Pre-ESRD Depression and Post-ESRD Mortality in Patients with Advanced CKD Transitioning to Dialysis

Clinical journal of the American Society of Nephrology: CJASN

Miklos Z. Molnar³ 

[1] *Division of Nephrology, Department of Medicine and..;*Division of Nephrology, Department of Medicine and..*Division of Nephrology, Department of Medicine and..‖Division of Biostatistics, Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee;*Division of Nephrology, Department of Medicine and..‡Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California;‡Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California

关键词: mortality;    chronic kidney disease;    end stage kidney disease;    transition;    African Americans;    Comorbidity;    Confidence Intervals;    depression;    diabetes mellitus;    Disease Progression;    hospitalization;    Humans;    Kidney Failure, Chronic;    Male;    Proportional Hazards Models;    quality of life;    renal dialysis;    Renal Insufficiency, Chronic;    Risk;    Veterans;   

DOI  :  10.2215/CJN.00570117

学科分类：泌尿医学

来源: American Society of Nephrology

【 摘 要 】

Background and objectives Depression in patients with nondialysis-dependent CKD is often undiagnosed, empirically overlooked, and associated with higher risk of death, progression to ESRD, and hospitalization. However, there is a paucity of evidence on the association between the presence of depression in patients with advanced nondialysis-dependent CKD and post-ESRD mortality, particularly among those in the transition period from late-stage nondialysis-dependent CKD to maintenance dialysis.Design, setting, participants, & measurements From a nation-wide cohort of 45,076 United States veterans who transitioned to ESRD over 4 contemporary years (November of 2007 to September of 2011), we identified 10,454 (23%) patients with a depression diagnosis during the predialysis period. We examined the association of pre-ESRD depression with all-cause mortality after transition to dialysis using Cox proportional hazards models adjusted for sociodemographics, comorbidities, and medications.Results Patients were 72±11 years old (mean±SD) and included 95% men, 66% patients with diabetes, and 23% blacks. The crude mortality rate was similar in patients with depression (289/1000 patient-years; 95% confidence interval, 282 to 297) versus patients without depression (286/1000 patient-years; 95% confidence interval, 282 to 290). Compared with patients without depression, patients with depression had a 6% higher all-cause mortality risk in the adjusted model (hazard ratio, 1.06; 95% confidence interval, 1.03 to 1.09). Similar results were found across all selected subgroups as well as in sensitivity analyses using alternate definitions of depression.Conclusion Pre-ESRD depression has a weak association with post-ESRD mortality in veterans transitioning to dialysis.

【 授权许可】

CC BY