Longitudinal Association of Depressive Symptoms with Rapid Kidney Function Decline and Adverse Clinical Renal Disease Outcomes
Longitudinal Association of Depressive Symptoms with Rapid Kidney Function Decline and Adverse Clinical Renal Disease Outcomes
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DOI：
10.2215/cjn.03840510
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发表时间：
2011-04-01
影响因子：
9.8
通讯作者：
Gottdiener, John S.
中科院分区：
文献类型：
--
作者：
Kop, Willem J.;Seliger, Stephen L.;Gottdiener, John S.
背景和目的抑郁是透析患者不良结局的风险指标，但其对未接受透析患者预后的影响尚不清楚。本研究检查抑郁症状是否与肾功能下降、新发慢性肾脏病（CKD）、终末期肾病或急性肾损伤（阿基）住院治疗纵向相关。设计、设置、参与者和测量抑郁症状在纵向队列研究中使用10项流行病学研究中心抑郁量表测量，使用先前验证的截止值（>= 8）。CKD在研究开始时和随访期间被定义为估计的GFR（eGFR）< 60 ml/min/m2。结果是eGFR快速下降（> 3 ml/min/m2/年）、新发CKD、ESRD（基于美国肾脏数据系统）和阿基（基于裁定的病历审查）。中位随访时间为10.5年。结果在多变量分析中，抑郁参与者（21.2%）在基线时显示出比非抑郁参与者更高的CKD患病率。在未校正的模型中，抑郁症与随后eGFR、ESRD事件和阿基的快速下降风险相关，但与CKD事件无关。在多变量分析中，只有抑郁症状与阿基的相关性仍然显着。结论抑郁症状升高与随后的不良肾脏疾病结局相关。抑郁症相关的阿基风险升高与传统的肾脏疾病风险因素无关，部分原因可能是抑郁症对急性冠状动脉综合征和心力衰竭住院的预测价值。Clin J Am Soc Nephrol 6：834-844，2011. doi：10.2215/CJN.03840510
Background and objectives Depression is a risk indicator for adverse outcomes in dialysis patients, but its prognostic impact in individuals who are not yet on dialysis is unknown. This study examines whether depressive symptoms are longitudinally associated with renal function decline, new-onset chronic kidney disease (CKD), ESRD, or hospitalization with acute kidney injury (AKI).Design, setting, participants, & measurements Depressive symptoms were measured in a longitudinal cohort study with the 10-item Centers for Epidemiologic Studies Depression scale using a previously validated cut-off value (>= 8). CKD at study entry and during follow-up was defined as an estimated GFR (eGFR) < 60 ml/min per m(2). Outcomes were rapid decline in eGFR (> 3 ml/min per m(2) per year), new-onset CKD, ESRD (U.S. Renal Data System-based), and AKI (based on adjudicated medical record review). The median follow-up duration was 10.5 years.Results Depressed participants (21.2%) showed a higher prevalence of CKD at baseline compared with non-depressed participants in multivariable analysis. Depression was associated with a subsequent risk of rapid decline in eGFR, incident ESRD, and AKI, but not incident CKD in unadjusted models. In multivariable analyses, only associations of depressive symptoms with AKI remained significant.Conclusions Elevated depressive symptoms are associated with subsequent adverse renal disease outcomes. The depression-related elevated risk of AKI was independent of traditional renal disease risk factors and may in part be explained by the predictive value of depression for acute coronary syndromes and heart failure hospitalizations that can be complicated by AM. Clin J Am Soc Nephrol 6: 834-844, 2011. doi: 10.2215/CJN.03840510