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Levassort H, Boucquemont J, Lambert O, Liabeuf S, Laville SM, Teillet L, Tabcheh AH, Frimat L, Combe C, Fouque D, Laville M, Jacquelinet C, Helmer C, Alencar de Pinho N, Pépin M, Massy ZA, On Behalf Of Ckd-Rein Study Collaborators. Urea Level and Depression in Patients with Chronic Kidney Disease. Toxins (Basel) 2024; 16:326. [PMID: 39057966 DOI: 10.3390/toxins16070326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/10/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
Depression is common in patients with chronic kidney disease (CKD). Experimental studies suggest the role of urea toxicity in depression. We assessed both the incidence of antidepressant prescriptions and depressive symptoms (measured by CESD (Center for Epidemiologic Depression) scale) in 2505 patients with CKD (Stage 3-4) followed up over 5 years in the Chronic Kidney Disease Renal Epidemiology and Information Network (CKD-REIN) cohort. We used a joint model to assess the association between the serum urea level and incident antidepressant prescriptions, and mixed models for the association between the baseline serum urea level and CESD score over the 5-year follow-up. Among the 2505 patients, 2331 were not taking antidepressants at baseline. Of the latter, 87 started taking one during a median follow-up of 4.6 years. After adjustment for confounding factors, the hazard ratio for incident antidepressant prescription associated with the serum urea level (1.28 [95%CI, 0.94,1.73] per 5 mmol/L increment) was not significant. After adjustment, the serum urea level was associated with the mean change in the CESD score (β = 0.26, [95%CI, 0.11,0.41] per 5 mmol/L increment). Depressive symptoms burden was associated with serum urea level unlike depression events. Further studies are needed to draw firm conclusions and better understand the mechanisms of depression in CKD.
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Affiliation(s)
- Hélène Levassort
- Geriatrics, Hôpital Ambroise-Paré, Assistance Publique des Hôpitaux de Paris (APHP), UVSQ, 9 Avenue Charles de Gaulle, F-92100 Boulogne-Billancourt, France
- Centre for Research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Inserm U1018, Paris-Saclay University, 12 Avenue Paul Vaillant Couturier, F-94800 Villejuif, France
| | - Julie Boucquemont
- Centre for Research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Inserm U1018, Paris-Saclay University, 12 Avenue Paul Vaillant Couturier, F-94800 Villejuif, France
| | - Oriane Lambert
- Centre for Research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Inserm U1018, Paris-Saclay University, 12 Avenue Paul Vaillant Couturier, F-94800 Villejuif, France
| | - Sophie Liabeuf
- Pharmacoepidemiology Unit, Department of Clinical Pharmacology, Amiens-Picardie University Medical Center, F-80054 Amiens, France
- MP3CV Laboratory, Jules Verne University of Picardie, F-80054 Amiens, France
| | - Solene M Laville
- Pharmacoepidemiology Unit, Department of Clinical Pharmacology, Amiens-Picardie University Medical Center, F-80054 Amiens, France
- MP3CV Laboratory, Jules Verne University of Picardie, F-80054 Amiens, France
| | - Laurent Teillet
- Geriatrics, Hôpital Ambroise-Paré, Assistance Publique des Hôpitaux de Paris (APHP), UVSQ, 9 Avenue Charles de Gaulle, F-92100 Boulogne-Billancourt, France
- Centre for Research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Inserm U1018, Paris-Saclay University, 12 Avenue Paul Vaillant Couturier, F-94800 Villejuif, France
| | - Abdel-Hay Tabcheh
- Centre for Research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Inserm U1018, Paris-Saclay University, 12 Avenue Paul Vaillant Couturier, F-94800 Villejuif, France
| | - Luc Frimat
- Service de Néphrologie, CHRU de Nancy, F-54000 Vandoeuvre-lès-Nancy, France
- Université de Lorraine, APEMAC, F-54000 Nancy, France
| | - Christian Combe
- Service de Néphrologie Transplantation Dialyse Aphérèse, Centre Hospitalier Universitaire de Bordeaux, F-33076 Bordeaux, France
- Inserm U1026, Université Bordeaux Segalen, F-33076 Bordeaux, France
| | - Denis Fouque
- Service de Néphrologie, Centre Hospitalier Lyon Sud, Université de Lyon, Carmen, F-69495 Pierre-Bénite, France
| | - Maurice Laville
- Université Claude Bernard Lyon 1, Carmen INSERM U1060, F-69495 Pierre-Bénite, France
| | - Christian Jacquelinet
- Centre for Research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Inserm U1018, Paris-Saclay University, 12 Avenue Paul Vaillant Couturier, F-94800 Villejuif, France
- Agence de la Biomédecine, F-93212 Saint-Denis La Plaine, France
| | - Catherine Helmer
- Bordeaux Population Health Center, INSERM U1219, 146 rue Léo Saignat, F-33076 Bordeaux, France
| | - Natalia Alencar de Pinho
- Centre for Research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Inserm U1018, Paris-Saclay University, 12 Avenue Paul Vaillant Couturier, F-94800 Villejuif, France
| | - Marion Pépin
- Geriatrics, Hôpital Ambroise-Paré, Assistance Publique des Hôpitaux de Paris (APHP), UVSQ, 9 Avenue Charles de Gaulle, F-92100 Boulogne-Billancourt, France
- Centre for Research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Inserm U1018, Paris-Saclay University, 12 Avenue Paul Vaillant Couturier, F-94800 Villejuif, France
| | - Ziad A Massy
- Centre for Research in Epidemiology and Population Health (CESP), Clinical Epidemiology Team, Inserm U1018, Paris-Saclay University, 12 Avenue Paul Vaillant Couturier, F-94800 Villejuif, France
- Association Pour L'Utilisation du Rein Artificiel dans la Région Parisienne (AURA), 185a rue Raymond Losserand, F-75014 Paris, France
- Ambroise Paré University Hospital, APHP, Department of Nephrology, 9 Avenue Charles de Gaulle, F-92100 Boulogne-Billancourt, France
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Tutan D, Erdoğan Kaya A, Eser B. The relationship between neutrophil lymphocyte ratio, platelet lymphocyte ratio, and depression in dialysis patients. Medicine (Baltimore) 2023; 102:e35197. [PMID: 37713848 PMCID: PMC10508398 DOI: 10.1097/md.0000000000035197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/22/2023] [Indexed: 09/17/2023] Open
Abstract
Chronic kidney disease is a worldwide public health issue with rising incidence, morbidity/mortality, and cost. Depression and chronic renal disease often coexist, and psychological illnesses are associated with poor results. Early identification of depression reduces morbidity and death. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are reported as practical biomarkers of inflammation and immune system activation. In this study, we aimed to determine the association of NLR and PLR with depression in dialysis patients. This study included 71 adults over 18 without known hematologic or oncologic disease, drug use, or chronic inflammatory diseases. Comorbid chronic diseases, laboratory data, and Beck depression inventory scores were prospectively recorded. A comparison of 2 groups according to the existence of depression was made, and a binomial logistic regression test was used to determine the association between the variables and the presence of depression after adjusting for confounding factors. A receiver operating curve analysis was used to differentiate groups with and without severe depression. Seventy-one patients met the study criteria, with 46 hemodialysis and 25 peritoneal dialysis patients. The majority had hypertension and diabetes mellitus, with 47.89% having minimal-minor depression and 52.11% having moderate-major depression. The 2 groups were similar regarding chronic diseases, with no significant differences in serum creatinine levels, glucose, lipid profiles, or electrolytes. However, when the NLR of the 2 groups was compared, the median was higher in patients with moderate or major depression. Multivariate analysis showed no significant differences between the groups in PLR, triglyceride to glucose ratio, and C-reactive peptide to albumin ratio. The best NLR cutoff value was 3.26, with 48.6% sensitivity, 88.2% specificity, 81.8% positive predictive value, 61.2% negative predictive value, and 67.6% test accuracy. Depression is one of the most common psychiatric conditions in dialysis patients and is linked to increased morbidity, mortality, treatment failure, expense, and hospitalization. NLR helped predict moderate-to-major depression in dialysis patients, even after controlling for confounding factors in multivariate analysis. This study indicated that an NLR successfully identified depressive groups, and patients with an NLR value >3.26 were 6.1 times more likely to have moderate or major depression.
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Affiliation(s)
- Duygu Tutan
- Erol Olçok Training and Research Hospital, Department of Internal Medicine, Çorum, Turkey
| | - Ayşe Erdoğan Kaya
- Erol Olçok Training and Research Hospital, Department of Psychiatry, Çorum, Turkey
| | - Bariş Eser
- Hitit University Faculty of Medicine, Department of Nephrology, Çorum, Turkey
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Nazneen S, Yadla M, Reddy P. Assessment of Depression and Its Correlation with Serum Levels of Interleukin-6 in Patients on Maintenance Hemodialysis. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2023; 34:397-405. [PMID: 38995298 DOI: 10.4103/1319-2442.397201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024] Open
Abstract
Depression is the most common psychiatric disorder in patients on hemodialysis. An imbalance between proinflammatory and anti-inflammatory cytokines is thought to play a role in the pathogenesis of depression in patients on dialysis. We undertook this study to assess the correlations of the proinflammatory cytokine interleukin 6 (IL-6) and the anti-inflammatory cytokine IL-10 with depression in patients on maintenance hemodialysis. This cross-sectional observational study was carried out at our hospital, a tertiary care referral government teaching hospital, over 2 years. Depression was assessed using the Becks Depression Inventory score. A higher cutoff of >16 was taken for a diagnosis of depression. Clinical, demographic, and laboratory parameters were analyzed. Cytokines were assessed using enzyme-linked immunosorbent assays. Eighty patients satisfied the inclusion criteria. The prevalence of depression in our study was 41.5%. Depression was more common in those who were unemployed and/or illiterate. Mild depression was found in patients from the upper-lower and lower-middle classes, but severe depression was seen in lower-economic classes. Serum levels of IL-6 showed a positive correlation with the severity of depression. Depression was common in patients on maintenance hemodialysis. High levels of serum IL-6 were observed in those with depression. Depression in patients on maintenance hemodialysis is associated with a considerable risk of mortality.
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Affiliation(s)
- Shabana Nazneen
- Department of Nephrology, Gandhi Medical College, Hyderabad, Telangana, India
| | - Manjusha Yadla
- Department of Nephrology, Gandhi Medical College, Hyderabad, Telangana, India
| | - Prabhakar Reddy
- Department of Clinical Pharmacology and Medical Research, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
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Devaraj SM, Roumelioti ME, Yabes JG, Schopp M, Erickson S, Steel JL, Rollman BL, Weisbord SD, Unruh M, Jhamb M. Correlates of Rates and Treatment Readiness for Depressive Symptoms, Pain, and Fatigue in Hemodialysis Patients: Results from the TĀCcare Study. KIDNEY360 2023; 4:e1265-e1275. [PMID: 37461138 PMCID: PMC10547226 DOI: 10.34067/kid.0000000000000213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/23/2023] [Accepted: 07/10/2023] [Indexed: 09/29/2023]
Abstract
Key Points Lower neighborhood walkability was associated with higher depressive symptoms and fatigue and younger age with depressive symptoms. Depressive symptoms, pain, and fatigue were frequently reported, often occurred together, and were often not all already treated. Patients with a higher symptom burden and men may be more likely to be ready to seek treatment for depressive symptoms, pain, or fatigue. Background Patients on hemodialysis (HD) often experience clinically significant levels of pain, fatigue, and depressive symptoms. We explored potential sociodemographic differences in symptom burden, current treatment, and readiness to seek treatment for these symptoms in patients screened for the TĀCcare trial. Methods In-center HD patients from Pennsylvania and New Mexico were screened for fatigue (≥5 on 0–10-point Likert scale), pain (Likert scale ≥4), depressive symptoms (≥10 Patient Health Questionnaire-9), and readiness to seek treatment (5–item Stages of Behavior Change questionnaire). Symptom burden and treatment status by sociodemographic factors were evaluated using chi square, Fisher exact tests, and logistic regression models. Results From March 2018 to December 2021, 506 of 896 (57%) patients screened met eligibility criteria and completed the symptom screening (mean age 60±13.9 years, 44% female, 17% Black, 25% American Indian, and 25% Hispanics). Of them, 77% screened positive for ≥1 symptom and 35% of those were receiving treatment for ≥1 of these symptoms. Pain, fatigue, and depressive symptom rates were 52%, 64%, and 24%, respectively. Age younger than 65 years was associated with a higher burden of depressive symptoms, pain, and reporting ≥1 symptom (P <0.05). The percentage of patients ready to seek treatment increased with symptom burden. More men reported readiness to seek treatment (85% versus 68% of women, P <0.001). Among those with symptoms and treatment readiness, income was inversely associated with pain (>$60,000/yr: odds ratio [OR]=0.16, confidence interval [CI]=0.03 to 0.76) and living in less walkable neighborhoods with more depressive symptoms (OR= 5.34, CI=1.19 to 24.05) and fatigue (OR= 5.29, CI=1.38 to 20.33). Conclusions Pain, fatigue, and depressive symptoms often occurred together, and younger age, less neighborhood walkability, and lower income were associated with a higher burden of symptoms in HD patients. Male patients were less likely to be receiving treatment for symptoms. These findings could inform priority HD patient symptom identification and treatment targets.
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Affiliation(s)
- Susan M. Devaraj
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Maria-Eleni Roumelioti
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Jonathan G. Yabes
- Center for Research on Heath Care Data Center, Division of General Internal Medicine; Department of Medicine and Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mary Schopp
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Sarah Erickson
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Jennifer L. Steel
- Department of Surgery, Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Bruce L. Rollman
- Center for Behavioral Health, Media, and Technology, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Steven D. Weisbord
- Renal Section and Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Mark Unruh
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Manisha Jhamb
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Li Y, Zhu B, Shen J, Miao L. Depression in maintenance hemodialysis patients: What do we need to know? Heliyon 2023; 9:e19383. [PMID: 37662812 PMCID: PMC10472011 DOI: 10.1016/j.heliyon.2023.e19383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 08/10/2023] [Accepted: 08/21/2023] [Indexed: 09/05/2023] Open
Abstract
Chronic kidney disease (CKD) is now recognized as a major public health problem in the world. The global prevalence of CKD is estimated at 13.4% (11.7-15.1%), with an estimated 490.2 to 7.083 million patients with End stage renal disease requiring renal replacement therapy. Hemodialysis is the main treatment for End stage renal disease patients because of its high safety and efficiency. The survival time of these patients was significantly prolonged, but many psychological problems followed. Depression is a type of mood disorder caused by a variety of causes, often manifested as disproportionate depression and loss of interest, sometimes accompanied by anxiety, agitation, even hallucinations, delusions and other psychotic symptoms. Depression has become the most common mental disorder in maintenance hemodialysis (MHD) patients according to the meta-analysis. In recent years, depression has seriously affected the quality of life and prognosis of MHD patients from dietary, sleep, treatment adherence, energy and other dimensions. This article reviews the epidemiology, etiology, diagnosis and treatment of depression in MHD patients.
