Christopher D Knapp, Kayla Horak, Nicholas S Roetker, Abigail Fink, Allan Gao, Kirsten L Johansen, Anne Murray, Allyson Hart
{"title":"在CKD患者队列中，抑郁症状不会随着时间的推移而加重：BRINK研究","authors":"Christopher D Knapp, Kayla Horak, Nicholas S Roetker, Abigail Fink, Allan Gao, Kirsten L Johansen, Anne Murray, Allyson Hart","doi":"10.34067/KID.0000000670","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The prevalence of depression is high in the chronic kidney disease (CKD) (20-40%) and dialysis (30-50%) populations. Less is known about how depressive symptoms change over time in patients with CKD.</p><p><strong>Methods: </strong>Participants in the Brain in Kidney Disease (BRINK) cohort study completed a depressive symptom questionnaire (PHQ-9) and serum creatinine testing annually. We used linear mixed effects models to examine changes in PHQ-9 scores over time and compared rates of change between participants with different ranges of eGFR impairment and those with normal eGFR.</p><p><strong>Results: </strong>At baseline, 147 participants had normal eGFR, 424 had impaired eGFR without dialysis dependence, and 31% reported a diagnosis of depression, with a mean baseline PHQ-9 score of 4.3. Participants were followed for up to 5 years. After adjustment for factors associated with depression, mean PHQ-9 scores decreased (improved) by 0.25 points per year (95% confidence interval [CI] 0.07, 0.42) among participants with normal eGFR (>60 ml/min/1.73m2) and by 0.35 points (95% CI 0.14, 0.56), 0.30 points (95% CI 0.13,0.46) and 0.42 points (95% CI 0.06, 0.77) among participants with eGFR of 45 to 59 ml/min/1.73m2, 30 to 44 ml/min/1.73m2, and participants who developed dialysis dependence, respectively. PHQ-9 scores among participants with eGFR <30 ml/min/1.73m2 did not change significantly. We did not observe any statistically significant differences in mean change in PHQ-9 score between participants with any degree of eGFR impairment and those with normal eGFR, nor between participants with dialysis-dependence and those with eGFR of ≤15 ml/min/1.73m2. Participants with a PHQ-9 score ≥5 had 80% greater odds of immediate study attrition than participants with a PHQ-9 score of 0-4.\"</p><p><strong>Conclusions: </strong>The mean PHQ-9 scores of participants were largely stable over time, and we observed no differences in the change in PHQ-9 scores between those with impaired eGFR and those with normal eGFR.</p>","PeriodicalId":17882,"journal":{"name":"Kidney360","volume":" ","pages":""},"PeriodicalIF":3.2000,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Depression Symptoms Do Not Worsen Over Time in a Cohort of CKD Patients: The BRINK Study.\",\"authors\":\"Christopher D Knapp, Kayla Horak, Nicholas S Roetker, Abigail Fink, Allan Gao, Kirsten L Johansen, Anne Murray, Allyson Hart\",\"doi\":\"10.34067/KID.0000000670\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The prevalence of depression is high in the chronic kidney disease (CKD) (20-40%) and dialysis (30-50%) populations. Less is known about how depressive symptoms change over time in patients with CKD.</p><p><strong>Methods: </strong>Participants in the Brain in Kidney Disease (BRINK) cohort study completed a depressive symptom questionnaire (PHQ-9) and serum creatinine testing annually. We used linear mixed effects models to examine changes in PHQ-9 scores over time and compared rates of change between participants with different ranges of eGFR impairment and those with normal eGFR.