老年血液透析患者抑郁症状与血液透析稳定的相关性研究

目的 :研究老年维持性血透患者抑郁症状与血透过程中并发症的关系。方法 :采用抑郁自评量表 (SDS)对我院 19例老年血透患者、 3 2例中青年血透患者及 3 1例健康人员进行心理测评。结果 :血透患者总体抑郁自评量表标准分显著高于正常对照组 ,两组比较P <0 0 1。老年组透析中高血压、低血压、头痛、胃肠反应、室性早搏及房性早搏发生率明显高于中青年组 ;SDS标准分 >60的老年患者低血压、头痛、胃肠反应、室性早搏及房性早搏的发生率显著高于SDS标准分小于 5 9的老年患者 ;SDS标准分大于 60的老年患者低血压及室性、房性早搏发生率明显高于SDS标准分小于 60的中青年患者 ;而后者胃肠反应显著高于SDS标准分大于 60的老年患者。SDS标准分大于 60的中青年患者高血压、头痛、胃肠反应及房性早搏发生率显著高于SDS标准分小于 5 9的中青年患者。结论 :老年血透患者合并抑郁症状时 ,在血液透析中并发症发生率增多     

血液透析患者的抑郁发生及其相关因素研究

目的了解血液透析患者抑郁的发生与社会支持、应对方式的关系以及各因素之间的相关性。方法采用问卷调查的形式对行血液透析治疗的68例患者进行抑郁及其社会支持、应对方式的调查。结果66.2%的血液透析患者处于不同程度的抑郁状态;血液透析患者非抑郁组与抑郁组,在人均月收入方面有显著性差异(P<0.05);两组在社会支持方面无显著性差异(P>0.05);在应对方式中,两组在解决问题、自责、幻想、退避方面有显著性差异(P<0.05);在相关性方面,抑郁与应对方式量表中的解决问题、求助因子之间有显著负相关,与幻想、退避因子正相关极显著;应对方式量表中,解决问题、求助因子与社会支持显著正相关;退避因子与抑郁之间存在线性关系。结论血液透析患者抑郁的发生率高,经济状况对透析患者抑郁的产生有着重要的影响;血液透析患者在生活中多使用"退避"等消极的应对方式,消极的应对方式可以加重或促发血液透析患者的抑郁情绪;良好的社会支持可以改善血液透析患者的应对方式,从而减轻或缓解患者的抑郁状态。     

Psychosomatic aspects of patients on hemodialysis. 3. Clinical usefulness of alexithymia

The clinical usefulness of alexithymia in dialysis patients was examined from psychosomatic aspects. Before hemodialysis (HD), primary alexithymia was present in 50-53% of HD patients with diabetes. After 2 years' HD therapy, an additional 32-36% of HD patients without diabetes developed secondary alexithymia. In contrast, the prevalence of alexithymia was low in patients receiving continuous ambulatory peritoneal dialysis (CAPD), which requires a higher self-control ability than HD. Alexithymia may reflect dialysis patients' ability to take care of themselves and therefore serve as a useful index in (1) selecting the type of dialysis, either HD or CAPD, and (2) identifying patients on dialysis likely to develop somatic complications due to lack of adequate self-control.     

