Depression and all-cause mortality in hemodialysis patients.
Depression and all-cause mortality in hemodialysis patients.
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DOI：
10.1159/000363539
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发表时间：
2014
影响因子：
4.2
通讯作者：
Weiner DE
中科院分区：
文献类型：
--
作者：
Fan L;Sarnak MJ;Tighiouart H;Drew DA;Kantor AL;Lou KV;Shaffi K;Scott TM;Weiner DE
关于血液透析患者抑郁与死亡率之间关系的数据有限。在323名维持性血液透析患者中，使用流行病学研究中心抑郁量表（CES-D）评估抑郁症状，评分≥16与抑郁一致。调整后的考克斯比例风险模型，包括抗抑郁药物使用的额外分析，用于评估抑郁症和死亡率之间的关系。基线CES-D评分用于主要分析，而次要时间依赖性分析纳入了后续CES-D结果。平均年龄为62.9 ± 16.5岁，46%为女性，22%为非洲裔美国人。平均基线CES-D评分为10.7 ± 8.3，83例（26%）受试者的CES-D评分≥16。在中位（第25，75）随访25（13，43）个月期间，154名参与者死亡。校正年龄、性别、种族、肾衰竭的主要原因、透析年份和通路后，基线抑郁与全因死亡风险增加相关[HR（95% CI）=1.51（1.06，2.17）]。进一步调整心血管疾病、吸烟、Kt/V、血清白蛋白、log CRP和抗抑郁药使用后，该效应减弱[HR=1.21（0.82，1.80）]。当评价时间依赖性CES-D时，在完全校正的模型中，抑郁症仍与死亡风险增加相关[HR=1.44（1.00，2.06）]。更严重的抑郁症状与血液透析患者死亡风险增加相关，特别是在考虑最接近的评估时。随着对合并症的调整，这种关系被减弱，表明临床特征和抑郁症状之间存在复杂的关系。未来的研究应该评估抑郁症治疗是否会影响HD患者的死亡率。
There are limited data regarding the relationship between depression and mortality in hemodialysis patients. Among 323 maintenance hemodialysis patients, depression symptoms were assessed using the Center for Epidemiologic Studies Depression (CES-D) scale, with a score of ≥16 consistent with depression. Adjusted Cox proportional hazards models, with additional analyses incorporating antidepressant medication use, were used to evaluate the association between depression and mortality. Baseline CES-D scores were used for primary analyses, while secondary time dependent analyses incorporated subsequent CES-D results. Mean age was 62.9 ± 16.5 years, 46% were women and 22% African American. Mean baseline CES-D score was 10.7 ± 8.3, and 83 (26%) participants had CES-D scores ≥16. During median (25th, 75th) follow-up of 25 (13, 43) months, 154 participants died. After adjusting for age, sex, race, primary cause of kidney failure, dialysis vintage and access, baseline depression was associated with an increased risk of all-cause mortality [HR (95% CI)=1.51 (1.06, 2.17)]. This attenuated with further adjustment for cardiovascular disease, smoking, Kt/V, serum albumin, log CRP and antidepressant use [HR=1.21 (0.82, 1.80)]. When evaluating time-dependent CES-D, depression remained associated with increased mortality risk in the fully adjusted model [HR=1.44 (1.00, 2.06)]. Greater symptoms of depression are associated with an increased risk of mortality in hemodialysis patients, particularly when accounting for the most proximate assessment. This relationship was attenuated with adjustment for comorbid conditions, suggesting a complex relationship between clinical characteristics and depression symptoms. Future studies should evaluate whether treatment for depression impacts mortality among HD patients.
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