Depression as a predictor of mortality and hospitalization among hemodialysis patients in the United States and Europe
Depression as a predictor of mortality and hospitalization among hemodialysis patients in the United States and Europe
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DOI：
10.1046/j.1523-1755.2002.00411.x
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发表时间：
2002-07-01
影响因子：
19.6
通讯作者：
Port, FK
中科院分区：
文献类型：
--
作者：
Lopes, AA;Bragg, J;Port, FK
背景抑郁症在接受血液透析治疗的终末期肾病（ESRD）患者中并不少见。我们调查了是否可以通过医生诊断的抑郁症和患者的抑郁症自我报告来预测死亡风险和住院率。分析了来自透析结局和实践模式研究（DOPPS）的数据，这些数据来自美国（142家机构，2855例患者）和5个欧洲国家（101家机构，2401例患者）随机选择的接受血液透析治疗的ESRD患者。过去一年中抑郁症的诊断是从病历中摘录的。此外，患者还被要求指出，在过去的四周里，他们大部分时间都感到（1）“如此沮丧，没有什么能让你振作起来”和（2）“沮丧和忧郁”。“一个回应“好一点。“大多数”或“所有”时间被归类为抑郁。抑郁症的患病率接近20%。抑郁症患者死亡和住院的相对危险度（与非抑郁），调整透析时间，年龄，种族，社会经济状况，共病指标和国家分别为：医生诊断的抑郁症分别为1.23和1.11，“如此沮丧”的问题分别为1.48和1.15，抑郁和忧郁问题分别为1.35和1.11（P < 0.05）。这些关联在美国和欧洲患者之间没有显著差异。通过两个简单问题自我报告的抑郁与血液透析患者死亡率和住院风险增加相关。未来的研究需要评估早期识别和治疗抑郁症是否有助于改善血液透析患者的生活质量和生存率。
Background. Depression is not uncommon among patients with end-stage renal disease (ESRD) being treated by hemodialysis. We investigated whether risk of mortality and rate of hospitalization may be predicted from physician-diagnosed depression and patients' self-reports of depressive symptoms.Methods. Data were analyzed from the Dialysis Outcomes and Practice Patterns Study (DOPPS) for randomly selected ESRD patients being treated by hemodialysis in the United States (142 facilities, 2855 patients) and five European countries (101 facilities, 2401 patients). The diagnosis of depression during the past year was abstracted from the medical records. In addition, the patients were asked to indicate how, much of their time over the previous four weeks they had felt (1) "so down in the dumps that nothing could cheer you up" and (2) "downhearted and blue." A response of "a good bit." "most," or "all" of the time were classified as depressed.Results. The prevalence of depression was nearly 20%. The relative risks of mortality and hospitalization among depressed (vs. non-depressed), adjusted for time on dialysis, age, race, socioeconomic status, comorbid indicators and country were, respectively: 1.23 and 1.11 for physician-diagnosed depression, 1.48 and 1.15 for the "so down in the dumps" question, and 1.35 and 1.11 for the "downhearted and blue" question (P < 0.05 for all six relative risks). These associations were not significantly different between US and European patients.Conclusions. Self-reported depression by two simple questions was associated with increased risks of mortality and hospitalization for hemodialysis patients. Future research needs to assess whether early identification and treatment of depression may help to improve quality of life and survival in hemodialysis patients.