Deliberate self harm patients with depressive disorders: treatment and outcome

BACKGROUND: Depression is the most common psychiatric disorder in deliberate self-harm (DSH) patients and in those who commit suicide. The aim of this study was to examine the treatment received by DSH patients with depression and their progress following DSH. METHODS: A representative sample of 106 patients with an ICD-10 depressive episode who presented to a general hospital following an episode of DSH were investigated in terms of their treatment before and after the episode and their outcome at follow-up. RESULTS: Prior to the index episode of DSH, 39 patients (36.8%) were receiving treatment from the psychiatric services and a further 35 (33.0%) were receiving treatment for mental health problems from their general practitioner. Fifty-two patients (49.1%) were receiving antidepressants (in therapeutic dosages in 93.6%). After the episode of DSH 94 patients (88.7%) were offered treatment with the psychiatric services, either as a new referral or continuation of treatment they were receiving prior to DSH. Of the patients who were followed-up, 36.3% remained in contact with the psychiatric services, 52.3% showed poor compliance with recommended treatment and 60.2% no longer fulfilled the diagnostic criteria for depression. Almost one-third reported a further episode of DSH during the follow-up period. LIMITATIONS: The nature and quality of non-physical treatments provided by the psychiatric services was not investigated. Reports of the treatment provided by general practitioners, the timing of improvement in symptoms and compliance with treatment largely relied on patients' self report. CONCLUSIONS: All patients presenting following DSH need to be carefully screened for depressive illness. Randomised controlled studies need to be conducted on DSH patients with depression to determine which treatments are effective.     

Homeostasis of antioxidant status in hemodialysis patients]

Oxidative stress, which occurs when there is excessive free-radical production or low antioxidant levels, makes significant contributions to pathogenesis in many human diseases. Cardiovascular disease is the major cause of mortality in patients receiving hemodialysis. For these patients, oxidative stress and increased lipid peroxidation may contribute to increased risk of atherosclerosis. The aim of this study was to determine if hemodialysis patients were associated with disturbance of homeostasis of antioxidant status. In this experiment, total antioxidant status of serum is measured by its ability to inhibit generation of free radicals from 2,2'-amino-di-[3-ethylbenzthiazole sulphonate] by metmyoglobin and hydrogen peroxide. Status of radical scavengers, such as serum total protein, albumin, uric acid and total bilirubin, was also measured. Blood were collected from three different episodes of hemodialysis. In the first group (n = 29), blood were collected before and after hemodialysis. In the second group (n = 29), blood were collected after dialysis and before next hemodialysis. In the third group (n = 8), blood were collected before hemodialysis. After last hemodialysis, patients started ingesting vitamin C and blood were collected before next hemodialysis. There was a marked reduction of total antioxidant status after hemodialysis in the first group. There was a marked increase in total antioxidant status before next hemodialysis in the second group. High doses of vitamin C caused increase in total antioxidant status in the third group. In conclusion, disturbance of homeostasis of total antioxidant status were observed in patients receiving hemodialysis. This may play a role in the pathogenesis in these groups.     

Identifying the concerns of women undergoing chemotherapy

This cross-sectional study aimed to identify key concerns of cancer patients receiving in-patient chemotherapy, determine the prevalence of anxiety and depression, and assess whether ward nurses could identify patients' concerns. Thirty-three women on a chemotherapy ward in the northwest of England who had breast, ovarian, cervical or uterine cancer were interviewed using a Concerns Checklist and the Hospital Anxiety and Depression Scale. Patients expressed an average of 10.3 concerns (range: 2-27). Eighty percent of these were not identified by the nurses, who showed a clear bias towards physical symptoms and treatment-related concerns. The nurses were unable to identify the three main concerns in 70% of patients. Twenty-four percent of patients were found to be probable cases of anxiety and/or depression; there was a moderate correlation between the number of concerns and levels of anxiety and depression. Given the body of evidence that lack of identification of concerns leads to unmet needs, increased psychological distress, dissatisfaction with care and possible complaints, this study has provided clear evidence for the need to address this key area of care, and has highlighted the potential of the Concerns Checklist in busy clinical environments.     

