혈액투석 중인 환자의 우울증과 불안증 = Depression and Anxiety in Maintenance Hemodialysis Patients: A Single Center Study

국문 초록 (Abstract)

목 적: 불안증과 우울증은 만성 신부전으로 유지혈액투석중인 환자에서 흔한 문제이나 임상의료에서는 간과되는 경향이 있다. 본 연구에서 혈액투석중인 환자에서 우울증과 불안증의 유병율 및 이와 관련된 인자들을 알아보고자 하였다.
방 법: 유지 혈액투석중인 환자 104명을 대상으로 병원 불안-우울 척도를 이용하여 우울증 및 불안증을 진단하였으며, 관련 인자를 알기 위해 단변량 분석 및 다변량 로지스틱 회귀분석을 시행하였다.
결 과: 평균 나이는 58.2±12.1세이었으며, 만성신부전의 원인질환으로는 당뇨병 (50%), 고혈압 (27.9%), 만성 사구체신염 (8.7%), 그리고 기타 및 미상 (14%)이 있었다. 우울증의 유병율은 58.7%였으며 단변량 분석에서 comorbidity index, Karnofsky index, 혈청 크레아티닌, 나이가 우울증과 관련이 있었으나 다변량 로지스틱 회귀분석에서는 Karnofsky idex 만이 우울증과 관련 있는 독립 변수였다 [odds ratio (OR)= 5.834, p=0.007]. 불안증의 유병율은 27.9%였으며, 단변량 및 다변량 로지스틱 회귀분석에서 karnofsky index만이 관련 되어 있었다.
결 론: 우울증 및 불안증은 혈액투석중인 환자에서 흔한 문제이며, 일상활동 수행 능력이 떨어지는 환자에서 높은 유병율을 보였다.

다국어 초록 (Multilingual Abstract)

Purpose: Psychiatric problem such as depression and anxiety is prevalent and is associated with morbidity and mortality in hemodialysis patients. But it is difficult to assess and is undertreated. The aim of this study is investigating the prevalence and the risk factors for depression and anxiety among patients receiving maintenance hemodialysis.
Methods: We used the Hospital Anxiety and Depression scale (HADS. Korean version) as a screening test for 104 hemodialysis patients in a single center. Univariate analysis and mutltivariable logistic regression analysis were used to evaluate the association between the psychiatric problem (depression and anxiety) and other patients’ factors (social economic factors and medical conditions).
Results: The mean age was 58.2±12.1 years and the causes of ESRD were diabetes mellitus (50%), hypertension (27.9%), chronic glomerulonephritis (8.7%), and other or unknown causes (14%). The prevalence of depression was 58.7%, and univariate analysis revealed that comorbidity index, Karnofsky index, serum creatinine, and age were statistically significantly correlated with depression. But Multivariable logistic regression analysis demonstrated that only Karnofsky index was independently associated with depression [odds ratio (OR)=5.834, p=0.007]. The prevalence of anxiety was 27.9% and only karnofsky index was significantly correlated with anxiety on both univariate and multivariable logistic regression analysis.
Conclusion: Depression and anxiety were prevalent in hemodialysis patients. Poor performance status was highly associated with depression and anxiety.

참고문헌 (Reference)

