Tesia Sonali S, Nongpiur Arvind, Barman Bhupen, Lyngdoh Monaliza, Prithviraj Manoj, Roy Debjit, Das Jayanta
Psychiatrist, Mind and Wellness Clinic, Shillong, Meghalaya, India.
Department of Psychiatry, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India.
J Family Med Prim Care. 2024 Nov;13(11):5077-5082. doi: 10.4103/jfmpc.jfmpc_607_24. Epub 2024 Nov 18.
Patients with chronic kidney disease (CKD) frequently experience neuropsychiatric conditions, such as depression, anxiety, and cognitive impairment, which not only significantly diminish their quality of life, but also contribute to longer hospitalizations, poor treatment adherence, and increased mortality. This hospital-based cross-sectional study aimed to investigate neuropsychiatric complications in CKD patients, focusing on gender differences, and clinical and other sociodemographic factors.
Diagnosis of CKD was based on the Kidney Disease: Improving Global Outcomes (KDIGO) criteria, and patients aged 18 years or above were included. Delirium was assessed using the Confusion Assessment Method (CAM) Scale. Those without delirium underwent evaluation using the Hindi Mental Status Examination (HMSE), Brief Psychiatric Rating Scale (BPRS), and Hospital Anxiety and Depression Scale (HADS) to identify cognitive and psychiatric symptoms.
Among the 104 participants, 50% were male, with a predominant age group over 45 years (61.5%). A majority portion of the cohort was married (72.1%), employed (57.7%), and identified as Christian (56.7%). The majority of CKD cases were diagnosed as stage 5 (87.5%) and on dialysis treatment. Delirium was present in 19.2% of participants. In those without delirium, anxiety affected 46.3%, depression impacted 50.0%, and cognitive dysfunction was present in 11.1%. A gender-based analysis revealed no significant differences in age or illness duration; however, males exhibited a higher level of education ( < 0.02). While females tended to display more severe psychiatric symptoms ( < 0.06), males had more cognitive dysfunction ( < 0.08); however, these differences did not reach statistical significance. Socioeconomic status (SES) comparisons demonstrated that lower SES correlated with a reduced number of years of education ( < 0.00).
Anxiety and depression were prevalent in nearly half of CKD patients, without gender or socioeconomic disparities. This underscores the imperative need for holistic, multidisciplinary interventions to effectively manage these conditions and enhance overall quality of life.
慢性肾脏病（CKD）患者经常出现神经精神方面的状况，如抑郁、焦虑和认知障碍，这些不仅会显著降低他们的生活质量，还会导致住院时间延长、治疗依从性差以及死亡率增加。这项基于医院的横断面研究旨在调查CKD患者的神经精神并发症，重点关注性别差异以及临床和其他社会人口学因素。
CKD的诊断基于《改善全球肾脏病预后组织（KDIGO）标准》，纳入18岁及以上的患者。使用意识模糊评估法（CAM）量表评估谵妄。未发生谵妄的患者采用印地语精神状态检查（HMSE）、简明精神病评定量表（BPRS）和医院焦虑抑郁量表（HADS）进行评估，以识别认知和精神症状。
在104名参与者中，50%为男性，主要年龄组在45岁以上（61.5%）。队列中的大多数人已婚（72.1%）、就业（57.7%），且为基督教徒（56.7%）。大多数CKD病例被诊断为5期（87.5%）且正在接受透析治疗。19.2%的参与者存在谵妄。在未发生谵妄的患者中，焦虑影响了46.3%，抑郁影响了50.0%，认知功能障碍占11.1%。基于性别的分析显示，年龄或病程无显著差异；然而，男性的受教育程度较高（<0.02）。虽然女性往往表现出更严重的精神症状（<0.06），但男性有更多的认知功能障碍（<0.08）；然而，这些差异未达到统计学意义。社会经济地位（SES）比较表明，较低的SES与受教育年限减少相关（<0.00）。
焦虑和抑郁在近一半的CKD患者中普遍存在，不存在性别或社会经济差异。这凸显了全面、多学科干预对于有效管理这些状况和提高整体生活质量的迫切需求。