Psychological and relational factors in ESRD hemodialysis treatment in an underserved community

ObjectiveThe researchers investigated the association of depression with treatment adherence, and examined the possible moderating roles of social support and of the physician-patient working alliance (PPWA) on treatment adherence, satisfaction with treatment, and quality of life.MethodsThe current study sampled ninety-five patients with End Stage Renal Disease who were receiving outpatient hemodialysis (HD) treatment.ResultsFindings indicated that higher levels of depression were significantly associated with lower ratings of adherence, quality of life, and social support. In contrast, higher levels of social support and of the PPWA were significantly associated with higher ratings of adherence, satisfaction with treatment, and quality of life. Analyses of moderation showed no effect for PPWA between depression and adherence, satisfaction, or quality of life; however, there was a significant moderation effect for social support.ConclusionThere are mild but significant associations between PPWA and social support. Positive associations between the PPWA and social support on adherence, satisfaction, and quality of life indicate that each one, PPWA and social support, plays its own role on patients’ experiences of and behavior in treatment. Affective social support significantly limits the negative influence of depression on adherence.Practice ImplicationsAssessment of depression and social support is essential in hemodialysis treatment.     

Suppression of mixed lymphocyte culture by uremic adherent spleen cells and peritoneal macrophages is dependent on a cyclophosphamide-sensitive cell

The response of peripheral blood lymphocytes (PBL) to the antigen tetanus toxoid (TT) in patients with chronic renal failure being maintained on hemodialysis was examined. We have found that: (1) the response of patients' unfractionated PBL to TT is markedly suppressed when compared to the response of control PBL; (2) the response of patients' purified T cells and T4+ cells to TT co-cultured with 5% autologous monocytes is suppressed when compared to the response of comparable control cultures; (3) the response of patients' purified T lymphocytes co-cultured with 5% autologous monocytes is significantly enhanced over the response of patients' unfractionated PBL, and (4) the suppressed proliferation of patients' PBL to TT is not reversed by hemodialysis. Thus, the presence of suppressor monocytes and the inability of the responding T cells and accessory monocytes to react to antigen contribute to the suppressed antigen-specific T cell proliferation observed in chronic renal failure patients. These results are relevant to the suppressed cell-mediated immunity observed in uremia.     

心理因素对血液透析患者睡眠质量的影响

目的 探讨哈尔滨市终末期肾脏疾病血液透析患者睡眠质量与心理因素的相关性.方法 86例终末期肾脏疾病血液透析患者均使用肾脏疾病生存质量量表中的睡眠质量分量表、艾森克人格问卷(EPQ)、Zung's抑郁自评问卷和Zung's焦虑自评问卷、社会支持问卷、应对方式问卷进行调查.结果 睡眠质量得分与性别、神经质、焦虑、抑郁、年龄、透析年限呈负相关,并存在线性回归关系.与客观支持、对支持的利用度呈正相关.结论 终末期肾脏疾病血液透析患者的睡眠质量与焦虑、抑郁等心理因素相关.因此,必须把心理治疗和躯体治疗有效结合来提高整体治疗的效果.     

Diabetologists' assessments of their outpatients' emotional state and health beliefs: accuracy and possible sources of bias

The accuracy of physicians' perceptions of their patients' emotional state and health attitudes was examined in a diabetes outpatient clinic by comparing patients' ratings of anxiety, depression and health locus of control with physicians' ratings. In 234 patients, doctors' and patients' ratings correlated significantly for depression and anxiety. The physicians rated patients with a strong belief in control of health by others as most dependent on doctors. Men but not women with external locus of control were also rated as very dependent on doctors. Anxious or depressed patients were rated by their doctors as less able to cope with diabetes. The results indicate that non-psychiatric physicians are able to assess their patients' emotions and health attitudes with greater accuracy than is usually assumed.     

Sympathetic overactivity in patients with chronic renal failure.