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Affiliation(s)
- Yulu Li
- Department of Nephrology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Bin Zhu
- Department of Critical Care Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Jianqin Shen
- Blood Purification Centre, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Liying Miao
- Department of Nephrology, The Third Affiliated Hospital of Soochow University, Changzhou, China
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De la Cruz-Ahumada CJ, Topete-Reyes JF, Mena-Ramírez JP, Guzmán-Flores JM, Guzmán-González JI, Ramírez-De los Santos S. Inflammatory Determinants and Associated Morbidity in Hemodialysis Patients. J Pers Med 2023; 13:1311. [PMID: 37763079 PMCID: PMC10532888 DOI: 10.3390/jpm13091311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/20/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
Hemodialysis deteriorates patients' physical, metabolic, and mental status. Clinical outcomes derived from inflammation determine a worse status but are less frequently identified. The objective of the study was to identify inflammatory determinants and the effect of SNP-related serum IL-6 and IL-10 levels on associated morbidity in hemodialysis. A sample of hemodialysis patients at IMSS Regional Hospital No.46 in Guadalajara (n = 85) were tested using the Malnutrition Inflammation Score (MIS) and Patient Health Questionnaire-9 (PHQ-9) to assess the associated morbidity. Serum cytokine levels were quantified by enzyme-linked immunosorbent assay (ELISA). The restriction fragment length polymorphism (RFLP) technique was used for analysis of IL-6-572C/G and IL-10-1082A/G. Using data visualization methods, we identified relevant determinants of inflammation. A simple regression model was constructed between predictors and targets with genotypes as covariates. Results showed malnutrition in 85.9% of patients and depressive symptoms in 50.6%. IL-10 was the most relevant inflammatory determinant, with regression coefficients (R2) between 0.05 and 0.11. The GG genotype of IL-10-1082 A/G evinced small effect on both clinical outcomes (δ of 0.35 and 0.37, respectively). Hemodialysis increases the associated morbidity, cytokines act as inflammatory determinants, and genetic variability contributes to the severity of clinical outcomes. Further studies need to refine the causal relationship between inflammation and CKD.
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Affiliation(s)
- Claudia Jackelin De la Cruz-Ahumada
- Laboratorio de Investigación en Biociencias, Centro Universitario de los Altos, Universidad de Guadalajara, Tepatitlán de Morelos 47620, Jalisco, Mexico; (C.J.D.l.C.-A.)
| | | | | | - Juan Manuel Guzmán-Flores
- Laboratorio de Investigación en Biociencias, Centro Universitario de los Altos, Universidad de Guadalajara, Tepatitlán de Morelos 47620, Jalisco, Mexico; (C.J.D.l.C.-A.)
| | - Jesúa Ivan Guzmán-González
- Laboratorio de Investigación en Biociencias, Centro Universitario de los Altos, Universidad de Guadalajara, Tepatitlán de Morelos 47620, Jalisco, Mexico; (C.J.D.l.C.-A.)
| | - Saúl Ramírez-De los Santos
- Departamento de Psicología Básica, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Jalisco, Mexico
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Sanad EA, El-Shinnawy HAEH, Hebah HA, Farrag DA, Soliman ERA, Abdelgawad MA. Effect of intra-dialytic physical exercise on depression in prevalent hemodialysis patients. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022. [DOI: 10.1186/s41983-022-00560-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Abstract
Background
Depression is associated with morbidity, death, diminished quality of life, decreased longevity, and even suicidal ideation in hemodialysis patients. Intra-dialytic exercise is considered as integral component of the clinical care management of hemodialysis patients as it improves hemodialysis effectiveness, reducing systemic inflammation, increasing exercise tolerance, decreasing depression and improving quality of life. The objective of this study was to assess the effect of intra-dialytic physical exercise on depression and physical activity in prevalent hemodialysis patients. This prospective cohort research comprised 50 hemodialysis patients maintained on regular hemodialysis 3 times/week with duration since starting dialysis (1–5 years), not practicing any previous physical activity, suffering from depressive symptoms, not maintained on antidepressants and separated into two groups: group I underwent intra-dialytic exercise for 3 months and group II was matched in age and gender but did not undertake any exercise.
Results
Hamilton depression rating scale was significantly decreased in group I after completing the exercise program compared to baseline (P = 0.000), while there was no significant change in group II. Serum tumor necrosis factor alpha significantly decreased in group I compared to baseline (P = 0.000), while there was no significant change in group II. A positive correlation was found between serum tumor necrosis factor alpha and Hamilton depression rating scale (r = 0.676), (P = 0.000). Physical activity tests; 6-min walk test, rapid assessment of physical activity and peak volume of oxygen consumption were significantly improved in group I compared to baseline (P = 0.000), while there was no statistically significant difference in group II. Serum phosphorus and parathyroid hormone levels were significantly decreased in group I compared to baseline (P < 0.01), while urea reduction ratio was significantly increased in group I compared to baseline (P = 0.000), but there was no significant change in group II.
Conclusions
Intra-dialysis exercise can improve depression and physical performance in hemodialysis patients. As positive correlation was found between serum tumor necrosis factor alpha and Hamilton depression rating scale, so tumor necrosis factor alpha may be considered as marker of depression in hemodialysis patients. Intra-dialytic exercise can improve dialysis efficacy by improving urea reduction ratio.
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Pruritus in Chronic Kidney Disease: An Update. ALLERGIES 2022. [DOI: 10.3390/allergies2030009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Chronic kidney disease-associated pruritus (CKDaP) is an often under-diagnosed and under-recognized condition, despite its considerable prevalence within the chronic kidney disease (CKD) population. Universally accepted guidelines are also lacking. The true prevalence of CKDaP worldwide therefore remains unknown, although its negative impact on mortality and health-related quality of life outcomes is very clear. The pathophysiological mechanisms leading to the onset of CKDaP are only partly understood. CKDaP is currently believed to be caused by a multifactorial process, from local skin changes, metabolic alterations, the development of neuropathy and dysregulation of opioid pathways, and psychological factors. Much work has been carried out towards a more systematic and structured approach to clinical diagnosis. Various tools are now available to assess the severity of CKDaP. Many of these tools require greater validation before they can be incorporated into the guidelines and into routine clinical practice. Further efforts are also needed in order to increase the awareness of clinicians and patients so that they can identify the CKDaP signs and symptoms in a timely manner. Currently established treatment options for CKDaP focus on the prevention of xerosis via topical emollients, the optimization of dialysis management, early referral to kidney transplantation if appropriate, oral antihistamine, and a variety of neuropathic agents. Other novel treatment options include the following: topical analgesics, topical tacrolimus, cannabinoid-containing compounds, antidepressants, oral leukotrienes, opioids, and non-pharmacological alternative therapies (i.e., phototherapy, dietary supplements, acupuncture/acupressure). We provide an updated review on the evidence relating to the epidemiology, the pathophysiology, the clinical assessment and diagnosis, and the management of CKDaP.
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Schricker S, Kimmel M. Unravelling the pathophysiology of chronic kidney disease-associated pruritus. Clin Kidney J 2022; 14:i23-i31. [PMID: 34987780 PMCID: PMC8702819 DOI: 10.1093/ckj/sfab200] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Indexed: 12/12/2022] Open
Abstract
For decades, itch related to chronic kidney disease (CKDaP) has been a clinical problem, but the aetiology and pathophysiology of CKDaP are still not yet fully understood—currently the underlying pathophysiological mechanisms are thought to be multifactorial. As new therapeutic targets have recently been identified and clinical trials have shown promising results, our current understanding of the interrelationships has expanded significantly. Here we review the pathophysiology and recent findings on modulation and sensitization of itch contributing to the development of CKDaP, covering hypothesis regarding immune system dysfunction, metabolic changes, uremic toxin deposition, peripheral neuropathy and imbalances in the endogenous opioid system.
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Affiliation(s)
- Severin Schricker
- Department of General Internal Medicine and Nephrology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Martin Kimmel
- Department of Internal Medicine, Division of Nephrology, Hypertension and Autoimmune Disorders, Alb-Fils Kliniken, Göppingen, Germany
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Almohaimeed HM, Hamed S, Seleem HS, Batawi AH, Mohammedsaleh ZM, Balgoon MJ, Ali SS, Al Jaouni S, Ayuob N. An Ethanolic Extract of Cucurbita pepo L. Seeds Modifies Neuroendocrine Disruption in Chronic Stressed Rats and Adrenal Expression of Inflammatory Markers and HSP70. Front Pharmacol 2021; 12:749766. [PMID: 34867356 PMCID: PMC8636010 DOI: 10.3389/fphar.2021.749766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Pumpkins (Cucurbita pepo L.) were described to have antioxidant, anti-inflammatory, anti-fatigue, and antidepressant-like effect. The adrenal gland is an important stress-responsive organ that maintains homeostasis during stress. Objectives: This study aimed to assess the efficacy of the administration of Cucurbita pepo L. (CP) extract in relieving behavioral, biochemical, and structural changes in the adrenal gland induced by exposure to chronic unpredictable mild stress (CUMS) and to explore the mechanism behind this impact. Materials and Methods: Forty male albino rats were divided into 4 groups (n = 10): control, CUMS, fluoxetine-treated, and CP-treated groups. Behavioral changes, corticosterone level, pro-inflammatory cytokines TNF-α and IL-6, and oxidant/antioxidant profile were assessed in the serum at the end of the experiment. Adrenal glands were processed for histopathological and immunohistochemical assessment. Gene expression of caspase-3 and Ki67 and heat shock protein 70 (HSP70) were assessed in adrenal glands using RT-PCR. Results: The CP extract significantly reduced the corticosterone level (p < 0.001), immobility time (p < 0.001), and inflammatory and oxidative changes associated with CUMS-induced depression compared to the untreated group. The CP extract alleviated CUMS-induced adrenal histopathological changes and significantly reduced apoptosis (p < 0.001) and significantly upregulated antioxidant levels in the serum. Conclusion:Cucurbita pepo L. effectively ameliorated the chronic stress-induced behavioral, biochemical, and adrenal structural changes mostly through its antioxidant and anti-inflammatory effects.
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Affiliation(s)
- Hailah M Almohaimeed
- Department of Basic Science, College of Medicine, Princess Nourah Bint Abdulrahman University (PNU), Riyadh, Saudi Arabia
| | - Shereen Hamed
- Department of Medical Histology and Cell Biology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Hanan S Seleem
- Histology Department, Faculty of Medicine, Menoufia University, Shebin ElKoum, Egypt.,Department of Basic Medical Sciences, Unaizah College of Medicine and Medical Sciences, Qassim University, Buraydah, Saudi Arabia
| | - Ashwaq H Batawi
- Department of Biological Science, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Zuhair M Mohammedsaleh
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk, Saudi Arabia
| | - Maha Jameal Balgoon
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Soad S Ali
- Department of Histology and Cell Biology, Faculty of Medicine, Assuit University, Asyut, Egypt.,Yousef Abdullatif Jameel Chair of Prophetic Medical Applications (YAJCPMA), Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Soad Al Jaouni
- Yousef Abdullatif Jameel Chair of Prophetic Medical Applications (YAJCPMA), Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Hematology/Pediatric Oncology, King Abdulaziz University Hospital (KAUH), Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Nasra Ayuob
- Department of Medical Histology, Faculty of Medicine, Damietta University, Damietta, Egypt
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11
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Ha M, Yang Y, Shi Y, Lu Y, Chen K, Zhang S, Luo Y. Efficacy of Tai Chi on Patients With Chronic Kidney Disease. Biol Res Nurs 2021; 24:115-122. [PMID: 34825589 DOI: 10.1177/10998004211047993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Previous systematic reviews elucidate the efficacy of Tai Chi on the rehabilitation and treatment for various chronic diseases. Yet, no consensus has been reached on its efficacy and safety from those with chronic kidney disease (CKD). Therefore, we conducted a systematic review to critically summarize what is already known about the prevailing benefits of Tai Chi for CKD patients. There was no evidence that Tai Chi had adverse effects on CKD patients. Long-term Tai Chi exercises could improve quality of life, cardiorespiratory fitness, and physical motor function for the end-stage renal disease (ERSD) patients undergoing dialysis. Regular Tai Chi exercises might exert modest influences in delaying CKD progression for mild-moderate CKD patients. However, there is insufficient evidence to demonstrate positive effects of Tai Chi exercises on bone health of the ESRD patients. Accordingly, rigorously designed, longer-term studies of Tai Chi are warranted to identify its efficacy on CKD patients across different stages, especially targeting potential mechanisms in terms of Tai Chi altering biological gene profile expressions.