• 1 정연순, "유지 혈액투석치료를 받는 만성신부전에 수반된 우울증에서 항우울제 치료에 따른 우울증상 및 영양지표의 변화" 대한신장학회 27 (27): 94-101, 2008
• 2 "U.S. Renal Data System U: Annual Report"
• 3 Burton HJ, "The relationship of depression to survival in chronic renal failure" 48 : 261-269, 1986
• 4 Sareen J, "The relationship between anxiety disorders and physical disorders in the U.S. National Comorbidity Survey" 21 : 193-202, 2005
• 5 Evans RW, "The quality of life of patients with end-stage renal disease" 312 : 553-559, 1985
• 6 Zigmond AS, "The hospital anxiety and depression scale" 67 : 361-370, 1983
• 7 Riezebos RK, "The association of depressive symptoms with survival in a Dutch cohort of patients with end-stage renal disease" 25 : 231-236, 2010
• 8 Martin CR, "The Hospital Anxiety and Depression Scale in patients undergoing peritoneal dialysis: Internal and test re-test reliablity" 6 : 77-79, 2002
• 9 Fukuhara S, "Symptoms of depression, prescription of benzodiazepines, and the risk of death in hemodialysis patients in Japan" 70 : 1866-1872, 2006
• 10 Kimmel PL, "Survival in hemodialysis patients: the role of depression" 4 : 12-27, 1993
• 11 House JS, "Social relationships and health" 241 : 540-545, 1988
• 12 Robinson BM, "Revisiting survival differences by race and ethnicity among hemodialysis patients: the dialysis outcomes and practice patterns study" 17 : 2910-2918, 2006
• 13 Patel SS, "Psychosocial variables, quality of life, and religious beliefs in ESRD patients treated with hemodialysis" 40 : 1013-1022, 2002
• 14 Devins GM, "Psychosocial predictors of survival in end-stage renal disease" 178 : 127-133, 1990
• 15 Kimmel PL, "Psychosocial factors, behavioral compliance and survival in urban hemodialysis patients" 54 : 245-254, 1998
• 16 Kimmel PL, "Psychosocial factors in dialysis patients" 59 : 1599-1613, 2001
• 17 Ziarnik JP, "Psychological correlates of survival on renal dialysis" 164 : 210-213, 1977
• 18 Kimmel PL, "Psychiatric illness in patients with end-stage renal disease" 105 : 214-221, 1998
• 19 Taskapan H, "Psychiatric disorders and large interdialytic weight gain in patients on chronic haemodialysis" 10 : 15-20, 2005
• 20 McEwen BS, "Protective and damaging effects of mediators of stress. Elaborating and testing the concepts of allostasis and allostatic load" 896 : 30-47, 1999
• 21 Christensen AJ, "Predictors of survival among hemodialysis patients: effect of perceived family support" 13 : 521-525, 1994
• 22 Snow V, "Pharmacologic treatment of acute major depression and dysthymia. American college of physicians-american society of internal medicine" 132 : 738-742, 2000
• 23 Peterson RA, "PL, Sacks CR, Mesquita ML, Simmens SJ, Reiss D: Depression, perception of illness and mortality in patients with end-stage renal disease" 21 : 343-354, 1991
• 24 Kimmel PL, "Multiple measurements of depression predict mortality in a longitudinal study of chronic hemodialysis outpatients" 57 : 2093-2098, 2000
• 25 Kao TW, "Impact of religious activity on depression and quality of life of chronic peritoneal dialysis patients in Taiwan" 102 : 127-130, 2003
• 26 Kimmel PL, "Immunologic function and survival in hemodialysis patients" 54 : 236-244, 1998
• 27 Lisspers J, "Hospital Anxiety and Depression Scale (HAD): some psychometric data for a Swedish sample" 96 : 281-286, 1997
• 28 Kimmel PL, "ESRD patient quality of life: symptoms, spiritual beliefs, psychosocial factors, and ethnicity" 42 : 713-721, 2003
• 29 Lopes AA, "Dialysis Outcomes and Practice Patterns Study (DOPPS): Depression as a predictor of mortality and hospitalization among hemodialysis patients in the United States and Europe" 62 : 199-207, 2002
• 30 Smith MD, "Diagnosis of depression in patients with end-stage renal disease. Comparative analysis" 79 : 160-166, 1985
• 31 Kimmel PL, "Depression in patients with chronic renal disease: what we know and what we need to know" 53 : 951-956, 2002
• 32 Hinrichsen GA, "Depression in hemodialysis patients" 30 : 284-289, 1989
• 33 Kimmel PL, "Depression in end-stage renal disease patients treated with hemodialysis: tools, correlates, outcomes, and needs" 18 : 91-97, 2005
• 34 Cukor D, "Depression in end-stage renal disease hemodialysis patients" 2 : 678-687, 2006
• 35 Cukor D, "Depression and anxiety in urban hemodialysis patients" 2 : 484-490, 2007
• 36 Koo JR, "Association of depression with malnutrition in chronic hemodialysis patients" 41 : 1037-1042, 2003
• 37 Kroenke K, "Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection" 146 : 317-325, 2007
• 38 Cukor D, "Anxiety disorders in adults treated by hemodialysis: a single-center study" 52 : 128-136, 2008
• 39 Oh SM, "A study on the standardization of the hospital anxiety and depression scale for Koreans: a comparison of normal, depressed and anxious groups" 38 : 289-296, 1999