腎代替療法モダリティにおけるうつ病スクリーニング質問票の診断精度と実用的有用性

Depression is common yet underdiagnosed in patients receiving renal replacement therapies (RRT). Several questionnaires have shown utility for depression screening, mainly among in-centre haemodialysis patients; however, no instruments have been evaluated for diagnostic accuracy in home dialysis or kidney transplant populations. This study aimed to assess the diagnostic performance of the Beck Depression Inventory-Second Edition (BDI-II), the Beck Depression Inventory-Fast Screen (BDI-FS), and the Depression Subscale of the Hospital Anxiety and Depression Scale (HADS-D) across RRT modalities and to identify the most efficient tool for clinical use.

Adult patients across RRT modalities completed the BDI-II, BDI-FS, and HADS-D, and were evaluated with the Structured Clinical Interview as the reference standard.

Among the 203 included patients (mean age 67.3 years; 65% male), 18.2% met SCID-I criteria for depression. Optimal cut-offs were BDI-II ≥15 for in-centre haemodialysis and ≥ 16 for home dialysis and transplantation; BDI-FS ≥3 for in-centre and home dialysis and ≥ 4 for transplantation; and HADS-D ≥ 5 for in-centre haemodialysis and ≥ 6 for home dialysis and transplantation. Sensitivity and negative predictive values exceeded 90% for all instruments except the HADS-D, which showed lower sensitivity in transplanted (86.7%) and home dialysis patients (70%).

The BDI-II, BDI-FS, and HADS-D are useful for depression screening in renal populations, though the HADS-D demonstrated reduced performance in home dialysis. Standard cut-offs were inadequate, and modality-specific thresholds improved diagnostic accuracy. The BDI-FS, combining strong accuracy with brevity and ease of use, emerged as the most efficient tool for routine screening across RRT modalities.