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Affiliation(s)
- Mei Ha
- School of Nursing, 12525Army Medical University, Chongqing, China.,Chongqing Medical and Pharmaceutical College, Chongqing, China
| | - Yuhui Yang
- School of Nursing, 12525Army Medical University, Chongqing, China
| | - Yu Shi
- Department of Nephrology, 12525Xinqiao Hospital of Army Medical University, Chongqing, China
| | - Ya Lu
- School of Nursing, 12525Army Medical University, Chongqing, China
| | - Kun Chen
- School of Nursing, 12525Army Medical University, Chongqing, China
| | - Suofei Zhang
- School of Nursing, 12525Army Medical University, Chongqing, China
| | - Yu Luo
- School of Nursing, 12525Army Medical University, Chongqing, China
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12
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McKeaveney C, Slee A, Adamson G, Davenport A, Farrington K, Fouque D, Kalantar-Zadeh K, Mallett J, Maxwell AP, Mullan R, Noble H, O'Donoghue D, Porter S, Seres DS, Shields J, Witham M, Reid J. Using a generic definition of cachexia in patients with kidney disease receiving haemodialysis: a longitudinal (pilot) study. Nephrol Dial Transplant 2021; 36:1919-1926. [PMID: 33150449 DOI: 10.1093/ndt/gfaa174] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Research indicates that cachexia is common among persons with chronic illnesses and is associated with increased morbidity and mortality. However, there continues to be an absence of a uniformed disease-specific definition for cachexia in chronic kidney disease (CKD) patient populations. OBJECTIVE The primary objective was to identify cachexia in patients receiving haemodialysis (HD) using a generic definition and then follow up on these patients for 12 months. METHOD This was a longitudinal study of adult chronic HD patients attending two hospital HD units in the UK. Multiple measures relevant to cachexia, including body mass index (BMI), muscle mass [mid-upper arm muscle circumference (MUAMC)], handgrip strength (HGS), fatigue [Functional Assessment of Chronic Illness Therapy (FACIT)], appetite [Functional Assessment of Anorexia/Cachexia Therapy (FAACT)] and biomarkers [C-reactive protein (CRP), serum albumin, haemoglobin and erythropoietin resistance index (ERI)] were recorded. Baseline analysis included group differences analysed using an independent t-test, dichotomized values using the χ2 test and prevalence were reported using the Statistical Package for the Social Sciences 24 (IBM, Armonk, NY, USA). Longitudinal analysis was conducted using repeated measures analysis. RESULTS A total of 106 patients (30 females and 76 males) were recruited with a mean age of 67.6 years [standard deviation (SD) 13.18] and dialysis vintage of 4.92 years (SD 6.12). At baseline, 17 patients were identified as cachectic, having had reported weight loss (e.g. >5% for >6 months) or BMI <20 kg/m2 and three or more clinical characteristics of cachexia. Seventy patients were available for analysis at 12 months (11 cachectic versus 59 not cachectic). FAACT and urea reduction ratio statistically distinguished cachectic patients (P = 0.001). However, measures of weight, BMI, MUAMC, HGS, CRP, ERI and FACIT tended to worsen in cachectic patients. CONCLUSION Globally, cachexia is a severe but frequently underrecognized problem. This is the first study to apply the defined characteristics of cachexia to a representative sample of patients receiving HD. Further, more extensive studies are required to establish a phenotype of cachexia in advanced CKD.
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Affiliation(s)
- Clare McKeaveney
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, Belfast, UK
| | - Adrian Slee
- Division of Medicine, Faculty of Medical Sciences, University College London, London, UK
| | - Gary Adamson
- School of Psychology, Ulster University, Coleraine Campus, Londonderry, UK
| | - Andrew Davenport
- UCL Centre for Nephrology, Royal Free Hospital, University College London, London, UK
| | - Ken Farrington
- Renal Unit, Lister Hospital, East and North Hertfordshire University NHS Trust, Stevenage, UK
| | - Denis Fouque
- Department of Nephrology, Centre Hospitalier Lyon Sud, University Lyon, CARMEN, Pierre-Benite, France
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology and Hypertension, University of California Irvine, Orange, California 92868, USA
| | - John Mallett
- School of Psychology, Ulster University, Coleraine Campus, Londonderry, UK
| | - Alexander P Maxwell
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Science, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, Northern Ireland.,Regional Nephrology Unit, Belfast City Hospital, Belfast Health Social Care Trust, Belfast, BT9 7AB, Northern Ireland
| | - Robert Mullan
- Department of Nephrology, Antrim Area Hospital, Northern Health Social Care Trust, Antrim, BT41 2RL, Northern Ireland
| | - Helen Noble
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, Belfast, UK
| | | | - Sam Porter
- Department of Social Sciences and Social Work, Bournemouth University, UK
| | - David S Seres
- Department of Medicine, Columbia University Medical Centre / New York Presbyterian Hospital, New York, USA
| | - Joanne Shields
- Regional Nephrology Unit, Belfast City Hospital, Belfast Health Social Care Trust, Belfast, BT9 7AB, Northern Ireland
| | - Miles Witham
- NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, UK
| | - Joanne Reid
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, Belfast, UK
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13
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Use of Sertraline in Hemodialysis Patients. MEDICINA-LITHUANIA 2021; 57:medicina57090949. [PMID: 34577872 PMCID: PMC8470022 DOI: 10.3390/medicina57090949] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/29/2021] [Accepted: 09/06/2021] [Indexed: 11/25/2022]
Abstract
Depression and anxiety are the most common psychiatric disorders in end-stage renal disease (ESRD) patients treated with hemodialysis (HD) and may correlate with lower quality of life and increased mortality. Depression treatment in HD patients is still a challenge both for nephrologists and psychiatrists. The possible treatment of depressive disorders can be pharmacological and non-pharmacological. In our article, we focus on the use of sertraline, the medication which seems to be relatively safe and efficient in the abovementioned population, taking under consideration several limitations regarding the use of other selective serotonin reuptake inhibitors (SSRIs). In our paper, we discuss different aspects of sertraline use, taking into consideration possible benefits and side effects of drug administration like impact on QTc (corrected QT interval) prolongation, intradialytic hypotension (IDH), chronic kidney disease-associated pruritus (CKD-aP), bleeding, sexual functions, inflammation, or fracture risk. Before administering the medication, one should consider benefits and possible side effects, which are particularly significant in the treatment of ESRD patients; this could help to optimize clinical outcomes. Sertraline seems to be safe in the HD population when provided in proper doses. However, we still need more studies in this field since the ones performed so far were usually based on small samples and lacked placebo control.
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14
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Almohaimeed HM, Batawi AH, Mohammedsaleh ZM, Al Jaouni S, Mutlq Alsawat SA, Abd El Wahab MG, AbdElfattah AA, Ayuob NN. Musk ( Moschus moschiferus) Attenuates Changes in Main Olfactory Bulb of Depressed Mice: Behavioral, Biochemical, and Histopathological Evidence. Front Behav Neurosci 2021; 15:704180. [PMID: 34512285 PMCID: PMC8430345 DOI: 10.3389/fnbeh.2021.704180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 07/29/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Musk (Moschus moschiferus) has been described to have a significant impact on the central nervous system, as well as anticonvulsion and antidepressant effects. This study was designed to evaluate the efficacy of musk in alleviating alterations induced in olfactory bulb of depressed mice exposed to chronic stress and identify the mechanism behind it. METHODS Fifty male albino mice were divided into five groups (n = 10 each): control, musk, chronic unpredictable mild stress (CUMS), fluoxetine-treated, and musk-treated groups were included in this study. Behavioral changes and serum levels of corticosterone and proinflammatory cytokines included tumor necrosis factor α, interleukin 6, and oxidant/antioxidant profile were assessed at the end of the experiment. Main olfactory bulb (MOB) has been processed for histopathological examination. Gene expression of caspase-3, glial fibrillary acidic protein, and Ki67 were assessed in the MOB using quantitative real-time polymerase chain reaction. RESULTS The study showed that musk inhalation significantly reduced (p < 0.001) corticosterone level, immobility time, inflammatory cytokines, and oxidative stress markers in CUMS-exposed mice compared to the untreated CUMS group. Musk lessened CUMS-associated neuronal alterations in the MOB and significantly reduced apoptosis and enhanced neural cell proliferation (p < 0.001) comparable to fluoxetine. Musk significantly enhanced the level of antioxidants in the serum and significantly reduced inflammatory cytokines. The anti-inflammatory and antioxidant activity of musk and its constituents seemed to be behind its neuroprotective effect observed in this study. CONCLUSION Musk effectively ameliorated the chronic stress-induced behavioral, biochemical, and neuronal structural changes in MOB mostly through its antioxidant and anti-inflammatory effect.
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Affiliation(s)
- Hailah M. Almohaimeed
- Department of Basic Science, Medical College, Princess Nourah Bint Abdulrahman University (PNU), Riyadh, Saudi Arabia
| | - Ashwaq H. Batawi
- Department of Biological Science, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Zuhair M. Mohammedsaleh
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk, Saudi Arabia
| | - Soad Al Jaouni
- Department of Hematology/Pediatric Oncology, Yousef Abdullatif Jameel Chair of Prophetic Medical Applications, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Manal G. Abd El Wahab
- Department of Anatomy, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
- Faculty of Nurses, National Gard, King Saud University, Jeddah, Saudi Arabia
| | - Amany A. AbdElfattah
- Department of Medical Histology and Cell Biology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Nasra N. Ayuob
- Department of Medical Histology, Faculty of Medicine, Damietta University, Damietta, Egypt
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15
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Premature Aging in Chronic Kidney Disease: The Outcome of Persistent Inflammation beyond the Bounds. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158044. [PMID: 34360333 PMCID: PMC8345753 DOI: 10.3390/ijerph18158044] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/22/2021] [Accepted: 07/26/2021] [Indexed: 01/08/2023]
Abstract
Over the last hundred years, life expectancy in developed countries has increased because of healthier living habits and the treatment of chronic pathologies causing premature aging. Aging is an inexorable, time-dependent, multifactorial process characterized by a series of progressive and irreversible physiological changes associated with loss of functional, psychological, and social capabilities. Numerous factors, such as oxidative stress, inflammation, and cellular senescence, and an irreversible geriatric syndrome known as frailty, contribute to human body deterioration in aging. The speed of aging may differ between individuals depending on the presence or absence of multiple factors (genetic and/or environment) and the subsequent misbalance of homeostasis, together with the increase of frailty, which also plays a key role in developing chronic diseases. In addition, pathological circumstances have been reported to precipitate or accelerate the aging process. This review investigated the mechanisms involved in the developing pathologies, particularly chronic kidney disease, associated with aging.
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16
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Fu L, Wu Y, Zhu A, Wang Z, Qi H. Depression of caregivers is significantly associated with depression and hospitalization of hemodialysis patients. Hemodial Int 2021; 26:108-113. [PMID: 34227223 DOI: 10.1111/hdi.12967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/25/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The current study aims to elucidate the relationships of depression of caregivers with depression of hemodialysis patients and determine predictors of hospitalization of hemodialysis patients. METHODS The single-center, cross-sectional study consisted of 200 pairs of eligible hemodialysis patients and caregivers from January 2019 to January 2020. Depression was evaluated using Hospital Anxiety and Depression Scale (HADS) questionnaire. FINDINGS There were 89 hemodialysis patients with depression (44.5%) and 74 caregivers with depression (37.0%). In multi-variable logistic regression analysis, the hemodialysis patients with depressed caregivers were at increased risk of depression after adjusting for potential confounders (OR = 2.36, p = 0.04). Depression of hemodialysis patients (β = 0.51, p = 0.00) and depression of caregivers (β = 0.36, p = 0.04) were predictors of hospitalization of hemodialysis patients. DISCUSSION Depression was prevalent among hemodialysis patients and their caregivers. Depression of caregivers was a risk factor for depression and hospitalization of hemodialysis patients. Implementation of appropriate screening programs and specific interventions for depression of hemodialysis patients and their caregivers is required.
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Affiliation(s)
- Lili Fu
- Department of Nephrology, People's Hospital of Pudong New Area, Shanghai University of medicine & Health Sciences, Shanghai, China
| | - Yanfen Wu
- Department of Nephrology, People's Hospital of Pudong New Area, Shanghai University of medicine & Health Sciences, Shanghai, China
| | - Aiguo Zhu
- Department of Nephrology, People's Hospital of Pudong New Area, Shanghai University of medicine & Health Sciences, Shanghai, China
| | - Zhihong Wang
- Department of Nephrology, People's Hospital of Pudong New Area, Shanghai University of medicine & Health Sciences, Shanghai, China
| | - Hualin Qi
- Department of Nephrology, People's Hospital of Pudong New Area, Shanghai University of medicine & Health Sciences, Shanghai, China
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17
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Virani A, Shah RP, Haneef G, Khan AT, Dias CC, Pereira KN, Gupta S, Sharma P. Depression Impairs Level of Functioning in Chronic Kidney Disease Inpatients: A Case-Control Study. Cureus 2021; 13:e16017. [PMID: 34336507 PMCID: PMC8320405 DOI: 10.7759/cureus.16017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 01/23/2023] Open
Abstract
Objectives To evaluate the difference in demographics and clinical correlates during hospitalization for chronic kidney disease (CKD) between patients with depression and those without depression, and its impact on the severity of illness and in-hospital mortality. Methods We conducted a case-control study and included 2,296 adult inpatients (age ≥18 years) with a primary discharge diagnosis of CKD using the nationwide inpatient sample (NIS). We used propensity score matching to extract the cases i.e., CKD inpatients with depression (N = 1,264) and the controls i.e. CKD inpatients without depression (N = 1,032). The matching was done based on demographic characteristics of age at admission, sex, race, and median household income. Our outcomes of interest are the severity of illness and all-cause in-hospital mortality. All patient refined drg (APR-DRG) are allocated using health information systems software by the NIS and the severity of illness within each base APR-DRG was classified into minor, moderate, or major loss of body functions. Binomial logistic regression analysis was conducted to find the odds ratio (OR) of association for major loss of function in CKD inpatients with depression, and this model was adjusted for potential confounders of congestive heart failure (CHF), coronary artery disease (CAD), diabetes, hypertension, obesity, and tobacco abuse, and utilization of hemodialysis. Results A higher proportion of CKD inpatients with depression had a statistically significant higher prevalence of major loss of function (49.8% vs. 40.3% in non-depressed). There was a statistically significant difference with higher utilization of hemodialysis in CKD inpatients with depression (76.2% vs. 70.7% in non-depressed). The all-cause in-hospital mortality rate was lower in CKD inpatients with depression (2.1% vs. 3.5% in non-depressed). After controlling the logistic regression model for potential comorbidities and utilization of hemodialysis, depression was associated with increased odds (OR 1.46; 95% CI 1.227 - 1.734) for major loss of function versus in non-depressed CKD inpatients Conclusion Comorbid depression increases the likelihood of major loss of functioning in CKD inpatients by 46%. Treating depression can allow patients to better cope emotionally and physically with CKD and other comorbidities and significantly improve the patient's quality of life (QoL) and health outcome.
