Association of depressive symptoms with 25(OH) vitamin D in hemodialysis patients and effect of gender

Association between Chronic Kidney Disease-Mineral and Bone Disorder Biomarkers and Symptom Burden in Older Patients with Advanced Chronic Kidney Disease: Results from the EQUAL Study

Key Points

In nondialysis patients with advanced CKD, mild-to-moderately increased parathyroid hormone is associated with lower levels of reported symptoms. Phosphate and calcium are not independently associated with overall symptom burden. Patients with both severe hyperphosphatemia and severe hyperparathyroidism had the highest symptom burden.

Background

Patients with advanced CKD develop numerous symptoms, with a multifactorial origin. Evidence linking mineral disorders (CKD-Mineral and Bone Disorder) and uremic symptoms is scant and mostly limited to dialysis patients. Here, we aim to assess the association between CKD-Mineral and Bone Disorder and symptom burden in nondialysis patients with CKD.

Methods

We used data from the European Quality study, which includes patients aged ≥65 years with eGFR ≤20 ml/min per 1.73 m2 from six European countries, followed up to 5 years. We used generalized linear mixed-effect models to determine the association between repeated measurements of parathyroid hormone (PTH), phosphate, and calcium with the overall symptom number (0–33), the overall symptom severity (0–165), and the presence of 33 CKD-related symptoms. We also analyzed subgroups by sex, age, and diabetes mellitus and assessed effect mediation and joint effects between mineral biomarkers.

Results

The 1396 patients included in the study had a mean of 13±6 symptoms at baseline, with a median overall severity score of 32 (interquartile range, 19–50). The association between PTH levels and symptom burden appeared U-shaped with a lower symptom burden found for mild-to-moderately increased PTH levels. Phosphate and calcium were not independently associated with overall symptom burden. The highest symptom burden was found in patients with a combination of both severe hyperparathyroidism and severe hyperphosphatemia (+2.44 symptoms [0.50–4.38], P = 0.01). The association of both hypocalcemia and hyperphosphatemia with symptom burden seemed to differ by sex and age.

Conclusions

In older patients with advanced CKD not on dialysis, mild-to-moderately increased PTH was associated with a lower symptom burden, although the effect size was relatively small (less than one symptom). Neither phosphate nor calcium were associated with the overall symptom burden, except for the combination of severe hyperphosphatemia and severe hyperparathyroidism which was associated with an increased number of symptoms.

Global research trends and mapping knowledge structure of depression in dialysis patients

BACKGROUND

Depression is one of the most common and important psychological issues faced by dialysis patients. It can make it more difficult for them to adhere to their treatment regimen, which, in turn, can worsen their physical symptoms and lead to poorer health outcomes.

AIM

To examine the evolution and growth of publications related to dialysis and depression. The objectives were to identify the number of publications, the top active countries, the contributed institutions, funding agencies and journals, as well as to perform citation and research theme analysis.

METHODS

The search was conducted using the Scopus database for publications related to dialysis and depression between 1970 and 2022. Subsequently, bibliometric analysis was carried out on the data obtained using VOSviewer software, version 1.6.9. This analysis included visualization analysis, co-occurrence analysis and examination of publication trends in dialysis and depression.

RESULTS

We identified 800 publications that met the search criteria. The number of publications related to dialysis and depression has increased significantly in the past two decades. The USA led the way with 144 publications, which is 18% of all publications on this topic. Turkey came second with 88 publications (11%), followed by China with 55 publications (6.88%) and Iran with 52 publications (6.5%). Analysis of the research theme identified three main clusters related to gender differences in prevalence, identification of depression as a risk factor, and effective interventions to relieve depression. Future research direction analysis shows a shift toward effective interventions to relieve depression in dialysis patients.

CONCLUSION

This study provides a comprehensive overview of growth, trends and research themes related to dialysis and depression that could help researchers identify gaps in the literature and develop future research.

Clinical Significance of Analysis of Vitamin D Status in Various Diseases

Vitamin D plays a role not only in the proper functioning of the skeletal system and the calcium-phosphate equilibrium, but also in the immune system, the cardiovascular system and the growth and division of cells. Although numerous studies have reported on the analysis of vitamin D status in various groups of patients, the clinical significance of measurements of vitamin D forms and metabolites remains ambiguous. This article reviews the reports analyzing the status of vitamin D in various chronic states. Particular attention is given to factors affecting measurement of vitamin D forms and metabolites. Relevant papers published during recent years were identified by an extensive PubMed search using appropriate keywords. Measurement of vitamin D status proved to be a useful tool in diagnosis and progression of metabolic syndrome, neurological disorders and cancer. High performance liquid chromatography coupled with tandem mass spectrometry has become the preferred method for analyzing the various forms and metabolites of vitamin D in biological fluids. Factors influencing vitamin D concentration, including socio-demographic and biochemical factors as well as the genetic polymorphism of the vitamin D receptor, along with vitamin D transporters and enzymes participating in vitamin D metabolism should be considered as potential confounders of the interpretation of plasma total 25(OH)D concentrations.