BACKGROUND: Hypertension is a frequent complication of chronic renal failure, but its causes are not fully understood. There is indirect evidence that increased activity of the sympathetic nervous system might contribute to hypertension in patients with end-stage renal disease, but sympathetic-nerve discharge has not been measured directly in patients or animals with chronic renal failure. METHODS: We recorded the rate of postganglionic sympathetic-nerve discharge to the blood vessels in skeletal muscle by means of microelectrodes inserted into the peroneal nerve in 18 patients with native kidneys who were undergoing long-term treatment with hemodialysis (of whom 14 had hypertension), 5 patients receiving hemodialysis who had undergone bilateral nephrectomy (of whom 1 had hypertension), and 11 normal subjects. RESULTS. The mean (+/- SE) rate of sympathetic-nerve discharge was 2.5 times higher in the patients receiving hemodialysis who had not undergone nephrectomy than in the normal subjects (58 +/- 3 vs. 23 +/- 3 bursts per minute, P < 0.01). In contrast, the rate of sympathetic-nerve discharge was similar in the patients receiving hemodialysis who had undergone bilateral nephrectomy (21 +/- 6 bursts per minute) and the normal subjects. The rate of sympathetic-nerve discharge in the patients receiving hemodialysis who had not undergone nephrectomy was also significantly higher (P < 0.01) than that in the patients with bilateral nephrectomy, and it was accompanied in the former group by higher values for vascular resistance in the calf (45 +/- 4 vs. 22 +/- 4 units, P < 0.05) and mean arterial pressure (106 +/- 4 vs. 76 +/- 14 mm Hg, P < 0.05). The rate of sympathetic-nerve discharge was not correlated with either plasma norepinephrine concentrations or plasma renin activity. CONCLUSIONS: Chronic renal failure may be accompanied by reversible sympathetic activation, which appears to be mediated by an afferent signal arising in the failing kidneys.     

The effects of antidepressant treatment on serum cytokines and nutritional status in hemodialysis patients

The aim of this study was to investigate the effects of antidepressant treatment on serum cytokines and nutritional status in hemodialysis patients. Twenty-eight hemodialysis patients with a depressed mood were given 20 mg of fluoxetine for 8 weeks. The degree of depressive symptoms, the serum levels of interleukin-1beta, interleukin-2, interleukin-6, tumor necrosis factor-alpha, c-reactive protein, and markers of nutritional status were assessed at baseline and after treatment. The outcome was assessed in terms of response to treatment (>50% reduction in the score of the Hamilton depression rating scale). Antidepressant treatment decreased the serum level of interleukin-beta1 in both response and nonresponse groups, and increased the serum level of interleukin-6 only in the response group. At baseline, the level of interleukin-6 in the response group was lower than in the nonresponse group. Antidepressant treatment also increased fat distribution significantly in the response group which might have slightly improved the nutritional status. This study suggests that antidepressant treatment improve depressive symptoms and may affect immunological functions and nutritional status in chronic hemodialysis patients with depression.     

Effects of anti-lymphocytic globulin in human subjects.

Some of the immunological effects of anti-lymphocytic globulin (ALG) were examined in patients taking part in a clinical study of equine ALG in ulcerative colitis. ALG administration led to reduction in the percentage of peripheral blood lymphocytes forming spontaneous rosettes with sheep erythrocytes (E rosettes). Evidence was obtained that this reduction was the result of genuine depletion of circulating T (thymus-dependent) lymphocytes, rather than blockade of E-rosette formation by ALG on lymphocyte surfaces. Using an immunofluorescence technique, horse Ig was demonstrated on lymphocytes from patients receiving ALG. By combining this technique with E-rosette formation, horse Ig was detected on patients' E-rosette-positive and -negative lymphocytes. Horse Ig levels in patients' sera were measured by haemagglutination inhibition, and the sera were also examined for anti-lymphocytic antibodies. Although lymphocyte-binding horse Ig was detectable in teh patients' sera, lymphocytotoxic antibody could not be demonstrated. It can be concluded that lymphocytotoxic antibody was rapidly removed from the serum of patients receiving ALG, by binding to circulating lymphocytes.     