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Affiliation(s)
- Anuj Virani
- Family Medicine, Windsor University School of Medicine, Cayon, KNA
| | - Rushi P Shah
- Medicine, Byramjee Jeejeebhoy Medical College, Ahmedabad, Rajkot, IND
| | - Goher Haneef
- Internal Medicine, University of Health Sciences, Lahore, PAK
- Emergency Medicine, University of Cincinnati Medical Center, Cincinnati, USA
| | - Asma T Khan
- Internal Medicine, Larkin Community Hospital, South Miami, USA
| | - Caroline C Dias
- Psychiatry, Yenepoya Medical College and Hospital, Toronto, CAN
| | | | - Siddharth Gupta
- Internal Medicine, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, IND
| | - Prerna Sharma
- Psychiatry, Government Medical College, Amritsar, IND
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18
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Balgoon MJ, Al-Zahrani MH, Jaouni SA, Ayuob N. Combined Oral and Topical Application of Pumpkin ( Cucurbita pepo L.) Alleviates Contact Dermatitis Associated With Depression Through Downregulation Pro-Inflammatory Cytokines. Front Pharmacol 2021; 12:663417. [PMID: 34040528 PMCID: PMC8141732 DOI: 10.3389/fphar.2021.663417] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/07/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Depression and contact dermatitis (CD) are considered relatively common health problems that are linked with psychological stress. The antioxidant, anti-inflammatory, and antidepressant activities of pumpkin were previously reported. Objectives: This study aimed to evaluate the efficacy of the combined topical and oral application of pumpkin fruit (Cucurbita pepo L.) extract (PE) in relieving CD associated with chronic stress-induced depression and compare it to the topical pumpkin extract alone and to the standard treatment. Materials and Methods: Forty male albino rats were exposed to chronic unpredictable mild stress (CUMS) for 4 weeks for induction of depression and then exposed to (1-fluoro-2, 4-dinitrofluorobenzene, DNFB) for 2 weeks for induction of CD. Those rats were assigned into 4 groups (n = 10 each); untreated, betamethasone-treated, PE-treated and pumpkin extract cream, and oral-treated groups. Treatments were continued for 2 weeks. All groups were compared to the negative control group (n = 10). Depression was behaviorally and biochemically confirmed. Serum and mRNA levels of pro-inflammatory cytokines, such as TNF-α, IL-6, COX-2, and iNOS, were assessed. Oxidant/antioxidant profile was assessed in the serum and skin. Histopathological and immunohistochemical assessments of affected skin samples were performed. Results: Pumpkin extract, used in this study, included a large amount of oleic acid (about 56%). The combined topical and oral administration of PE significantly reduced inflammatory and oxidative changes induced by CD and depression compared to the CD standard treatment and to the topical PE alone. PE significantly alleviated CD signs and the histopathological score (p < 0.001) mostly through the downregulation of pro-inflammatory cytokines and the upregulation of antioxidants. Conclusion: Pumpkin extract, applied topically and orally, could be an alternative and/or complementary approach for treating contact dermatitis associated with depression. Further studies on volunteer patients of contact dermatitis are recommended.
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Affiliation(s)
- Maha Jameal Balgoon
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Maryam H Al-Zahrani
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Soad Al Jaouni
- Department of Hematology/Pediatric Oncology and Yousef Abdullatif Jameel Chair of Prophetic Medical Applications (YAJCPMA), Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Nasra Ayuob
- Department of Medical Histology, Faculty of Medicine, Damietta University, Damietta, Egypt
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19
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Santana Gomes T, Espirito Santo Silva DD, Xavier Junior GF, de Farias Costa PR, Gusmão Sena MHL, Barreto Medeiros JM. Sarcopenia and Mortality in Patients With Chronic Non-dialytic Renal Disease: Systematic Review and Meta-Analysis. J Ren Nutr 2021; 32:135-143. [PMID: 33840585 DOI: 10.1053/j.jrn.2021.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 01/30/2021] [Accepted: 02/10/2021] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To analyze the results of prospective studies on the presence of sarcopenia and its association with cardiovascular events and mortality in patients with non-dialysis-dependent chronic renal disease. METHODS This study used the PRISMA protocol for systematic review. The systematic review and meta-analysis protocol was recorded in the prospective record of systematic reviews by PROSPERO International: CRD42019120391. DATA SOURCES MEDLINE via PubMed, Embase, Cochrane Library, CINAHL, Scopus, Web of Science and LILACS from December 2018 to April 20, 2019, with the survey results updated in January 2021. DATA ANALYSIS Random effect models were calculated to compare the results due to high heterogeneity identified. RESULTS The survey identified 951 studies. Of these, 392 were removed by duplicates and 559 references were selected for analysis. In the stage of evaluating titles and abstracts, 555 articles were excluded because they did not include inclusion criteria related to the population and study design, leaving 4 articles that were included in the systematic review and meta-analysis. A meta-analysis identified that the presence of sarcopenia increased the risk of mortality by 143%. CONCLUSION(S) The meta-analysis identified the influence of sarcopenia on mortality in non-dialysis-dependent chronic renal disease.
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Affiliation(s)
- Tarcisio Santana Gomes
- Federal University of Bahia, School of Nutrition, Postgraduate Program in Food, Nutrition and Health, Bahia, Brazil.
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20
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Effect of Cool Dialysate on Depression in Patients with Chronic Renal Failure Treated with Hemodialysis: A Randomized Clinical Trial. Nephrourol Mon 2021. [DOI: 10.5812/numonthly.112174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Depression is one of the most common psychiatric problems in hemodialysis patients. Objectives: This study aimed to evaluate the effect of cool dialysate on depression in patients with chronic renal failure treated with hemodialysis. Methods: This randomized clinical trial was performed on 66 hemodialysis patients suffering from depression. Patients were selected by a convenience sampling method and divided equally into intervention and control groups randomly by permuted block allocation, each group containing 33 patients. Data were acquired with the Beck Depression inventory-I. The intervention and control groups underwent one month of treatment with cool dialysate at 35.5 and 37°C, respectively. The severity of depression for each group was measured at the end of each treatment stage and two weeks after the intervention. Data were analyzed using R version 25 software with a confidence level of 95%. Results: There was no statistically significant difference between the control and intervention groups before and after the intervention (P-values more than 0.05). While the mean of depression severity for the control group decreased from 26.15 ± 1.46 to 22.24 ± 2.00 (P-values < 0.01), the mean of depression severity for the intervention group decreased from 25.56 ± 1.28 to 22.41 ± 1.65 by the intervention (P-value > 0.05). Conclusions: The application of cool dialysate as a non-pharmacological method did not significantly reduce the severity of depression in patients undergoing hemodialysis. Therefore, it is advised to perform further studies that include more research units from different geographical locations, considering a longer intervening duration.
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21
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Hilderman M, Bruchfeld A. The cholinergic anti-inflammatory pathway in chronic kidney disease-review and vagus nerve stimulation clinical pilot study. Nephrol Dial Transplant 2021; 35:1840-1852. [PMID: 33151338 PMCID: PMC7643692 DOI: 10.1093/ndt/gfaa200] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/17/2020] [Accepted: 06/09/2020] [Indexed: 12/15/2022] Open
Abstract
Inflammation and autonomic dysfunction are common findings in chronic and end-stage kidney disease and contribute to a markedly increased risk of mortality in this patient population. The cholinergic anti-inflammatory pathway (CAP) is a vagal neuro-immune circuit that upholds the homoeostatic balance of inflammatory activity in response to cell injury and pathogens. CAP models have been examined in preclinical studies to investigate its significance in a range of clinical inflammatory conditions and diseases. More recently, cervical vagus nerve stimulation (VNS) implants have been shown to be of potential benefit for patients with chronic autoimmune diseases such as rheumatoid arthritis and inflammatory bowel disease. We have previously shown that dialysis patients have a functional CAP ex vivo. Here we review the field and the potential role of the CAP in acute kidney injury and chronic kidney disease (CKD) as well as in hypertension. We also present a VNS pilot study in haemodialysis patients. Controlling inflammation by neuroimmune modulation may lead to new therapeutic modalities for improved treatment, outcome, prognosis and quality of life for patients with CKD.
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Affiliation(s)
- Marie Hilderman
- Department of Clinical Science, Intervention and Technology, Division of Renal Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Annette Bruchfeld
- Department of Clinical Science, Intervention and Technology, Division of Renal Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine, Linköping University, Linköping, Sweden
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22
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Buoli M, Caldiroli L, Guenzani D, Carnevali GS, Cesari M, Turolo S, Barkin JL, Messa P, Agostoni C, Vettoretti S. Associations Between Cholesterol and Fatty Acid Profile on the Severity of Depression in Older Persons With Nondialysis Chronic Kidney Disease. J Ren Nutr 2020; 31:537-540. [PMID: 33386204 DOI: 10.1053/j.jrn.2020.08.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/22/2020] [Accepted: 08/30/2020] [Indexed: 11/11/2022] Open
Abstract
Depressive symptoms worsen the outcomes of patients affected by chronic kidney disease (CKD). The purpose of the present article is to study the association between serum lipid profile and the severity of depression in patients with CKD. We evaluated 132 older subjects with advanced CKD (stage 3-5, not receiving dialysis) in regular follow-up in a nephrology clinic. Blood samples were collected after an overnight fast. All patients were evaluated with the Geriatric Depression Scale which is comprised of 30 items that assess the severity of depressive symptoms. A backward multivariate regression analysis was performed to study the association between lipid profile and severity of depression. Low-density lipoprotein levels (β = 2.77, P = .008) and arachidonic acid/linoleic acid ratio (β = 2.51, P = .015) were found to be significantly associated with severity of depressive symptoms. Change in dietary habits or the use of hypocholesterolemic drugs could potentially prevent depressive symptoms and ameliorate outcome of patients affected by CKD. Data from prospective studies are needed to confirm these preliminary results.
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Affiliation(s)
- Massimiliano Buoli
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
| | - Lara Caldiroli
- Unit of Nephrology Dialysis and Renal Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Dalila Guenzani
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Matteo Cesari
- Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Stefano Turolo
- Pediatric Department of Nephrology Dialysis and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Piergiorgio Messa
- Unit of Nephrology Dialysis and Renal Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Carlo Agostoni
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Simone Vettoretti
- Unit of Nephrology Dialysis and Renal Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Gao B, Song X, Hao J, Han Y, Zhang M, Sun N, Li J, Qi P, Uchida S, Chang W. Association Between Serum Uric Acid and Depression in Patients with Chronic Kidney Disease not Requiring Kidney Dialysis: Cross-Sectional and Longitudinal Analyses. MEDICAL SCIENCE MONITOR : INTERNATIONAL MEDICAL JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2020; 26:e925386. [PMID: 32980854 PMCID: PMC7528616 DOI: 10.12659/msm.925386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Depression is the main problem of psycho-nephrology. We aimed to investigate clinical risk factors for depression in patients with non-dialysis chronic kidney disease (CKD). MATERIAL AND METHODS A non-dialysis CKD cohort study was conducted with 223 patients. Information on demographic and clinical parameters was collected at baseline. Beck Depression Inventory (BDI) and Pittsburgh Sleep Quality Index (PSQI) questionnaires were used to estimate depression and sleep quality in the patients. The questionnaires were repeated in 158 patients after 6 months. Logistic regression was performed to identify independent factors associated with depression and any longitudinal changes in BDI scores. RESULTS At baseline, 17 patients (7.72%) in the CKD cohort presented with depression. Multivariate logistic regression revealed that being female (odds ratio [OR] 0.319, 95% confidence interval [CI] 0.108 to 0.944, P=0.039) and having lower levels of serum uric acid (SUA) (OR 0.675, 95% CI 0.469 to 0.970, P=0.034) were independent risk factors for depression. A decrease in PSQI score (OR 0.873, 95% CI 0.777 to 0.981, P=0.022) and an increase in SUA level (OR 1.383, 95% CI 1.115 to 1.715, P=0.003) were independently associated with decline in BDI scores in the patients in the 6-month follow-up group. CONCLUSIONS Lower SUA levels and being female were independent risk factors for depression in non-dialysis CKD patients. Improving sleep quality and increasing SUA levels may relieve depression to some extent.
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Affiliation(s)
- Bin Gao
- Department of Nephrology, Tianjin First Center Hospital, Tianjin, China (mainland)
| | - Xinyuan Song
- Department of Nephrology, Tianjin First Center Hospital, Tianjin, China (mainland)
| | - Jie Hao
- Department of Nephrology, Tianjin First Center Hospital, Tianjin, China (mainland)
| | - Yingying Han
- Department of Nephrology, Tianjin First Center Hospital, Tianjin, China (mainland)
| | - Miaomiao Zhang
- Department of Nephrology, Tianjin First Center Hospital, Tianjin, China (mainland)
| | - Na Sun
- Department of Nephrology, Tianjin First Center Hospital, Tianjin, China (mainland)
| | - Jinping Li
- Department of Nephrology, Tianjin First Center Hospital, Tianjin, China (mainland)
| | - Pingping Qi
- Department of Nephrology, Tianjin First Center Hospital, Tianjin, China (mainland)
| | - Shunya Uchida
- Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Wenxiu Chang
- Department of Nephrology, Tianjin First Center Hospital, Tianjin, China (mainland)
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24
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Bennett PN, Hussein WF, Reiterman M, Yu J, Schiller B. The effects of laughter therapy on depression symptoms in patients undergoing center hemodialysis: A pragmatic randomized controlled trial. Hemodial Int 2020; 24:541-549. [DOI: 10.1111/hdi.12870] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 01/17/2023]
Affiliation(s)
| | - Wael F. Hussein
- Satellite Healthcare, Inc San Jose California USA
- Department of Medicine, Division of Nephrology Stanford University School of Medicine Stanford California USA
| | | | - Junhua Yu
- Satellite Healthcare, Inc San Jose California USA
| | - Brigitte Schiller
- Satellite Healthcare, Inc San Jose California USA
- Department of Medicine, Division of Nephrology Stanford University School of Medicine Stanford California USA
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25
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Kim O, Yeom EY, Jeon HO. Relationships between depression, family function, physical symptoms, and illness uncertainty in female patients with chronic kidney disease. Nurs Health Sci 2020; 22:548-556. [PMID: 32150660 DOI: 10.1111/nhs.12691] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 01/02/2020] [Accepted: 02/06/2020] [Indexed: 12/11/2022]
Abstract
This study investigated the relationship between depression, family function, physical symptoms, and illness uncertainty in women with chronic kidney disease. Data were collected through structured questionnaire that was completed by 120 women undergoing hemodialysis. Assessment instruments consisted of the Family Adaptability, Partnership, Growth, Affection, Resolve Scale, Symptom Experience Scale, Mishel's Uncertainty in Illness Scale for Adults, and the Center for Epidemiological Studies-Depression Scale. The higher the uncertainty about illness and physical symptoms, the higher is the level of depression, and the better the family function, the lower is the level of depression. Greater uncertainty was associated with poorer family function and worsening physical symptoms. A regression model explained 41% of the variance in depression. Significant predictors of depression were physical symptoms, living alone, illness uncertainty, and "poor" subjective health status. To improve depression of women with chronic kidney disease, nurses need to reduce physical symptoms and illness uncertainty in these patients and improve their subjective health status. In addition, the establishment of a therapeutic support system considering living arrangement will help to reduce depression in women with chronic kidney disease.
