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Kallem CJ, Alghwiri AA, Yabes JG, Roumelioti ME, Erickson S, Rollman BL, Weisbord S, Unruh M, Vodovotz Y, Jhamb M, Steel JL. Association of Symptoms and Collaborative Care Intervention with Systemic Inflammation Biomarkers in ESKD. KIDNEY360 2024; 5:1299-1310. [PMID: 39012260 DOI: 10.34067/kid.0000000000000512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 07/10/2024] [Indexed: 07/17/2024]
Abstract
Key Points
There were no associations between biomarkers and patient-reported pain, fatigue, and depression in a large ESKD cohort at baseline.Compared with control, the Technology-Assisted stepped Collaborative Care intervention had a short-term impact on reducing inflammatory burden.Treatment modified the association between changes in symptoms and in certain proinflammatory biomarkers (TNF-α and high sensitivity C-reactive protein) over time.
Background
Patient-reported symptoms are associated with inflammation biomarkers in many chronic diseases. We examined associations of inflammation biomarkers with pain, fatigue, and depression in patients with ESKD and the effects of a Technology-Assisted stepped Collaborative Care (TĀCcare) intervention on these biomarkers.
Methods
In the TĀCcare multisite randomized control trial, data on patient-reported symptoms were collected at baseline and 3 and 6 months. Anti-inflammatory (IL-1 receptor agonist, IL-10), proinflammatory (TNF-α, high sensitivity C-reactive protein, IL-6), and regulatory (IL-2) biomarkers were assayed. Linear mixed-effects modeling was used to examine within-group and between-group differences after adjusting for age, sex, race, and comorbidities.
Results
Among the 160 patients (mean age 58±14 years, 55% men, 52% white), there were no significant associations between inflammation biomarkers and pain, fatigue, or depression at baseline. Both intervention and control groups demonstrated reductions in IL-10 and IL-1 receptor agonist over 6 months (β range=−1.22 to −0.40, P range=<0.001–0.02) At 3 months, the treatment group exhibited decreases in TNF-α (β=−0.22, P < 0.001) and IL-2 (β=−0.71, P < 0.001), whereas the control group showed increases in IL-6/IL-10 ratio (β=0.33, P = 0.03). At 6 months, both groups exhibited decreases in IL-2 (β range=−0.66 to −0.57, P < 0.001); the control group showed significant increases in the ratio of IL-6/IL-10 (β=0.75, P < 0.001) and decrease in TNF-α (β=−0.16, P = 0.02). Compared with controls, the treatment group demonstrated significantly decreased IL-2 at 3 months (β=−0.53, P < 0.001). Significant interaction effects of treatment were observed on the association between changes in proinflammatory biomarkers (TNF-α and high sensitivity C-reactive protein) levels and changes in symptom scores from baseline to 6 months.
Conclusions
The TĀCcare intervention had a short-term impact on reducing inflammatory burden in patients with ESKD. More studies are needed to confirm our findings and to determine whether these biomarkers mediate the link between symptoms and disease progression.
Clinical Trial registration number:
ClinicalTrials.gov NCT03440853.
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Affiliation(s)
- Cramer J Kallem
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Alaa A Alghwiri
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jonathan G Yabes
- Division of General Internal Medicine, Department of Medicine and Biostatistics, Center for Research on Heath Care Data Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Maria-Eleni Roumelioti
- Division of Nephrology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Sarah Erickson
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico
| | - Bruce L Rollman
- Division of General Internal Medicine, Center for Behavioral Health, Media, and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Steven Weisbord
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- 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
| | - Yoram Vodovotz
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Manisha Jhamb
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jennifer L Steel
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Psychology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Jayakumar S, Jennings S, Halvorsrud K, Clesse C, Yaqoob MM, Carvalho LA, Bhui K. A systematic review and meta-analysis of the evidence on inflammation in depressive illness and symptoms in chronic and end-stage kidney disease. Psychol Med 2023; 53:5839-5851. [PMID: 36254747 DOI: 10.1017/s0033291722003099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Depression affects approximately 27% of adults with chronic kidney disease (CKD) and end-stage kidney failure (ESKF). Depression in this population is associated with impaired quality of life and increased mortality. The extent of inflammation and the impact on depression in CKD/ESKF is yet to be established. Through a systematic literature review and meta-analysis, we aim to understand the relationship between depression and inflammation in CKD/ESKF patients. METHODS We searched nine electronic databases for published studies until January 2022. Titles and abstracts were screened against inclusion and exclusion criteria. Data extraction and study quality assessment was carried out independently by two reviewers. A meta-analysis was carried out where appropriate; otherwise a narrative review of studies was completed. RESULTS Sixty studies met our inclusion criteria and entered the review (9481 patients included in meta-analysis). Meta-analysis of cross-sectional associations revealed significantly higher levels of pro-inflammatory biomarkers; C-reactive protein; Interleukin 6 (IL-6) and tumour necrosis factor-alpha in patients with depressive symptoms (DS) compared to patients without DS. Significantly lower levels of anti-inflammatory cytokine IL-10 were found in patients with DS compared to patients without DS. Considerable heterogeneity was detected in the analysis for most inflammatory markers. CONCLUSION We found evidence for an association of higher levels of pro-inflammatory and lower anti-inflammatory cytokines and DS in patients with CKD/ESKF. Clinical trials are needed to investigate whether anti-inflammatory therapies will be effective in the prevention and treatment of DS in these patients with multiple comorbidities.
