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      Development and Validation of a Nomogram Model for Accurately Predicting Depression in Maintenance Hemodialysis Patients: A Multicenter Cross-Sectional Study in China

      research-article
      1 , 2 , 3
      Risk Management and Healthcare Policy
      Dove
      nomogram, depression, maintenance hemodialysis, risk factors, prediction

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          Abstract

          Purpose

          Depression is a major concern in maintenance hemodialysis. However, given the elusive nature of its risk factors and the redundant nature of existing assessment forms for judging depression, further research is necessary. Therefore, this study was devoted to exploring the risk factors for depression in maintenance hemodialysis patients and to developing and validating a predictive model for assessing depression in maintenance hemodialysis patients.

          Patients and Methods

          This cross-sectional study was conducted from May 2022 to December 2022, and we recruited maintenance hemodialysis patients from a multicentre hemodialysis centre. Risk factors were identified by Lasso regression analysis and a Nomogram model was developed to predict depressed patients on maintenance hemodialysis. The predictive accuracy of the model was assessed by ROC curves, area under the ROC (AUC), consistency index (C-index), and calibration curves, and its applicability in clinical practice was evaluated using decision curves (DCA).

          Results

          A total of 175 maintenance hemodialysis patients were included in this study, and cases were randomised into a training set of 148 and a validation set of 27 (split ratio 8.5:1.5), with a depression prevalence of 29.1%. Based on age, employment, albumin, and blood uric acid, a predictive map of depression was created, and in the training set, the nomogram had an AUC of 0.7918, a sensitivity of 61.9%, and a specificity of 89.2%. In the validation set, the nomogram had an AUC of 0.810, a sensitivity of 100%, and a specificity of 61.1%. The bootstrap-based internal validation showed a c-index of 0.792, while the calibration curve showed a strong correlation between actual and predicted depression risk. Decision curve analysis (DCA) results indicated that the predictive model was clinically useful.

          Conclusion

          The nomogram constructed in this study can be used to identify depression conditions in vulnerable groups quickly, practically and reliably.

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          Most cited references38

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          Chronic Kidney Disease Diagnosis and Management

          Chronic kidney disease (CKD) is the 16th leading cause of years of life lost worldwide. Appropriate screening, diagnosis, and management by primary care clinicians are necessary to prevent adverse CKD-associated outcomes, including cardiovascular disease, end-stage kidney disease, and death.
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            Prevalence of depression in chronic kidney disease: systematic review and meta-analysis of observational studies.

            Prevalence estimates of depression in chronic kidney disease (CKD) vary widely in existing studies. We conducted a systematic review and meta-analysis of observational studies to summarize the point prevalence of depressive symptoms in adults with CKD. We searched MEDLINE and Embase (through January 2012). Random-effects meta-analysis was used to estimate the prevalence of depressive symptoms. We also limited the analyses to studies using clinical interview and prespecified criteria for diagnosis. We included 249 populations (55,982 participants). Estimated prevalence of depression varied by stage of CKD and the tools used for diagnosis. Prevalence of interview-based depression in CKD stage 5D was 22.8% (confidence interval (CI), 18.6-27.6), but estimates were somewhat less precise for CKD stages 1-5 (21.4% (CI, 11.1-37.2)) and for kidney transplant recipients (25.7% (12.8-44.9)). Using self- or clinician-administered rating scales, the prevalence of depressive symptoms for CKD stage 5D was higher (39.3% (CI, 36.8-42.0)) relative to CKD stages 1-5 (26.5% (CI, 18.5-36.5)) and transplant recipients (26.6% (CI, 20.9-33.1)) and suggested that self-report scales may overestimate the presence of depression, particularly in the dialysis setting. Thus, interview-defined depression affects approximately one-quarter of adults with CKD. Given the potential prevalence of depression in the setting of CKD, randomized trials to evaluate effects of interventions for depression on patient-centered outcomes are needed.
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              Chronic kidney disease and cardiovascular risk in six regions of the world (ISN-KDDC): a cross-sectional study.

              Chronic kidney disease is an important cause of global mortality and morbidity. Data for epidemiological features of chronic kidney disease and its risk factors are limited for low-income and middle-income countries. The International Society of Nephrology's Kidney Disease Data Center (ISN-KDDC) aimed to assess the prevalence and awareness of chronic kidney disease and its risk factors, and to investigate the risk of cardiovascular disease, in countries of low and middle income.
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                Author and article information

                Journal
                Risk Manag Healthc Policy
                Risk Manag Healthc Policy
                rmhp
                Risk Management and Healthcare Policy
                Dove
                1179-1594
                03 September 2024
                2024
                : 17
                : 2111-2123
                Affiliations
                [1 ]Department of Nephrology, the First People’s Hospital of Pinghu , Jiaxing, Zhejiang, People’s Republic of China
                [2 ]Jiaxing University Master Degree Cultivation Base, Zhejiang Chinese Medical University , Hangzhou, Zhejiang, People’s Republic of China
                [3 ]Department of Nephrology, Jiaxing Hospital of Traditional Chinese Medicine , Jiaxing, Zhejiang, People’s Republic of China
                Author notes
                Correspondence: Fuxiang Zhu, Department of Nephrology, Jiaxing Hospital of Traditional Chinese Medicine , Jiaxing, Zhejiang, People’s Republic of China, Email zfxywh@163.com
                [*]

                These authors contributed equally to this work

                Author information
                http://orcid.org/0009-0008-0641-5406
                http://orcid.org/0009-0008-7840-4140
                Article
                456499
                10.2147/RMHP.S456499
                11380485
                39246589
                e32edcc2-eb33-4d40-8e94-826eeb0bbc26
                © 2024 Zhou and Zhu.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                : 24 January 2024
                : 23 March 2024
                Page count
                Figures: 7, Tables: 3, References: 38, Pages: 13
                Categories
                Original Research

                Social policy & Welfare
                nomogram,depression,maintenance hemodialysis,risk factors, prediction
                Social policy & Welfare
                nomogram, depression, maintenance hemodialysis, risk factors, prediction

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