）评估抑郁症状，得分≥10表明患有抑郁症。通过生物电阻抗分析测量PhA。通过营养不良炎症评分（MIS）评估营养状况。使用多变量逻辑回归模型研究PhA与抑郁症之间的关联。采用受限立方样条（RCS）分析来检验这种关联。使用受试者工作特征曲线确定抑郁症患者PhA的临界值。
共有15.2%的患者（62.8%为男性，中位年龄66岁）患有抑郁症。抑郁症男性患者的PhA中位数水平（四分位间距）为4.4°（3.9 - 4.9°），女性为3.9°（3.2 - 4.7°）。随着PhA水平四分位数的增加，抑郁症患病率显著降低。在多变量逻辑回归分析中，在调整年龄、性别、教育水平、spKt/V、透析龄、Charlson合并症指数、血红蛋白和血清白蛋白后，与较高PhA水平（最高四分位组）相比，较低PhA水平（最低四分位组）与抑郁症状显著相关（调整后的优势比为 2.19；95%置信区间为1.07至4.48）。RCS分析显示PhA与抑郁症之间存在相对的线性反向关联。抑郁症患者PhA的最佳临界值男性为4.9°，女性为3.5°。亚组分析验证了在包括年龄、性别、糖尿病、教育程度和营养不良等患者特征方面的研究结果。
我们的研究结果表明，中国MHD患者中PhA与抑郁症状之间存在反向关联，这表明PhA可作为评估该人群抑郁症风险的有价值指标。需要进一步研究探索PhA作为预后工具的潜力及其对干预策略的影响。