IgE against ethylene oxide-altered human serum albumin in patients with anaphylactic reactions to dialysis

We have measured total antibody and IgE directed against ethylene oxide-altered human serum albumin (ETO-HSA) in the sera of 24 patients who have experienced anaphylaxis during hemodialysis and of 41 patients who have not had such episodes during hemodialysis. ETO is used to sterilize dialyzers and other medical equipment. The geometric mean level of IgE to ETO-HSA in patients with reactions (0.9 ng ETO-HSA bound to IgE per milliliter of serum) is significantly higher than in nonreacting patients (0.1 ng/ml, p less than 0.0001). Sixteen of 24 patients with reactions had detectable levels of IgE to ETO-HSA, whereas only three of 41 nonreacting patients had detectable levels (p less than 0.0001 chi-square). The geometric mean level of total antibody to ETO-HSA is also significantly higher in patients with reactions (270 ng ETO-HSA bound per milliliter) than in nonreacting patients (31 ng/ml, p less than 0.0001). Fourteen of 24 patients with reactions but only four of 39 nonreacting patients had total antibody binding of ETO-HSA (p less than 0.0001 chi-square). These data extend our previous observations on a small group of 13 patients receiving hemodialysis (seven patients with reactions, and six nonreacting patients) and clearly demonstrate an association between the presence of IgE or total antibody to ETO-HSA and immediate anaphylactic reactions in this group of 65 patients receiving hemodialysis.     

从基因分型看血液透析及肾移植患者丙型肝炎病毒感染状况

采用国产和美国Ｏｒｔｈｏ公司第２代抗丙型肝炎病毒（ＨＣＶ）试剂对１００例维持性血透及肾移植患者进行血清丙型肝炎病毒抗体（抗－ＨＣＶ）对比检测。阳性标本用聚合酶键反应（ＰＣＲ）法检测ＨＣＶＲＮＡ并采用型特异的ＨＣＶ亚基因探针对其非结构蛋白ＮＳＳ区扩增产物进行了杂交基因分型。结果表明，这组病人中抗－ＨＣＶ阳性率为４１％，肾移植术后再透析者达５６．５２％，且与透析时间、输血次数、受血量成正相关；国产抗－ＨＣＶ试剂同美国Ｏｒｔｈｏ公司试剂比较阳性符合率达９１．４３％；抗－ＨＣＶ阳性患者中有３１．４３％（１１／３２）血清ＨＣＶＲＮＡＮＳ５阳性；透析患者中，ＨＣＶ基因型各型均有，以混合型为主，占６３．６４％。     

The role of depression in the quality of life among patients undergoing renal substitutive therapy

BACKGROUND: Depression is highly prevalent among patients with end-stage renal disease, nevertheless few patients are assessed or offered medical treatment to minimize its effects. This study assessed quality of life among these patients and studied the association between end-stage renal disease and depression. MATERIAL AND METHODS: We carried out a cross-sectional study with 123 patients over 19 who were undergoing renal substitutive therapy. Quality of life and depression were assessed using the Kidney Disease Quality of Life Short Form-36 and the Beck Depression Inventor. In order to measure the patients' metabolic state, we carried out medical and laboratory tests. Quality of life predictors were analyzed with multiple ordinal logistic regression models. RESULTS: The highest scores from the generic core belonged to social functioning dimensions (62.7) and mental health (65.9). For the specific core, the highest scores were in dimensions associated with support offered by the dialysis team (78.2) and from social support networks (75.3). Depression was the most consistent predictor of quality of life. CONCLUSION: The use of programs and measuring tools to measure quality of life prior to and during renal dialysis or hemodialysis, as well as a timely psychiatric evaluation, can be very useful in monitoring improvement, decline and response to anti-depressant treatment throughout the course of end-stage renal disease.     

Medication Adherence in Greek Hemodialysis Patients: The Contribution of Depression and Health Cognitions

Background

Several studies have shown that non-adherence is a common and increasing problem among individuals with chronic illnesses, including hemodialysis patients.

Purpose

The present study aimed to investigate the influence of depression and health cognitions on medication adherence among patients undergoing hemodialysis.

Method

A sample of 168 participants was recruited from six general hospitals in the broader area of Athens, consisting of patients undergoing in-center hemodialysis. Measurements were conducted with the following instruments: the Medication Adherence Rating Scale, the Center for Epidemiologic Studies Depression Scale (CES-D), and the Multidimensional Health Locus of Control (MHLC) scale.