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Affiliation(s)
- Oksoo Kim
- College of Nursing, Ewha Womans University, Seoul, Republic of Korea
| | - Eun Yi Yeom
- Department of Nursing, Chungwoon University, Chungwoon, Republic of Korea
| | - Hae Ok Jeon
- Department of Nursing, Cheongju University, Cheongju, Republic of Korea
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26
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Zegarow P, Manczak M, Rysz J, Olszewski R. The influence of cognitive-behavioral therapy on depression in dialysis patients - meta-analysis. Arch Med Sci 2020; 16:1271-1278. [PMID: 33224325 PMCID: PMC7667424 DOI: 10.5114/aoms.2019.88019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 12/31/2018] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Depressive disorders are the most common mental health problem among patients undergoing dialysis. Furthermore, depression is an independent factor increasing the mortality and frequency of hospitalization in this group of patients, yet psychological intervention programs aimed at improving the mental health of dialysis patients have still not been developed. This meta-analysis aimed to assess the effects of cognitive-behavioral therapy on depressive symptoms in dialysis patients. The main hypothesis of this study is that cognitive-behavioral therapy is an effective psychological method of reducing the severity of depression symptoms among patients undergoing dialysis. MATERIAL AND METHODS A systematic search was conducted using Medline, PubMed, Web of Science, Scopus and Google Scholar. Data extraction was carried out by two independent researchers. The severity of depression symptoms in the included studies was measured by the Beck Depression Inventory. A random-effects model was used to estimate the pooled mean difference of these values between patients undergoing CBT and the controls. RESULTS Four of the 1841 search results met the inclusion criteria with data from 226 patients who had undergone dialysis therapy due to renal disorders and psychological intervention based on cognitive-behavioral therapy. This therapy significantly reduced the level of depression symptoms in all studies included in the meta-analysis (mean difference = -5.3, p = 0.001; 95% CI: -7.95 to -2.66). CONCLUSIONS The study showed that the use of psychological intervention based on cognitive- behavioral therapy was an effective method of decreasing the severity of depressive symptoms in hemodialyzed patients. For the sake of patient well-being, it seems reasonable to extend renal replacement therapy with psychological intervention such as cognitive-behavioral therapy.
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Affiliation(s)
- Pawel Zegarow
- Department of Gerontology, Public Health and Didactics, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Malgorzata Manczak
- Department of Gerontology, Public Health and Didactics, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Jacek Rysz
- Department of Nephrology, Hypertension and Family Medicine, University Clinical Hospital Military Memorial Medical Academy – Central Veterans’ Hospital, Lodz, Poland
| | - Robert Olszewski
- Department of Gerontology, Public Health and Didactics, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
- Department of Ultrasound, Institute of Fundamental Technological Research, Polish Academy of Sciences, Warsaw, Poland
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27
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Inflammation and Oxidative Stress in Chronic Kidney Disease-Potential Therapeutic Role of Minerals, Vitamins and Plant-Derived Metabolites. Int J Mol Sci 2019; 21:ijms21010263. [PMID: 31906008 PMCID: PMC6981831 DOI: 10.3390/ijms21010263] [Citation(s) in RCA: 194] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/23/2019] [Accepted: 12/27/2019] [Indexed: 02/07/2023] Open
Abstract
Chronic kidney disease (CKD) is a debilitating pathology with various causal factors, culminating in end stage renal disease (ESRD) requiring dialysis or kidney transplantation. The progression of CKD is closely associated with systemic inflammation and oxidative stress, which are responsible for the manifestation of numerous complications such as malnutrition, atherosclerosis, coronary artery calcification, heart failure, anemia and mineral and bone disorders, as well as enhanced cardiovascular mortality. In addition to conventional therapy with anti-inflammatory and antioxidative agents, growing evidence has indicated that certain minerals, vitamins and plant-derived metabolites exhibit beneficial effects in these disturbances. In the current work, we review the anti-inflammatory and antioxidant properties of various agents which could be of potential benefit in CKD/ESRD. However, the related studies were limited due to small sample sizes and short-term follow-up in many trials. Therefore, studies of several anti-inflammatory and antioxidant agents with long-term follow-ups are necessary.
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28
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Gregg LP, Carmody T, Le D, Martins G, Trivedi M, Hedayati SS. A Systematic Review and Meta-Analysis of Depression and Protein-Energy Wasting in Kidney Disease. Kidney Int Rep 2019; 5:318-330. [PMID: 32154453 PMCID: PMC7056860 DOI: 10.1016/j.ekir.2019.12.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/17/2019] [Accepted: 12/16/2019] [Indexed: 12/20/2022] Open
Abstract
Introduction Depression comorbid with chronic disease may be mediated by inflammation. We sought to characterize relationships between inflammatory biomarkers and depressive symptoms in patients with chronic kidney disease and end-stage kidney disease. Methods A systematic literature search was conducted by 2 authors up to March 19, 2019, for studies of patients with chronic kidney disease or end-stage kidney disease evaluating circulating inflammatory biomarkers associated with depression of chronic disease: albumin, C-reactive protein (CRP), high-sensitivity CRP, interleukin-6 (IL-6), tumor necrosis factor-α, and interleukin-1. Standardized mean differences in biomarkers between individuals with and without depression were computed and analyzed using mixed effects models. Correlations between biomarkers and the severity of depressive symptoms were computed. Results Thirty-four studies (5652 participants) compared biomarkers between depressed and nondepressed individuals. Individuals with depression had lower albumin levels (standardized mean difference, −0.37; 95% confidence interval [CI], −0.61 to −0.13), higher CRP levels (standardized mean difference, 0.76; 95% CI, 0.16–1.37), and higher IL-6 levels (standardized mean difference, 0.42; 95% CI, 0.21–0.63). Studies were heterogeneous for albumin, CRP, high-sensitivity CRP, and tumor necrosis factor-α. Twenty-three studies (3047 participants) investigated correlations between biomarkers and depressive symptoms. The severity of depressive symptoms correlated with albumin (Z = −0.25; 95% CI, −0.36 to −0.14), high-sensitivity CRP (Z = 0.28; 95% CI, 0.13–0.43), and IL-6 (Z = 0.34; 95% CI, 0.18–0.49). There was heterogeneity across studies of IL-6. Only 6 studies (321 participants) investigated the effect of antidepressant treatment on inflammatory biomarkers, which was insufficient to combine in meta-analysis. Conclusion Lower albumin and higher IL-6 were associated with both the presence and severity of depression, CRP with the presence of depression, and high-sensitivity CRP with the severity of depressive symptoms. The effect of interventions to lower inflammation in patients with kidney disease and depression deserves investigation.
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Affiliation(s)
- L Parker Gregg
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Division of Nephrology, Medical Service, Veterans Affairs North Texas Health Care System, Dallas, Texas, USA
| | - Thomas Carmody
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Dustin Le
- Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Gerard Martins
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Madhukar Trivedi
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - S Susan Hedayati
- Division of Nephrology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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29
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Nadort E, Schouten RW, Dekker FW, Honig A, van Oppen P, Siegert CEH. The (cost) effectiveness of guided internet-based self-help CBT for dialysis patients with symptoms of depression: study protocol of a randomised controlled trial. BMC Psychiatry 2019; 19:372. [PMID: 31775685 PMCID: PMC6881986 DOI: 10.1186/s12888-019-2363-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 11/15/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Only a minority of dialysis patients with depressive symptoms are diagnosed and receive treatment. Depressive symptoms are highly prevalent in this population and are associated with adverse clinical outcomes. Underlying factors for this undertreatment may be the lack of evidence for the safety and effectivity of antidepressant medication, the reluctance of patients to adhere to antidepressant medication, the lack of mental healthcare provision in somatic healthcare environments and end-stage renal disease (ESRD) related physical limitations that complicate face-to-face psychotherapy. Guided Internet-based self-help treatment has demonstrated to be effective for depressive symptoms in other chronic patient populations and may overcome these barriers. The aim of this study is to investigate the (cost) effectiveness of a guided Internet-based self-help intervention for symptoms of depression in dialysis patients. METHODS This study is a cluster randomized controlled trial (RCT) that investigates the effectiveness of a 5-week Internet-based self-help Problem Solving Therapy (PST) for depressive symptoms in dialysis patients. Depressive symptoms will be measured using the Beck Depression Inventory - second edition (BDI-II), with a cut-off score of ≥10. We aim to include 206 dialysis patients with depressive symptoms who will be cluster randomized to the intervention or the Care as Usual (CAU) control group. Secondary outcomes will include anxiety symptoms, quality of life, economic costs and clinical outcomes, such as inflammatory factors and hair cortisol levels. Assessments will take place at baseline (T0), 2 weeks after intervention (T1) and 6 months (T2), 12 months (T3) and 18 months (T4) after intervention. The control group will be measured at the same time points. Analysis will be based on the intention-to-treat principle. Mixed models will be used to assess the changes within each condition between pre-treatment and post-treatment. DISCUSSION If demonstrated to be (cost) effective, Internet-based PST will offer new possibilities to treat dialysis patients with depressive symptoms and to improve their quality of care. TRIAL REGISTRATION Dutch Trial Register: Trial NL6648 (NTR6834) (prospectively registered 13th November 2017).
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Affiliation(s)
- Els Nadort
- Department of Nephrology, OLVG hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, Netherlands. .,Department of Psychiatry, OLVG, Jan Tooropstraat 164, 1061 AE, Amsterdam, Netherlands. .,Department of Amsterdam Public Health research institute, VUmc, Van der Boechorststraat 7, 1081 BT, Amsterdam, Netherlands.
| | - Robbert W. Schouten
- Department of Nephrology, OLVG hospital, Jan Tooropstraat 164, 1061 AE Amsterdam, Netherlands ,grid.440209.bDepartment of Psychiatry, OLVG, Jan Tooropstraat 164, 1061 AE Amsterdam, Netherlands ,0000 0004 0435 165Xgrid.16872.3aDepartment of Amsterdam Public Health research institute, VUmc, Van der Boechorststraat 7, 1081 BT Amsterdam, Netherlands
| | - Friedo W. Dekker
- 0000000089452978grid.10419.3dDepartment of Clinical Epidemiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, Netherlands
| | - Adriaan Honig
- grid.440209.bDepartment of Psychiatry, OLVG, Jan Tooropstraat 164, 1061 AE Amsterdam, Netherlands ,0000 0004 0435 165Xgrid.16872.3aDepartment of Amsterdam Public Health research institute, VUmc, Van der Boechorststraat 7, 1081 BT Amsterdam, Netherlands
| | - Patricia van Oppen
- 0000 0004 0435 165Xgrid.16872.3aDepartment of Amsterdam Public Health research institute, VUmc, Van der Boechorststraat 7, 1081 BT Amsterdam, Netherlands ,Department of Psychiatry, Amsterdam University Medical Centre, Amsterdam and GGZ inGeest, Oldenaller 1, 1081 HJ Amsterdam, Netherlands
| | - Carl E. H. Siegert
- Department of Nephrology, OLVG hospital, Jan Tooropstraat 164, 1061 AE Amsterdam, Netherlands
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30
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Guenzani D, Buoli M, Caldiroli L, Carnevali GS, Serati M, Vezza C, Armelloni S, Messa P, Vettoretti S. Malnutrition and inflammation are associated with severity of depressive and cognitive symptoms of old patients affected by chronic kidney disease. J Psychosom Res 2019; 124:109783. [PMID: 31443824 DOI: 10.1016/j.jpsychores.2019.109783] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 07/12/2019] [Accepted: 07/20/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Chronic kidney disease (CKD) is a disabling condition associated with different medical comorbidities including depression and cognitive impairment. We investigated the association between malnutrition, inflammation and depressive/cognitive symptoms in elderly subjects with advanced CKD. METHODS We evaluated cross-sectionally 132 elderly subjects (age ≥65 years) with advanced CKD (stage 4-5, non-dialytic-ND) in regular follow up at the outpatient clinic of nephrology. Blood and urinary samples were collected after an overnight fast. All patients were evaluated by Geriatric Depression Scale (GDS)-30 items for severity of depressive symptoms, Mini Mental State Examination (MMSE) and the Clock Drawing Test (CDT) for cognition. Nutritional status was assessed by Malnutrition Inflammation Score (MIS). Different linear regression models were performed to study the association between clinical variables, diet and inflammatory parameters with the above mentioned rating scale scores. A final linear regression model with only previous statistically significant variables was performed for GDS scores. RESULTS Our cohort consisted of 95 males and 37 females with a mean age of 78 ± 7. Female gender (B = 3.20, p < .01), higher MIS (B = 0.29, p = .02) and higher IL-12p70 serum levels (pg/mL) (B = 0.37, p = .03) were associated with severity of depressive symptoms. MIS was associated with the severity of cognitive impairment as assessed by MMSE (B = -0.19, p < .01) and CDT (B = 0.10, p = .03). CONCLUSION In elderly subjects affected by CKD the severity of depressive symptoms and cognitive impairment is associated with specific inflammatory and nutritional parameters. These results have to be considered as preliminary and need replication by further studies.
