Kimmel P L, Thamer M, Richard C M, Ray N F
Department of Medicine, George Washington University Medical Center, Washington, DC 20037, USA.
Am J Med. 1998 Sep;105(3):214-21. doi: 10.1016/s0002-9343(98)00245-9.
We sought to determine the prevalence of psychiatric illness in hospitalized patients with end-stage renal disease. We also examined the association between end-stage renal disease treatment modality and risk of hospitalization with a diagnosis of a mental disorder, and compared rates of hospitalization with a diagnosis of psychiatric illness in renal failure patients to patients with other chronic medical illnesses.
We performed a cohort study of all Medicare-enrolled dialysis patients in 1993. Risk of hospitalization with a diagnosis of a mental disorder among renal failure patients was compared with Medicare patients with diabetes mellitus, ischemic heart disease, cerebrovascular disease, and peptic ulcer disease.
Almost 9% of all dialysis patients were hospitalized with a mental disorder. Men, African-Americans, and younger patients were more likely to be hospitalized with a mental disorder. The adjusted risk of hospitalization for peritoneal dialysis patients was lower compared with hemodialysis patients for any mental disorder, depression, and alcohol and drug use. Hospitalization with mental disorders was 1.5 to 3.0 times higher for renal failure patients compared with other chronically ill patients.
Hospitalization with a psychiatric illness is common among the US end-stage renal disease population. Depression, dementia and drug-related disorders were especially common. The coexistence of psychiatric illness in patients with renal failure who require specialized medical regimens represents a challenge to nephrologists in diagnosis and treatment. Disparities between hospitalization rates of psychiatric illnesses among end-stage renal disease patients compared with other chronically ill populations warrant further research.
我们试图确定终末期肾病住院患者中精神疾病的患病率。我们还研究了终末期肾病治疗方式与因精神障碍诊断而住院风险之间的关联，并比较了肾衰竭患者与其他慢性疾病患者因精神疾病诊断而住院的比率。
我们对1993年所有参加医疗保险的透析患者进行了一项队列研究。将肾衰竭患者中因精神障碍诊断而住院的风险与患有糖尿病、缺血性心脏病、脑血管疾病和消化性溃疡疾病的医疗保险患者进行了比较。
几乎9%的透析患者因精神障碍住院。男性、非裔美国人以及年轻患者更有可能因精神障碍住院。对于任何精神障碍、抑郁症以及酒精和药物使用问题，腹膜透析患者经调整后的住院风险低于血液透析患者。肾衰竭患者因精神障碍住院的几率比其他慢性病患者高1.5至3.0倍。
在美国终末期肾病人群中，因精神疾病住院很常见。抑郁症、痴呆症和与药物相关的疾病尤其常见。需要特殊医疗方案的肾衰竭患者中精神疾病的共存给肾病学家的诊断和治疗带来了挑战。终末期肾病患者与其他慢性病患者群体之间精神疾病住院率的差异值得进一步研究。
