Depressive symptoms associate with high mortality risk and dialysis withdrawal in incident hemodialysis patients
Depressive symptoms associate with high mortality risk and dialysis withdrawal in incident hemodialysis patients
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DOI：
10.1093/ndt/gfr778
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发表时间：
2012-07-01
影响因子：
6.1
通讯作者：
Finkelstein, Fredric O.
中科院分区：
文献类型：
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作者：
Lacson, Eduardo, Jr.;Li, Nien-Chen;Finkelstein, Fredric O.
事件透析患者报告的抑郁症状的严重程度与第一年结局之间的关系尚不清楚，我们评估了2006年1月1日至12月31日在费森尤斯医疗北美机构入院的事件透析患者的抑郁症状自我报告与死亡率或最初调查后长达1年的透析退出之间的关系。采用逐步考克斯模型，我们在首次透析后46 ~ 24天内从一个平均年龄为62.3 ~ 15.2岁的队列中收集到了6415份SF-36问卷，这些问卷中的抑郁评分与精神和身体成分评分、病例组合和实验室变量无关。58例为糖尿病患者，45例为女性，69例为白人。抑郁评分增加1分与死亡率的未校正风险比（HR）为1.09（1.03，1.15）和退出透析的未校正风险比（HR）为1.15（1.05，1.26）相关。校正后，抑郁评分每增加1分，死亡率HR为1.08（1.01，1.14），退出率HR为1.19（1.08，1.31）。透析前90天内报告的抑郁症状与随后一年更大的透析退出和死亡风险相关。在这个早期脆弱期进一步评估和治疗抑郁症是否可以改善症状，增加生存率和减少过早退出透析需要在前瞻性临床试验中确认。
The relationship between severity of depressive symptoms reported by incident dialysis patients and first-year outcomes is not known.We evaluated the association between self-report of depressive symptoms in incident hemodialysis patients admitted at Fresenius Medical Care North America facilities between 1 January and 31 December 2006 and mortality or withdrawal from dialysis for up to 1 year after the initial survey. The impact of depression scores calculated from two Short Form-36 (SF-36) questionnaires was determined independently of the mental and physical component scores, case-mix and laboratory variables using stepwise Cox models.We received 6415 SF-36 responses within 46 24 days of first dialysis from a cohort with a mean age of 62.3 15.2 years; 58 were diabetic, 45 were female and 69 were Caucasian. A 1-point increase in depression score was associated with unadjusted hazard ratio (HR) of 1.09 (1.03, 1.15) for mortality and 1.15 (1.05, 1.26) for withdrawal from dialysis. After adjustment, a 1-point increase in depression score had a mortality HR of 1.08 (1.01, 1.14) and for withdrawal 1.19 (1.08, 1.31).Depressive symptoms reported within the first 90 days of dialysis were associated with greater dialysis withdrawal and mortality risk over the succeeding year. Whether further evaluation for and treatment of depression during this early vulnerable period may improve symptoms, increase survival and decrease premature withdrawal from dialysis requires confirmation in prospective clinical trials.