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Affiliation(s)
- Dalila Guenzani
- Department of Psychiatry, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
| | - Massimiliano Buoli
- Department of Psychiatry, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy; University of Milan, Milan, Italy.
| | - Lara Caldiroli
- Unit of Nephrology Dialysis and Renal Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Greta Silvia Carnevali
- Department of Psychiatry, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
| | - Marta Serati
- Department of Psychiatry, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy
| | - Carlotta Vezza
- University of Milan, Milan, Italy; Unit of Gerontology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvia Armelloni
- Unit of Nephrology Dialysis and Renal Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Piergiorgio Messa
- Unit of Nephrology Dialysis and Renal Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; University of Milan, Milan, Italy
| | - Simone Vettoretti
- Unit of Nephrology Dialysis and Renal Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Dimensions of Depressive Symptoms and Their Association With Mortality, Hospitalization, and Quality of Life in Dialysis Patients: A Cohort Study. Psychosom Med 2019; 81:649-658. [PMID: 31232914 PMCID: PMC6727937 DOI: 10.1097/psy.0000000000000723] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE Unraveling specific dimensions of depressive symptoms may help to improve screening and treatment in dialysis patients. We aimed to identify the best-fitting factorial structure for the Beck Depression Inventory-II (BDI) in dialysis patients and to assess the relation of these structure dimensions with quality of life (QoL), hospitalization, and mortality. METHODS This prospective study included chronic dialysis patients from 10 dialysis centers in five hospitals between 2012 and 2017. Dimensions of depressive symptoms within the BDI were analyzed using confirmatory factor analysis. To investigate the clinical impact of these dimensions, the associations between symptom dimensions and QoL, hospitalization rate, and mortality were investigated using logistic, Poisson, and Cox proportional hazard regression models. Multivariable regression models included demographic, social, and clinical variables. RESULTS In total, 687 dialysis patients were included. The factor model that included a general and a somatic factor provided the best-fitting structure of the BDI-II. Only the somatic dimension scores were associated with all-cause mortality (hazard ratio of 1.7 [1.2-2.5], p < .007) in the multivariable model. All dimensions were associated with increased hospitalization rate and reduced QoL. CONCLUSIONS The somatic dimension of the BDI-II in dialysis patients was associated with all-cause mortality, increased hospitalization rate, and reduced QoL. Other dimensions were associated with hospitalization rate and decreased QoL. These findings show that symptom dimensions of depression have differential association with adverse clinical outcomes. Future studies should take symptom dimensions into account when investigating depression-related pathways, screening, and treatment effects in dialysis patients.
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Alshogran OY, Al-Eitan LN, Altawalbeh SM, Khalil AA, Alqudah MAY, Oweis AO, Aman HA, Alhawari HH. Investigating the Contribution of NPSR1, IL-6 and BDNF Polymorphisms to Depressive and Anxiety Symptoms in Hemodialysis Patients. Prog Neuropsychopharmacol Biol Psychiatry 2019; 94:109657. [PMID: 31132388 DOI: 10.1016/j.pnpbp.2019.109657] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 05/21/2019] [Accepted: 05/22/2019] [Indexed: 12/20/2022]
Abstract
AIMS Psychological symptoms are prevalent in hemodialysis (HD) patients. Previous investigations showed that brain-derived neurotrophic factor (BDNF) and interleukin-6 (IL-6) as well as the interaction with neuropeptide S receptor 1 (NPSR1) are linked to the development of psychological distress. This study examined the association of polymorphisms of genes encoding these proteins with depression and anxiety in a representative group of Jordanian HD patients. METHODS A total of 302 HD patients were involved in the study and categorized into three groups based on the Hospital Anxiety and Depression Scale, HADS-D or HADS-A scores as follows: normal (<7), mild (8-10) and moderate-severe (11-21). Single nucleotide polymorphism (SNP) of NPSR1 Asn107Ile (rs324981), IL-6 G174C (rs1800795), and BDNF Val66Met (rs6265) was genotyped using blood samples. RESULTS The frequency of Ile-allele of NPSR1 Asn107Ile was significantly higher in patients with moderate-severe HADS-A scores versus normal (53% vs. 40.8%, p = .035). Using ordinal regression analysis, Asn-allele of NPSR1 polymorphism was nominally significantly associated with a lower risk of anxiety (OR = 0.57, CI: 0.33-0.97, p = .038) after adjusting for other covariates. A marginally significant difference in genotype distribution of IL-6 G174C was observed among patients according to HADS-D scores (p = .05). Furthermore, carriers of IL-6174 CC genotype showed lower median IL-6 serum concentration versus carriers of GG genotype (5.2 vs. 1.35 pg/mL, p < .05). CONCLUSIONS The results support the genetic role of NPSR1 in the pathogenesis of anxiety and suggest that carriers of NPSR1 Ile-allele are at increased risk of anxiety in HD patients. Neither BDNF Val66Met nor IL-6 G174C were linked to psychological symptoms. Future studies among other ethnicities are necessary to verify the observations.
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Affiliation(s)
- Osama Y Alshogran
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan.
| | - Laith N Al-Eitan
- Department of Applied Biological Sciences, Jordan University of Science and Technology, Irbid 22110, Jordan; Department of Biotechnology and Genetic Engineering, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Shoroq M Altawalbeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Amani A Khalil
- Department of Clinical Nursing, School of Nursing, The University of Jordan, Amman 11942, Jordan
| | - Mohammad A Y Alqudah
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Ashraf O Oweis
- Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Hatem A Aman
- Department of Applied Biological Sciences, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Hussein H Alhawari
- Department of Internal Medicine, Faculty of Medicine, The University of Jordan, Amman 11942, Jordan
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Choi NG, Sullivan JE, DiNitto DM, Kunik ME. Health Care Utilization Among Adults With CKD and Psychological Distress. Kidney Med 2019; 1:162-170. [PMID: 32734196 PMCID: PMC7380337 DOI: 10.1016/j.xkme.2019.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Rationale & Objective Despite extensive research on health care access for individuals with chronic kidney disease (CKD), there is little research on the relationship between health care access barriers and psychological distress. Study Design An observational study based on the publicly available 2013 to 2017 US National Health Interview Survey data. Setting & Participants 3,923 respondents 18 years or older who self-reported a diagnosis of CKD in the preceding 12 months. Predictor(s) and Outcome(s) Psychological distress was measured using the Kessler Psychological Distress Scale (K6). Barriers to health care access included lack of health insurance coverage, lack of a usual source of health care, and financial barriers to accessing/obtaining health care, including medical specialist services, prescription drugs, mental health counseling, and dental care. Analytical Approach Multinomial logistic regression with 3 levels of K6 scores (no distress, mild to moderate distress, and serious distress) as the dependent variable. Results 15% of respondents reported mild to moderate and 11% reported serious psychological distress. Compared with those with no distress, those with mild to moderate and serious distress were younger but less likely to have worked in the preceding year, had more chronic medical conditions, and visited an emergency department more frequently. Multivariable regression models show that each financial barrier to health care access (likely due to lack of health insurance) was significantly associated with mild to moderate and serious distress. Limitations CKD diagnosis was self-reported and CKD stage was unknown. Because this is a cross-sectional study, associations cannot be assumed to imply causal relationships. Conclusions Access to sick and preventive/routine care should be improved. People with CKD should be assessed for psychological distress, treated as needed, and offered case management and social services to help them navigate the health care system and alleviate personal stressors.
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Affiliation(s)
- Namkee G Choi
- The University of Texas at Austin Steve Hicks School of Social Work, Houston, TX
| | - John E Sullivan
- The University of Texas at Austin Steve Hicks School of Social Work, Houston, TX
| | - Diana M DiNitto
- The University of Texas at Austin Steve Hicks School of Social Work, Houston, TX
| | - Mark E Kunik
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX.,Michael E. Debakey VA Medical Center, Houston, TX.,VA South Central Mental Illness Research, Education and Clinical Center, Baylor College of Medicine, Houston, TX
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Mirzaei S, Burke L, Rosenfeld AG, Dunn S, Dungan JR, Maki K, DeVon HA. Protein Cytokines, Cytokine Gene Polymorphisms, and Potential Acute Coronary Syndrome Symptoms. Biol Res Nurs 2019; 21:552-563. [PMID: 31238711 DOI: 10.1177/1099800419857819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The purpose of this study was to determine whether relationships exist among protein cytokines, cytokine gene polymorphisms, and symptoms of potential acute coronary syndrome (ACS). Participants included 438 patients presenting to the emergency department (ED) whose symptoms triggered a cardiac evaluation (206 ruled in and 232 ruled out for ACS). Presence or absence of 13 symptoms was recorded upon arrival. Levels of tumor necrosis factor α (TNF-α), interleukin (IL)-6, and IL-18 were measured for all patients. A pilot analysis of 85 patients (ACS = 49; non-ACS = 36) genotyped eight single-nucleotide polymorphisms (SNPs; four TNF and four IL6 SNPs). Logistic regression models were tested to determine whether cytokines or SNPs predicted symptoms. Increased levels of TNF-α and IL-6 were associated with a decreased likelihood of chest discomfort for all patients. Increased levels of IL-6 were associated with a lower likelihood of chest discomfort and chest pressure for ACS patients, and an increased likelihood of shoulder and upper back pain for non-ACS patients. Elevated IL-18 was associated with an increased likelihood of sweating in patients with ACS. Of the four TNF SNPs, three were associated with shortness of breath, lightheadedness, unusual fatigue, and arm pain. In all, protein cytokines and TNF polymorphisms were associated with 11 of 13 symptoms assessed. Future studies are needed to determine the predictive ability of cytokines and related SNPs for a diagnosis of ACS or to determine whether biomarkers can identify patients with specific symptom clusters.
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Affiliation(s)
- Sahereh Mirzaei
- 1 College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Larisa Burke
- 1 College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Susan Dunn
- 1 College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Katherine Maki
- 1 College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Holli A DeVon
- 1 College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
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Schouten RW, Haverkamp GL, Loosman WL, Chandie Shaw PK, van Ittersum FJ, Smets YFC, Vleming LJ, Dekker FW, Honig A, Siegert CEH. Ethnic Differences in the Association of Depressive Symptoms with Clinical Outcome in Dialysis Patients. J Racial Ethn Health Disparities 2019; 6:990-1000. [PMID: 31215016 PMCID: PMC6736895 DOI: 10.1007/s40615-019-00600-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/25/2019] [Accepted: 05/13/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Studies show mixed results on the association between depressive symptoms and adverse clinical outcomes in patients on dialysis therapy. Ethnicity may play a role in these heterogeneous results. No studies have investigated the interplay between ethnicity and depressive symptoms on clinical outcome in this patient population. This study aims to examine interaction between ethnicity and depressive symptoms on hospitalization and mortality in dialysis patients. METHODS A multi-ethnic cohort in 10 dialysis centers included 687 dialysis patients between 2012 and 2017, with an average follow-up of 3.2 years. Depressive symptoms were measured using the Beck Depression Inventory. Interaction was assessed by investigating excess risk on an additive scale using both absolute rates and relative risks. Multivariable regression models included demographic, social, and clinical variables. RESULTS Adverse outcomes are more pronounced in native patients, compared to immigrant patients. The risk for mortality and hospitalization is considerably higher in native patients compared to immigrants. An excess risk on an additive scale indicates the presence of possible causal interaction. CONCLUSIONS Depressive symptoms are a risk factor for hospitalization and mortality, especially in native dialysis patients. Adverse clinical events associated with depressive symptoms differ among ethnic groups. This differential association could play a role in the conflicting findings in literature. Ethnicity is an important factor when investigating depressive symptoms and clinical outcome in dialysis patients. Future research should focus on the possible mechanisms and pathways involved in these differential associations.
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Affiliation(s)
- Robbert W Schouten
- Department of Nephrology, Amsterdam UMC (VU University Amsterdam), Amsterdam, The Netherlands. .,Department of Psychiatry, Amsterdam UMC (VU University Amsterdam), Amsterdam, The Netherlands.
| | - Gerlinde L Haverkamp
- Department of Nephrology, Amsterdam UMC (VU University Amsterdam), Amsterdam, The Netherlands.,Department of Psychiatry, Amsterdam UMC (VU University Amsterdam), Amsterdam, The Netherlands
| | - Wim L Loosman
- Department of Nephrology, Amsterdam UMC (VU University Amsterdam), Amsterdam, The Netherlands.,Department of Psychiatry, Amsterdam UMC (VU University Amsterdam), Amsterdam, The Netherlands
| | | | | | - Yves F C Smets
- Department of Nephrology, Amsterdam UMC (VU University Amsterdam), Amsterdam, The Netherlands
| | - Louis-Jean Vleming
- Department of Nephrology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Adriaan Honig
- Department of Psychiatry, Amsterdam UMC (VU University Amsterdam), Amsterdam, The Netherlands.,Department of Psychiatry, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Carl E H Siegert
- Department of Nephrology, Amsterdam UMC (VU University Amsterdam), Amsterdam, The Netherlands
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Schouten RW, Haverkamp GL, Loosman WL, Chandie Shaw PK, van Ittersum FJ, Smets YFC, Vleming LJ, Dekker FW, Honig A, Siegert CEH. Anxiety Symptoms, Mortality, and Hospitalization in Patients Receiving Maintenance Dialysis: A Cohort Study. Am J Kidney Dis 2019; 74:158-166. [PMID: 31027882 DOI: 10.1053/j.ajkd.2019.02.017] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 02/09/2019] [Indexed: 11/11/2022]
Abstract
RATIONALE & OBJECTIVE Anxiety symptoms are common in dialysis patients and have a large impact on quality of life. The association of anxiety symptoms with adverse clinical outcomes in dialysis patients is largely unknown. This study examined the association of anxiety symptoms with hospitalization and mortality in patients receiving maintenance dialysis. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS Maintenance dialysis patients treated at 10 dialysis centers in the Netherlands between 2012 and 2016. EXPOSURES Time-varying symptoms of anxiety and depression using the Beck Anxiety Inventory and Beck Depression Inventory. OUTCOMES All-cause mortality, 1-year hospitalization rate, and hospital length of stay. ANALYTICAL APPROACH Cox proportional hazards and Poisson regression models adjusted for sociodemographic and clinical variables. Sensitivity analyses included multiple imputation of missing data and restriction to incident patients only. RESULTS 687 patients were included, composed of 433 prevalent and 242 incident dialysis patients. Median follow-up time was 3.1 (IQR, 3.0-3.5) years, during which 172 deaths occurred. 22% of patients had anxiety symptoms and 42% had depressive symptoms. Anxiety symptoms were associated with all-cause mortality and 1-year hospitalization rate and length of stay in all multivariable models. Anxiety symptoms showed a clear dose-response relationship with mortality. LIMITATIONS Depression and anxiety often coexist and share symptoms. The observational design of this study limits inferences about causal mechanisms between anxiety and clinical outcomes. CONCLUSIONS Anxiety symptoms are independently associated with increased risk for mortality and 1-year hospitalization. Anxiety symptoms are a clinically relevant risk factor for morbidity and mortality in dialysis patients and warrant further research on effective treatment.
