Association Between Depression and Death in People With CKD: A Meta-analysis of Cohort Studies

作者：Palmer Suetonia C; Vecchio Mariacristina; Craig Jonathan C; Tonelli Marcello; Johnson David W; Nicolucci Antonio; Pellegrini Fabio; Saglimbene Valeria; Logroscino Giancarlo; Hedayati S Susan; Strippoli Giovanni F M^*

来源：American Journal of Kidney Diseases, 2013, 62(3): 493-505.

DOI：10.1053/j.ajkd.2013.02.369

• Depression
• dialysis
• mortality
• outcomes

Background: Depression occurs relatively commonly in people with chronic kidney disease (CKD), but it is uncertain whether depression is a risk factor for premature death in this population. Interventions to reduce mortality in CKD consistently have been ineffective and new strategies are needed. %26lt;br%26gt;Study Design: Systematic review and meta-analysis of cohort studies. %26lt;br%26gt;Setting %26 Population: Adults with CKD. %26lt;br%26gt;Selection Criteria for Studies: Cohort studies identified in Ovid MEDLINE through week 3 December 2012 without language restriction. %26lt;br%26gt;Predictor: Depression status as determined by physician diagnosis, clinical coding, or self-reported scales. %26lt;br%26gt;Selection Criteria for Studies: All-cause and cardiovascular mortality. Outcomes were summarized as relative risks (RRs) with 95% CIs using random-effects meta-analysis. %26lt;br%26gt;Results: 22 studies (83,381 participants) comprising 12,063 cases of depression (mean prevalence, 27.4%; 95% CI, 20.0%-36.3%) with a follow-up of 3 months to 6.5 years were included. Methodological quality generally was good or fair. Depression consistently increased the risk of death from any cause (RR, 1.59; 95% CI, 1.35-1.87), but had less certain effects on cardiovascular mortality (RR, 1.88; 95% CI, 0.84-4.19). Associations for mortality were similar regardless of the diagnostic method used for depression, but were weaker in analyses controlled for preexisting cardiovascular disease (RR, 1.36; 95% CI, 1.23-1.50). %26lt;br%26gt;Limitations: Meta-analyses adjusting for antidepressant medication use were not possible, and data for kidney transplant recipients and individuals with earlier stages of CKD not treated with dialysis were limited. %26lt;br%26gt;Conclusions: Depression is associated with a substantially increased risk of death in people with CKD. Effective treatment for depression in people with CKD may reduce mortality.

• 出版日期2013-9