Association between major depressive episodes in patients with chronic kidney disease and initiation of dialysis, hospitalization, or death.
Association between major depressive episodes in patients with chronic kidney disease and initiation of dialysis, hospitalization, or death.
复制标题
DOI：
10.1001/jama.2010.619
复制
发表时间：
2010-05-19
影响因子：
120.7
通讯作者：
Rush, A. John
中科院分区：
文献类型：
--
作者：
Hedayati, S. Susan;Minhajuddin, Abu T.;Afshar, Masoud;Toto, Robert D.;Trivedi, Madhukar H.;Rush, A. John
慢性肾脏病（CKD）患者的住院率和死亡率增加。抑郁症与发病率和死亡率相关。抑郁是否会导致未接受透析的CKD患者的不良结局尚不清楚。确定当前重度抑郁发作（MDE）的存在是否与CKD患者的不良结局相关。对2005年5月至2006年11月期间在VA医疗中心连续招募的267例CKD门诊患者（2-5期，未接受透析）进行了前瞻性队列研究，并随访了1年。由设盲人员使用精神疾病诊断和统计手册（第四版）标准诊断MDE。主要结局是无事件生存期，定义为死亡、透析开始或住院的复合终点。次要结局包括单独评估的这些事件。在267例患者中，56例（21%）目前存在MDE，211例（79%）没有。共有127起复合事件，116例住院，38例透析启动和18例死亡。与未发生MDE的患者相比，发生MDE的患者更常发生事件（分别为61% vs 44%，P= 0.03）。四名住院日期缺失的患者被排除在生存分析之外。发生MDE的患者至复合事件的平均（SD）时间为206.5（19.8）天（95% CI，167.7-245.3天），而未发生MDE的患者为273.3（8.5）天（95% CI，256.6-290.0天）（P= 0.003）。MDE患者复合事件的校正风险比（HR）为1. 86（95% CI，1. 23 - 2. 84）。基线MDE独立预测进展至透析（HR，3.51; 95% CI，1.77-6.97）和住院（HR，1.90; 95% CI，1.23-2.95）。MDE的存在与未接受透析的CKD患者的不良结局风险增加相关，与合并症和肾脏疾病严重程度无关。
Patients with chronic kidney disease (CKD) experience increased rates of hospitalization and death. Depressive disorders are associated with morbidity and mortality. Whether depression contributes to poor outcomes in patients with CKD not receiving dialysis is unknown. To determine whether the presence of a current major depressive episode (MDE) is associated with poorer outcomes in patients with CKD. Prospective cohort study of 267 consecutively recruited outpatients with CKD (stages 2–5 and who were not receiving dialysis) at a VA medical center between May 2005 and November 2006 and followed up for 1 year. An MDE was diagnosed by blinded personnel using the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria. The primary outcome was event-free survival defined as the composite of death, dialysis initiation, or hospitalization. Secondary outcomes included each of these events assessed separately. Among 267 patients, 56 had a current MDE (21%) and 211 did not (79%). There were 127 composite events, 116 hospitalizations, 38 dialysis initiations, and 18 deaths. Events occurred more often in patients with an MDE compared with those without an MDE (61% vs 44%, respectively, P=.03). Four patients with missing dates of hospitalization were excluded from survival analyses. The mean (SD) time to the composite event was 206.5 (19.8) days (95% CI, 167.7–245.3 days) for those with an MDE compared with 273.3 (8.5) days (95% CI, 256.6–290.0 days) for those without an MDE (P=.003). The adjusted hazard ratio (HR) for the composite event for patients with an MDE was 1.86 (95% CI, 1.23–2.84). An MDE at baseline independently predicted progression to dialysis (HR, 3.51; 95% CI, 1.77–6.97) and hospitalization (HR, 1.90; 95% CI, 1.23–2.95). The presence of an MDE was associated with an increased risk of poor outcomes in CKD patients who were not receiving dialysis, independent of comorbidities and kidney disease severity.
登录
查看更多内容
DOI：
10.2215/cjn.00030505
发表时间：
2006-05-01
影响因子：
9.8
作者：
Boulware, L. Ebony;Liu, Yongmei;Powe, Neil R.
通讯作者：
Powe, Neil R.
影响因子：
7
作者：
Drayer, Rebecca A.;Piraino, Beth;Rollman, Bruce L.
通讯作者：
Rollman, Bruce L.
影响因子：
19.6
作者：
Kimmel, PL;Peterson, RA;Veis, JH
通讯作者：
Veis, JH
DOI：
10.1053/j.ajkd.2009.03.017
发表时间：
2009-09
期刊：
American journal of kidney diseases : the official journal of the National Kidney Foundation
影响因子：
--
作者：
Hedayati SS;Minhajuddin AT;Toto RD;Morris DW;Rush AJ
通讯作者：
Rush AJ
DOI：
10.1097/00008483-200311000-00002
发表时间：
2003-11-01
期刊：
Journal of cardiopulmonary rehabilitation
影响因子：
--
作者：
Barefoot, John C;Burg, Matthew M;Sheps, David
通讯作者：
Sheps, David