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Affiliation(s)
- Robbert W Schouten
- Department of Nephrology, OLVG, Amsterdam, the Netherlands; Department of Psychiatry, OLVG, Amsterdam, the Netherlands.
| | - Gertrud L Haverkamp
- Department of Nephrology, OLVG, Amsterdam, the Netherlands; Department of Psychiatry, OLVG, Amsterdam, the Netherlands
| | - Wim L Loosman
- Department of Nephrology, OLVG, Amsterdam, the Netherlands; Department of Psychiatry, OLVG, Amsterdam, the Netherlands
| | | | | | - Yves F C Smets
- Department of Nephrology, OLVG, Amsterdam, the Netherlands
| | - Louis-Jean Vleming
- Department of Nephrology, Haga Teaching Hospital, The Hague, the Netherlands
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Adriaan Honig
- Department of Psychiatry, OLVG, Amsterdam, the Netherlands
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Antidepressant effect of helicid in chronic unpredictable mild stress model in rats. Int Immunopharmacol 2019; 67:13-21. [DOI: 10.1016/j.intimp.2018.11.052] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 11/26/2018] [Accepted: 11/28/2018] [Indexed: 01/29/2023]
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Abstract
OBJECTIVE Patients undergoing chronic dialysis often display sustained elevations of inflammation markers and also have a high prevalence of depressive symptoms. Although multiple studies demonstrated cross-sectional associations between inflammation markers and depressive symptoms in this patient group, longitudinal associations have not been examined. We therefore investigated whether longitudinal associations exist between inflammation markers and depressive symptoms in chronic dialysis patients. METHODS Data of three consecutive measurements of an observational, prospective cohort study among chronic dialysis patients were used. At baseline, 6-month, and 12-month follow-up, patients completed the Beck Depression Inventory, and inflammation markers (high-sensitivity C-reactive protein [HsCRP], interleukin (IL)-1β, IL-6, IL-10, and tumor necrosis factor α) were measured. We examined cross-sectional associations between inflammation markers and depressive symptoms using linear regression models. The longitudinal association between inflammation and depressive symptoms was assessed using a linear mixed model analyses. RESULTS A total of 513 patients were included. Cross-sectional associations were found between HsCRP and depressive symptoms at baseline (β = 0.9, confidence interval [CI] = 0.4-1.4) and 6-month follow-up (β = 1.1, CI = 0.3-2.0), and between IL-1β and depressive symptoms at 6-month follow-up (β = 1.3, CI = 0.8-1.8) and 12-month follow-up (β = 1.2, CI = 0.4-1.9). Inflammation makers (HsCRP, IL-6, IL-1β, IL-10, and tumor necrosis factor α) at baseline were not associated with depressive symptoms at follow-up and vice versa. CONCLUSIONS We confirmed the presence of cross-sectional associations between inflammation markers and depressive symptoms in chronic dialysis patients, but with our longitudinal data, we found no longitudinal associations. This supports an associative instead of a causal relationship between inflammation and depressive symptoms.
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Pereira PMDL, Soares ÍT, Bastos MG, Cândido APC. Thumb adductor muscle thickness used in the nutritional assessment of chronic kidney disease patients under conservative treatment. J Bras Nefrol 2019; 41:65-73. [PMID: 30281064 PMCID: PMC6534022 DOI: 10.1590/2175-8239-jbn-2018-0122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 07/19/2018] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Evaluate the association between the thumb adductor muscle thickness and the patient's nutritional status, and propose cutoff points for muscle mass depletion in elderly patients with chronic kidney disease (CKD) under conservative treatment. Epidemiological and cross-sectional study, including patients with CKD stages 3 to 5, older than 60 years. Socioeconomic, clinical, physical activity and anthropometric data was obtained. TAMT was described and compared according to CKD stage, socioeconomic data, physical activity, nutritional status and correlated with age, glomerular filtration rate and anthropometric variables. Receiver Operating Characteristic (ROC) curves were produced, considering the lean tissue index classification as reference. The cut-off point was defined by the Youden index. RESULTS We evaluated 137 individuals. The TAMT was lower in malnourished and/or depleted muscle mass individuals; among males it was higher among those who practiced physical activities (p <0.05). This measure was moderately correlated with BMI, calf and brachial circumferences, lean body tissue, lean tissue index and body cell mass (r <0.7); negatively with age (r = -0.34). The ROC curve analysis determined cut points of 15.33 mm for females and 20.33 mm for males, with 72.22% and 62.50% accuracy, respectively. CONCLUSION TAMT is used to estimate muscle mass and we suggest the cutoff point is useful to rule out the likelihood of muscle mass depletion. It is recommended that it be used in a complementary way in nutritional assessment.
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Affiliation(s)
| | - Íris Teixeira Soares
- Universidade Federal de Juiz de Fora, Instituto de Ciências Biológicas, Departamento de Nutrição, Juiz de Fora, MG, Brasil
| | - Marcus Gomes Bastos
- Universidade Federal de Juiz de Fora, Faculdade de Medicina, Departamento de Clínica Médica, Juiz de Fora, MG, Brasil
| | - Ana Paula Carlos Cândido
- Universidade Federal de Juiz de Fora, Instituto de Ciências Biológicas, Departamento de Nutrição, Juiz de Fora, MG, Brasil
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Roumelioti ME, Steel JL, Yabes J, Vowles KE, Vodovotz Y, Beach S, Rollman B, Weisbord SD, Unruh ML, Jhamb M. Rationale and design of technology assisted stepped collaborative care intervention to improve patient-centered outcomes in hemodialysis patients (TĀCcare trial). Contemp Clin Trials 2018; 73:81-91. [PMID: 30208343 PMCID: PMC6168366 DOI: 10.1016/j.cct.2018.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 08/17/2018] [Accepted: 09/07/2018] [Indexed: 01/08/2023]
Abstract
Most hemodialysis (HD) patients experience symptoms of depression, pain and fatigue that impair their health-related quality of life (HRQOL) significantly. These symptoms are associated with increased hospitalization and mortality, mediated by behavioral factors (e.g. non-adherence to medication and dialysis) and biological factors (e.g. inflammatory cytokines). Prior interventions to alleviate symptoms and improve HRQOL showed limited effectiveness in HD patients and their effect on bio-behavioral mediators is lacking evidence. It is imperative to improve patient-centered dialysis care and to address call from Kidney Disease Improving Global Outcomes (KDIGO) guidelines for integration of symptom assessment and management in routine HD-care. Technology-Assisted stepped Collaborative Care (TĀCcare) is a multi-center randomized controlled trial (RCT) of 150 diverse HD patients from Pennsylvania and New Mexico, designed to compare the effectiveness of a 12-week stepped collaborative care intervention (cognitive behavioral therapy, CBT) with an attention control arm of technology-delivered health education. Collaborative care provides an integrated multi-disciplinary structured management plan. Furthermore, a stepped approach to pharmacotherapy and/or CBT allows for individualization of treatment according to patients' clinical status, preferences and treatment response. To simplify the delivery of CBT and to minimize patient and provider burden, we will use live video-conferencing with patients in dialysis units. We will examine the effect of these interventions on patient symptoms, HRQOL, treatment adherence and inflammatory biomarkers. This RCT tests a readily implementable intervention that can be integrated in routine HD-care and will generate novel and meaningful insights on strategies to alleviate common symptoms and improve HRQOL in HD.
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Affiliation(s)
- Maria-Eleni Roumelioti
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine Albuquerque, NM, United States
| | - Jennifer L Steel
- Department of Surgery, Psychiatry and Psychology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jonathan Yabes
- Center for Research on Heath Care, Division of General Internal Medicine, Department of Medicine and Biostatistics, University of Pittsburgh, Pittsburgh, PA, United States
| | - Kevin E Vowles
- Department of Psychology, University of New Mexico & Division of Physical Medicine and Rehabilitation, University of New Mexico Health Sciences Center, Albuquerque, NM, United States
| | - Yoram Vodovotz
- Department of Immunology and Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Scott Beach
- Department of Psychology, University Center for Social and Urban Research, University of Pittsburgh, Pittsburgh, PA, United States
| | - Bruce Rollman
- Department of Medicine, Psychiatry, Biomedical Informatics, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh, PA, United States
| | - Steven D Weisbord
- Renal and Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Mark L Unruh
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine Albuquerque, NM, United States
| | - Manisha Jhamb
- Renal and Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
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Huang WH, Wu YF, Cong JM, Jiang X. Role of Different Blood Purification Nursing Models in Uremic Patients: A Preliminary Report. Med Sci Monit 2018; 24:6873-6881. [PMID: 30264774 PMCID: PMC6266723 DOI: 10.12659/msm.910877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Accumulation of uremic toxins is closely associated with chronic kidney disease (CKD)-related complications such as cerebrovascular accidents and cardiovascular diseases. Clinical nursing is accepted as a critical clinical prognosis factor for hospitalized patients. The present study was designed to compare the effects of different blood purification nursing models on clinical outcomes in patients with uremia. Material/Methods A total of 68 patients with uremia were selected and divided to control and intervention groups. The patients in the control group received traditional nursing model care, while the patients in intervention group received comprehensive high-quality nursing care for 6 months. Results After 6 months of treatment, the quality of life, anxiety, and depression were obviously ameliorated in both groups. The levels of blood urea nitrogen (BUN), parathyroid hormone (PTH), creatinine, β2-microglobulin (β2-MG), total cholesterol (TC), albumin (ALB), interleukin-1β (IL-1β), IL-6, tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), 8-isoprostane, and malondialdehyde (MDA), as well as superoxide dismutase (SOD) and catalase (CAT) activities were all significantly improved in both groups of patients, but the intervention group exhibited better results than the control group. Conclusions Our results demonstrated that comprehensive high-quality nursing care rectified the metabolic disorders and inhibited systematic inflammatory factors, and oxidative stress, which may be responsible for better amelioration of quality of life in patients with uremia.
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Affiliation(s)
- Wei-Hong Huang
- Department of Nephrology, Center of Blood Purification, The Second People's Hospital of Nantong, Nantong, Jiangsu, China (mainland)
| | - Yu-Feng Wu
- Department of Nephrology, Center of Blood Purification, The Second People's Hospital of Nantong, Nantong, Jiangsu, China (mainland)
| | - Jin-Mei Cong
- Department of Nephrology, Center of Blood Purification, The Second People's Hospital of Nantong, Nantong, Jiangsu, China (mainland)
| | - Xia Jiang
- Department of Nephrology, Center of Blood Purification, The Second People's Hospital of Nantong, Nantong, Jiangsu, China (mainland)
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Microbiota issue in CKD: how promising are gut-targeted approaches? J Nephrol 2018; 32:27-37. [PMID: 30069677 DOI: 10.1007/s40620-018-0516-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 07/15/2018] [Indexed: 12/12/2022]
Abstract
In chronic kidney disease (CKD), the progressive decline in the renal excretory function leads to accumulation of urea and toxins in the blood. The CKD-associated dysbiosis of gut microbiota further contributes to uremia by increasing intestinal toxins production. Gut microbiota is involved in a complex network of human organs, mediated by microbial metabolites: in CKD, gut-heart and gut-brain axes may have a role in increased cardiovascular risk and neuropsychiatric disorders. While the cardiovascular toxicity of some microbial molecules is well known, their presumptive neurotoxicity needs to be confirmed by specific studies. In this review, we describe gut-heart and gut-brain axes in CKD, with an overview of the experimental and human studies characterizing CKD-associated gut microbiota, and we discuss the benefits coming from new approaches aimed at gut manipulation. Microbiota metabolism is emerging as a modifiable non-traditional risk factor in nephrology. In order to take advantage of this issue, it is necessary to consider the microbiota manipulation as part of the nutritional management of CKD. Integrating the low-protein nutritional approach with prebiotic, probiotic and synbiotic supplementation is a promising tool to control disease progression and comorbidities, though an extensive validation in large-scale clinical trials is still required.
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Semaan V, Noureddine S, Farhood L. Prevalence of depression and anxiety in end-stage renal disease: A survey of patients undergoing hemodialysis. Appl Nurs Res 2018; 43:80-85. [PMID: 30220369 DOI: 10.1016/j.apnr.2018.07.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 07/25/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Dialysis is a lifelong treatment required by end stage renal disease patients who are not able to undergo renal transplantation. Dialysis impacts the patients' quality of life drastically, increasing the risk of mortality. Depression and anxiety are commonly reported among dialysis patients, but their prevalence and correlates vary by sociocultural context. OBJECTIVE The aim of this study is to examine the prevalence of anxiety and depression and associated factors among patients receiving hemodialysis at a major tertiary referral medical center in Lebanon that receives patients from all over the country. DESIGN A cross-sectional, descriptive design was used. METHODS Ninety patients receiving hemodialysis were targeted using convenience sampling, with a final sample size of 83 patients. The patients were interviewed while undergoing their dialysis session using the Hospital Anxiety and Depression Scale, and asked demographic and clinical questions. RESULTS The majority of participants were married men over 60 years of age; 48% achieved high school education. Depression was prevalent in 40.8% and anxiety in 39.6%, with 20 patients (24.1%) having both conditions. Although 24.1% self-reported anxiety symptoms, only 2.4% were taking anxiolytics. Illiterate patients had significantly higher depression scores than those with higher levels of education (p = 0.021). Patients who were living with their family had higher anxiety scores than those living alone (p = 0.014). CONCLUSION Anxiety and depression are underdiagnosed and undertreated in Lebanese dialysis patients. Screening and appropriate referral to mental health specialists are needed.