Results

The results indicated that medication adherence was associated positively with the dimensions of internal and doctor-attributed health locus of control, measured by the MHLC. It was also related negatively to depression, measured by the CES-D.

Conclusions

The present study demonstrates the importance of depression in understanding the medication adherence of hemodialysis patients, as well as the contribution of heath cognitions.     

The association of hepatitis C virus infection with the prognosis of chronic hemodialysis patients: A retrospective study of 3,064 patients between 1999 and 2010

The prevalence of hepatitis C virus (HCV) infection is high among patients receiving chronic hemodialysis. To clarify the risk ratio of HCV infection with respect to mortality and prognosis in chronic hemodialysis patients, a retrospective longitudinal cohort study was conducted in 2010 and involved 3,064 patients receiving chronic hemodialysis at nine dialysis facilities in Hiroshima, Japan, who were recruited from 1999 to 2003. Logistic regression and Cox hazards models were used to estimate the mortality risk among hemodialysis patients. Among the patients, 422 (14.0%) were positive for HCV RNA. HCV RNA positivity was associated with death in the logistic model (adjusted odds ratio = 1.79; P < 0.001). However, it was not a risk factor for the reduced of survival rate in the Cox proportional hazard model (adjusted risk ratio = 1.07; P = 0.4138). In summary, among hemodialysis patients, HCV RNA is correlated with the mortality rate; however, it is not significantly correlated with prognosis in terms of survival time. On the other hand, diabetes and age at dialysis onset are significantly correlated with survival. Diabetes control treatment should be preferentially selected for hemodialysis patients, and antiviral therapy for HCV should be introduced based on the clinical state of the patient. J. Med. Virol. 87:1558–1564, 2015. © 2015 The Authors. Journal of Medical Virology published by Wiley Periodicals, Inc.     

Depression in hemodialysis patients

Psychiatric evaluation of depression in medically ill patients using DSM-III-R or Research Diagnostic Criteria (RDC) is difficult because these diagnostic systems have not been validated for this population. Diagnosis of depression has been especially problematic in patients with end-stage renal disease (ESRD). This study found a 17.7% prevalence of RDC-defined minor depression and a 6.5% prevalence of major depression in 124 ESRD patients treated with hemodialysis. Vegetative symptoms of depression were less useful for discriminating between those with and without depression than were the psychological symptoms of suicidal ideation, depressed mood, and discouragement.     

Comorbidity of PTSD and depression following myocardial infarction

BACKGROUND: This study examines comorbidity of posttraumatic stress disorder (PTSD) and depression following myocardial infarction (MI). It has two aims: (a) to examine whether this comorbidity is predicted by the objective severity of the MI and the patients' initial appraisal and stress responses; and (b) to determine whether this comorbidity is associated with PTSD symptomatology, depression, physiological adjustment, and psychosocial adjustment seven months post-MI. METHOD: 116 MI patients were examined twice. At Time 1, within a week of the MI, initial appraisal, stress responses, and depressive reactions were assessed, and medical measures were obtained from patients' hospital records. At Time 2, seven months later, PTSD, depression, psychosocial functioning, and physical adjustment were assessed. RESULTS: Seven months post-MI, 16% of the patients were identified with PTSD; 8% with comorbid PTSD and depression; and 14% with high levels of depression without full PTSD. Initial level of depression was associated with comorbidity of PTSD and depression. While initial stress reactions did not predict comorbidity, they did predict depression, with or without comorbid PTSD. Comorbidity of PTSD and depression was associated with higher levels of adjustment difficulties. DISCUSSION: Comorbidity of PTSD and depression has some clinical significance. While initial level of depression predicts subsequent comorbidity of PTSD and depression, early stress reactions do not differentiate between MI patients who suffer from depression, with or without comorbid PTSD.