</p><p><strong>Results: </strong>At baseline, 147 participants had normal eGFR, 424 had impaired eGFR without dialysis dependence, and 31% reported a diagnosis of depression, with a mean baseline PHQ-9 score of 4.3. Participants were followed for up to 5 years. After adjustment for factors associated with depression, mean PHQ-9 scores decreased (improved) by 0.25 points per year (95% confidence interval [CI] 0.07, 0.42) among participants with normal eGFR (>60 ml/min/1.73m2) and by 0.35 points (95% CI 0.14, 0.56), 0.30 points (95% CI 0.13,0.46) and 0.42 points (95% CI 0.06, 0.77) among participants with eGFR of 45 to 59 ml/min/1.73m2, 30 to 44 ml/min/1.73m2, and participants who developed dialysis dependence, respectively. PHQ-9 scores among participants with eGFR <30 ml/min/1.73m2 did not change significantly. We did not observe any statistically significant differences in mean change in PHQ-9 score between participants with any degree of eGFR impairment and those with normal eGFR, nor between participants with dialysis-dependence and those with eGFR of ≤15 ml/min/1.73m2. 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引用次数: 0
摘要
背景：抑郁症在慢性肾病（CKD）（20-40%）和透析（30-50%）人群中的患病率很高。关于慢性肾病患者抑郁症状如何随时间变化的了解较少。方法：脑肾疾病（BRINK）队列研究的参与者每年完成一份抑郁症状问卷（PHQ-9）和血清肌酐检测。我们使用线性混合效应模型来检查PHQ-9评分随时间的变化，并比较不同eGFR损伤范围的参与者和eGFR正常的参与者之间的变化率。结果：基线时，147名参与者eGFR正常，424名参与者eGFR受损，无透析依赖，31%的参与者报告了抑郁症的诊断，平均基线PHQ-9评分为4.3。研究人员对参与者进行了长达5年的随访。调整抑郁相关因素后，在eGFR正常（60 ml/min/1.73m2）的参与者中，平均PHQ-9评分每年下降（提高）0.25分（95%置信区间[CI] 0.07, 0.42），在eGFR为45至59 ml/min/1.73m2、30至44 ml/min/1.73m2和有透析依赖的参与者中，分别下降0.35分（95% CI 0.14, 0.56）、0.30分（95% CI 0.13,0.46）和0.42分（95% CI 0.06, 0.77）。结论：随着时间的推移，参与者的平均PHQ-9评分基本稳定，我们观察到eGFR受损者和eGFR正常者的PHQ-9评分变化无差异。
Depression Symptoms Do Not Worsen Over Time in a Cohort of CKD Patients: The BRINK Study.
Background: The prevalence of depression is high in the chronic kidney disease (CKD) (20-40%) and dialysis (30-50%) populations. Less is known about how depressive symptoms change over time in patients with CKD.
Methods: Participants in the Brain in Kidney Disease (BRINK) cohort study completed a depressive symptom questionnaire (PHQ-9) and serum creatinine testing annually. We used linear mixed effects models to examine changes in PHQ-9 scores over time and compared rates of change between participants with different ranges of eGFR impairment and those with normal eGFR.
Results: At baseline, 147 participants had normal eGFR, 424 had impaired eGFR without dialysis dependence, and 31% reported a diagnosis of depression, with a mean baseline PHQ-9 score of 4.3. Participants were followed for up to 5 years. After adjustment for factors associated with depression, mean PHQ-9 scores decreased (improved) by 0.25 points per year (95% confidence interval [CI] 0.07, 0.42) among participants with normal eGFR (>60 ml/min/1.73m2) and by 0.35 points (95% CI 0.14, 0.56), 0.30 points (95% CI 0.13,0.46) and 0.42 points (95% CI 0.06, 0.77) among participants with eGFR of 45 to 59 ml/min/1.73m2, 30 to 44 ml/min/1.73m2, and participants who developed dialysis dependence, respectively. PHQ-9 scores among participants with eGFR <30 ml/min/1.73m2 did not change significantly. We did not observe any statistically significant differences in mean change in PHQ-9 score between participants with any degree of eGFR impairment and those with normal eGFR, nor between participants with dialysis-dependence and those with eGFR of ≤15 ml/min/1.73m2. Participants with a PHQ-9 score ≥5 had 80% greater odds of immediate study attrition than participants with a PHQ-9 score of 0-4."
Conclusions: The mean PHQ-9 scores of participants were largely stable over time, and we observed no differences in the change in PHQ-9 scores between those with impaired eGFR and those with normal eGFR.
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