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Affiliation(s)
- Victoria Semaan
- American University of Beirut Medical Center, Cairo Street, Beirut 1107 2020, Lebanon.
| | - Samar Noureddine
- American University of Beirut, Hariri School of Nursing, Beirut 1107 2020, Lebanon
| | - Laila Farhood
- American University of Beirut, Hariri School of Nursing, Beirut 1107 2020, Lebanon
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Alshogran OY, Khalil AA, Oweis AO, Altawalbeh SM, Alqudah MAY. Association of brain-derived neurotrophic factor and interleukin-6 serum levels with depressive and anxiety symptoms in hemodialysis patients. Gen Hosp Psychiatry 2018; 53:25-31. [PMID: 29727764 DOI: 10.1016/j.genhosppsych.2018.04.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 04/14/2018] [Accepted: 04/22/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This study assessed the possible association of serum brain-derived neurotrophic factor (BDNF) and interleukin-6 (IL-6) with depressive and anxiety symptoms in hemodialysis (HD) patients. METHOD An analytical cross-sectional study was conducted over 274 HD patients from March to October 2017. The Hospital Anxiety and Depression Scale (HADS) was utilized to evaluate depressive (HADS-D) and anxiety (HADS-A) symptoms. The HADS-D/A is a self-report instrument that has a maximum score of 21. Serum BDNF and IL-6 were measured using enzyme-linked immunosorbant assay (ELISA). RESULTS Serum IL-6 was significantly higher in patients with depressive symptoms compared to normal (20.47 ± 4.27 pg/mL for HADS-D ≥11 versus 9.26 ± 1.59 pg/mL for HADS-D <7, p = 0.014). Multivariable regression analysis revealed that IL-6, education level, hypertension, and dialysis duration were significant predictors of HADS-D. Also, gender, education level, hypertension, and the number of dialysis sessions/week were significant predictors of HADS-A. Significant positive correlation was shown between HADS-D and IL-6 (r = 0.1729, p = 0.004). CONCLUSION Collectively, HD patients with depressive symptoms showed higher levels of IL-6, supporting previous findings that the circulating inflammatory mediator IL-6 can be used as a biomarker for prediction of depressive symptoms in HD patients. Further longitudinal or interventional studies are needed to further validate this association.
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Affiliation(s)
- Osama Y Alshogran
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan.
| | - Amani A Khalil
- Department of Clinical Nursing, Faculty of Nursing, The University of Jordan, Amman, Jordan
| | - Ashraf O Oweis
- Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Shoroq M Altawalbeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad A Y Alqudah
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
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Goh ZS, Griva K. Anxiety and depression in patients with end-stage renal disease: impact and management challenges - a narrative review. Int J Nephrol Renovasc Dis 2018; 11:93-102. [PMID: 29559806 PMCID: PMC5856029 DOI: 10.2147/ijnrd.s126615] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Psychiatric disorders commonly co-exist with the diagnosis of chronic kidney disease (CKD). Research on depression and CKD has increased to a great extent. Multiple studies have demonstrated that depression is more prevalent in CKD and that end-stage renal disease is a robust risk factor for adverse outcomes such as hospitalization and mortality, yet these are often underdiagnosed or untreated. This review provides a selective overview on the prevalence rates of depression and anxiety in patients with CKD and across renal replacement therapies, the factors most consistently associated with symptoms of distress and their clinical implications. Finally, treatment and management strategies from relevant literature are appraised and discussed.
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Affiliation(s)
- Zhong Sheng Goh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Konstadina Griva
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Grabulosa CC, Manfredi SR, Canziani ME, Quinto BMR, Barbosa RB, Rebello JF, Batista MC, Cendoroglo M, Dalboni MA. Chronic kidney disease induces inflammation by increasing Toll-like receptor-4, cytokine and cathelicidin expression in neutrophils and monocytes. Exp Cell Res 2018; 365:157-162. [PMID: 29481790 DOI: 10.1016/j.yexcr.2018.02.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 02/17/2018] [Accepted: 02/19/2018] [Indexed: 11/28/2022]
Abstract
TLR expression in neutrophils and monocytes is associated with increased cytokine synthesis, resulting in increased inflammation. However, the inflammatory pathway related to TLR and cathelicidin expression in these cells from CKD patients is unclear. To evaluate TLR4, cathelicidin, TNF-α, IL-6, IL-10 and MCP-1 expression in neutrophils and monocytes from HD and CKD patients. Blood samples were drawn from 47 CKD and 43 HD patients and 71 age and gender-matched healthy volunteers (CONT). TLR4 was analyzed using flow cytometry. Cathelicidin, TNF-α, IL-6, IL-10 and MCP-1 were analyzed via ELISA.TLR4 expression in neutrophils was higher in HD patients than in stage 3 and 4 CKD patients. In these cells, we observed a positive correlation between TLR4 and cathelicidin, TNF-α, IL-6, IL-10 and MCP-1 levels. In monocytes, TLR4 expression was significantly higher in CKD 3 and 4 groups than in the control and HD groups and positively and negatively correlated with IL-6 and MCP-1 and cathelicidin, respectively. TNF-α, IL-6 and MCP-1 serum levels were higher in HD and CKD patients than in control. Cathelicidin and IL-10 levels were only higher in HD patients. IL-6 serum levels were positively correlated with all cytokines, and cathelicidin was negatively correlated with MCP-1 (r = - 0.35; p < 0.01) and positively correlated with IL-10 (r = 0.37; p = 0.001). These results suggest that a uremic environment induces high TLR4, cathelicidin and cytokine expression and may increase inflammation. Thus, future studies should be conducted to evaluate whether TLR4 and cathelicidin should be targets for anti-inflammatory therapeutic strategies.
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Affiliation(s)
| | | | | | | | | | | | - Marcelo C Batista
- Nephrology Division, Universidade Federal de São Paulo, Brazil; Tufts-New England Medical Center, Boston, USA; Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Miguel Cendoroglo
- Nephrology Division, Universidade Federal de São Paulo, Brazil; Tufts-New England Medical Center, Boston, USA; Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Maria A Dalboni
- Nephrology Division, Universidade Federal de São Paulo, Brazil; Universidade Nove de Julho, São Paulo, Brazil.
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Haddad Kashani H, Seyed Hosseini E, Nikzad H, Soleimani A, Soleimani M, Tamadon MR, Keneshlou F, Asemi Z. The Effects of Vitamin D Supplementation on Signaling Pathway of Inflammation and Oxidative Stress in Diabetic Hemodialysis: A Randomized, Double-Blind, Placebo-Controlled Trial. Front Pharmacol 2018; 9:50. [PMID: 29456507 PMCID: PMC5801479 DOI: 10.3389/fphar.2018.00050] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 01/15/2018] [Indexed: 01/02/2023] Open
Abstract
Objective: This study was carried out to determine the effects of vitamin D supplementation on signaling pathway of inflammation and oxidative stress in diabetic hemodialysis (HD) patients. Methods: This randomized double-blind placebo-controlled clinical trial was conducted among 60 diabetic HD patients. Subjects were randomly allocated into two groups to intake either vitamin D supplements at a dosage of 50,000 IU (n = 30) or placebo (n = 30) every 2 weeks for 12 weeks. Gene expression of inflammatory cytokines and biomarkers of oxidative stress were assessed in peripheral blood mononuclear cells (PBMCs) of diabetic HD patients with RT-PCR method. Results: Results of RT-PCR indicated that after the 12-week intervention, compared to the placebo, vitamin D supplementation downregulated gene expression of interleukin (IL)-1β (P = 0.02), tumor necrosis factor alpha (TNF-α) (P = 0.02) and interferon gamma (IFN-γ) (P = 0.03) in PBMCs of diabetic HD patients. Additionally, vitamin D supplementation, compared to the placebo, downregulated gene expression of transforming growth factor beta (TGF-β) (P = 0.04), protein kinase C (PKC) (P = 0.001), and mitogen-activated protein kinases 1 (MAPK1) (P = 0.02) in PBMCs of diabetic HD patients. Although not significant, vitamin D supplementation let to a reduction of nuclear factor kappa B (NF-kB) (p = 0.75) expression in PBMCs isolated from diabetic patients compared to the placebo group. There was no statistically significant change following supplementation with vitamin D on gene expression of interleukin (IL)-4, IL-6, and vascular endothelial growth factor (VEGF) in PBMCs of diabetic HD patients. Conclusions: Overall, we found that vitamin D supplementation for 12 weeks among diabetic HD patients had beneficial effects on few gene expression related to inflammation and oxidative stress. Clinical trial registration: IRCT201701035623N101. Registered on January 8, 2017.
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Affiliation(s)
- Hamed Haddad Kashani
- Anatomical Sciences Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Elahe Seyed Hosseini
- Anatomical Sciences Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Hossein Nikzad
- Anatomical Sciences Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Alireza Soleimani
- Department of Internal Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Maryam Soleimani
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran
| | - Mohammad Reza Tamadon
- Department of Internal Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Fariba Keneshlou
- Department of Urology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Zatollah Asemi
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran
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Guenzani D, Buoli M, Carnevali GS, Serati M, Messa P, Vettoretti S. Is there an association between severity of illness and psychiatric symptoms in patients with chronic renal failure? PSYCHOL HEALTH MED 2018; 23:970-979. [DOI: 10.1080/13548506.2018.1426868] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- D. Guenzani
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M. Buoli
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - G. S. Carnevali
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M. Serati
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - P. Messa
- Unit of Nephrology Dialysis and Renal Transplantation, Fondazione Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy
| | - S. Vettoretti
- Unit of Nephrology Dialysis and Renal Transplantation, Fondazione Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy
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Haverkamp GL, Loosman WL, Franssen CF, Kema IP, van Diepen M, Dekker FW, Honig A, Siegert CE. The role of tryptophan degradation in the association between inflammatory markers and depressive symptoms in chronic dialysis patients. Nephrol Dial Transplant 2018; 32:1040-1047. [PMID: 27220752 DOI: 10.1093/ndt/gfw212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 04/09/2016] [Indexed: 01/08/2023] Open
Abstract
Background Among chronic dialysis patients, associations have been found between inflammatory markers and depressive symptoms. In this population, no studies have examined the mechanism linking the association between inflammatory markers and depressive symptoms. We examined whether the association between inflammatory markers and depressive symptoms is mediated by tryptophan (TRP) degradation along the kynurenine (KYN) pathway. Methods The data are part of an observational, prospective cohort study in five urban dialysis centres in The Netherlands. Depressive symptoms were determined with the Beck Depression Inventory. Peripheral blood was collected before dialysis to measure inflammatory markers [high sensitivity C-reactive protein (HsCRP), interleukin (IL)-1β, IL-6, IL-10 and tumour necrosis factor-α (TNF-α)], TRP, KYN and 3-hydroxykynurenine. The KYN/TRP ratio was used as a measure of TRP degradation. The association between inflammatory markers and depressive symptoms was determined using linear regression analysis and adjusted for the KYN/TRP ratio. Results In total, 490 chronic dialysis patients were included. HsCRP [ β = 3.8; confidence interval (CI): 1.0-6.6], IL-6 ( β = 9.1; CI: 4.0-14.1) and TNF-α ( β = 1.3; CI: 0.9-1.7) were associated with the KYN/TRP ratio. We found significant associations between HsCRP ( β = 0.8; CI: 0.3-1.3) and IL-6 ( β = 1.2; CI: 0.3-2.2) levels and depressive symptoms. However, this association was not attenuated after adjustment for the KYN/TRP ratio. Also, no significant associations were found between the KYN/TRP ratio and depressive symptoms. Conclusion The association between inflammatory markers and depressive symptoms in chronic dialysis patients was not mediated by TRP degradation along the KYN pathway.
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Affiliation(s)
- Gertrud L Haverkamp
- Department of Nephrology, OLVG west, Amsterdam, The Netherlands.,Department of Psychiatry, OLVG west, Amsterdam, The Netherlands
| | - Wim L Loosman
- Department of Nephrology, OLVG west, Amsterdam, The Netherlands.,Department of Psychiatry, OLVG west, Amsterdam, The Netherlands
| | - Casper F Franssen
- Department of Nephrology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Ido P Kema
- Department of Laboratory Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Merel van Diepen
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Adriaan Honig
- Department of Psychiatry, OLVG west, Amsterdam, The Netherlands.,Department of Psychiatry, VU Medical Centre, Amsterdam, The Netherlands
| | - Carl E Siegert
- Department of Nephrology, OLVG west, Amsterdam, The Netherlands
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Haverkamp GL, Loosman WL, Schouten RW, Franssen CF, Kema IP, van Diepen M, Dekker FW, Siegert CE, Honig A. Differences in the association of inflammation and tryptophan with depressive symptoms between white and non-white chronic dialysis patients. Gen Hosp Psychiatry 2018; 50:76-82. [PMID: 29065338 DOI: 10.1016/j.genhosppsych.2017.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 10/09/2017] [Accepted: 10/11/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Possibly, different biochemical parameters are involved in the development of depressive symptoms in white and non-white dialysis patients. We examined whether the association between inflammation and depressive symptoms and between tryptophan and depressive symptoms differs between white and non-white dialysis patients and whether the association between inflammation and depressive symptoms is mediated by tryptophan degradation along the kynurenine pathway in both groups. METHOD Depressive symptoms were measured with the BDI-II. HsCRP, IL-1β, IL-6, IL-10, and TNFα and tryptophan and its degradation products kynurenine and 3-hydroxykynurenine were measured in 270 white and 220 non-white patients. RESULTS The presence of depressive symptoms was significantly higher in non-white patients (51%) than in white patients (37%) (P<0.01). Among white patients, HsCRP was significantly associated with depressive symptoms (β=0.6 (95% CI: 0.1-1.2)). Among non-white patients, significant associations with depressive symptoms were found for both HsCRP (β=1.0 (95% CI: 0.1-2.0)) and IL-6 (β=2.6 (95% CI: 0.8-4.4)). Tryptophan levels were only significantly associated with depressive symptoms in non-white patients (β=-0.3 (95% CI: -0.4--0.1)). Tryptophan degradation along the kynurenine pathway did not mediate the association between inflammatory markers and depressive symptoms in either group. CONCLUSION Our results indicate that for white and non-white dialysis patients different biochemical parameters are associated with depressive symptoms.
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Affiliation(s)
- Gertrud L Haverkamp
- Department of Nephrology, OLVG west, Amsterdam, The Netherlands; Department of Psychiatry, OLVG west, Amsterdam, The Netherlands.
| | - Wim L Loosman
- Department of Nephrology, OLVG west, Amsterdam, The Netherlands; Department of Psychiatry, OLVG west, Amsterdam, The Netherlands
| | - Robbert W Schouten
- Department of Nephrology, OLVG west, Amsterdam, The Netherlands; Department of Psychiatry, OLVG west, Amsterdam, The Netherlands
| | - Casper F Franssen
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ido P Kema
- Department of Laboratory Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Merel van Diepen
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Carl E Siegert
- Department of Nephrology, OLVG west, Amsterdam, The Netherlands
| | - Adriaan Honig
- Department of Psychiatry, OLVG west, Amsterdam, The Netherlands; Department of Psychiatry, VU Medical Center, Amsterdam, The Netherlands
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