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Affiliation(s)
- Simone Jayakumar
- Center for Psychiatry and Mental Health, Wolfson Institute of Population Health, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
- Department of Clinical Pharmacology, William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Stacey Jennings
- Center for Psychiatry and Mental Health, Wolfson Institute of Population Health, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | | | - Christophe Clesse
- Center for Psychiatry and Mental Health, Wolfson Institute of Population Health, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
- Department of Clinical Pharmacology, William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Muhammad Magdi Yaqoob
- Translational Medicine and Therapeutics, William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Livia A Carvalho
- Department of Clinical Pharmacology, William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Kamaldeep Bhui
- Center for Psychiatry and Mental Health, Wolfson Institute of Population Health, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
- Department of Psychiatry and Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- East London NHS Foundation Trust and Oxford Health NHS Foundation Trust, London, UK
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Slimani L, Jhilal F, Ahid S, Maoujoud A. Comparison of the Impact of Conventional Hemodialysis and Hemodiafiltration Techniques on the Evolution of Certain Mineral Bone Parameters in Chronic Hemodialysis Patients. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.10276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective: The aim of this study was to compare the impact of conventional hemodialysis (HDC) and hemodiafiltration (HDF) techniques on the evolution of the parameters of phosphocalcic metabolism in chronic hemodialysis patients.
Methods: This is a retrospective, descriptive and analytical study carried out in the hemodialysis center of Agadir medico-surgical center during 2015. The total number of patients is 34, 18 were treated by HDC ie 52.9% of cases. Also, 16 patients underwent HDF, ie 47.1% of cases. With each of the 2 techniques, the following parameters were measured: To assess the PTH level, we performed 3 measurements. To evaluate calcium, phosphorus, albumine and CRP levels, 7 measurements were taken. The data were entered via Excel and analyzed through Jamovi 1.6.9 software. We used the Wilcoxon or the Mann-Whitney test for the means. The factors associated with the variation of the studied parameters were analyzed in univariate and multivariate analyzes using the binary logistic regression model.
Results: Our population was made up of 41.2% women and 58.8% men. Their average age was 55 ± 11 years. Also, 82.3% of cases had a normal build, 11.7% were overweight and 6% were moderately obese. The distribution of patients according to the causal nephropathy of chronic renal insufficiency presented a predominance of diabetic nephropathy (32.3%) followed by vascular pathology in 10 patients (29.4%). There was no statistically significant difference in the evolution of the levels of the parameters studied (PTH, calcium, phosphorus, albumin and CRP levels) over time. Univariate analysis showed that only the initial nephropathy factors: other nephropathy-vascular nephropathy (p= 0.028; OR=0.060; IC95% [0.004-0.734]) and diabetic nephropathy-vascular nephropathy (p= 0.011; OR=0.050; IC95% [0.004-0.508]) were associated with the variation of the studied parameters. The same factors also emerge in the multivariate analysis: other nephropathy-vascular nephropathy (p= 0.034; OR=0.044; IC95% [0.002-0.791]) and diabetic nephropathy-vascular nephropathy (p= 0.009; OR=0.032; IC95% [0.002-0.429]).
Conclusion: According to our results, it seems that there are no significant differences in the evolution of some mineral bone parameters studied with the HDC and HDF techniques.
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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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Fan S, Lin L, Chen VC, Hsieh C, Hsiao H, McIntyre RS, Iacobucci M, Coles AS, Tsai D, Weng J, Chen Y. Effects of Lower Past‐Year Serum Sodium and Hyponatremia on Depression Symptoms and Cognitive Impairments in Patients With Hemodialysis. Ther Apher Dial 2019; 24:169-177. [DOI: 10.1111/1744-9987.13395] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/04/2019] [Accepted: 07/09/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Szu‐Shan Fan
- Department of SurgeryPingtung Christian Hospital Pingtung Taiwan
| | - Lian‐Feng Lin
- Department of Internal MedicineChristian Hospital Pingtung Taiwan
| | - Vincent Chin‐Hung Chen
- Department of Psychiatry, Chang Gung Medical FoundationChiayi Chang Gung Memorial Hospital Puzi Taiwan
- School of MedicineChang Gung University Taoyuan Taiwan
| | - Chin‐Wen Hsieh
- Graduate Institute of Medicine, College of MedicineKaohsiung Medical University Kaohsiung Taiwan
- Division of Nephrology, Department of Internal MedicinePingtung Christian Hospital Pingtung Taiwan
| | - Han‐Pin Hsiao
- Department of Psychiatry, Chang Gung Medical FoundationChiayi Chang Gung Memorial Hospital Puzi Taiwan
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health NetworkUniversity of Toronto Toronto ON USA
- Department of PsychiatryUniversity of Toronto Toronto ON USA
| | - Michelle Iacobucci
- Mood Disorders Psychopharmacology Unit, University Health NetworkUniversity of Toronto Toronto ON USA
| | - Alexandria S Coles
- Mood Disorders Psychopharmacology Unit, University Health NetworkUniversity of Toronto Toronto ON USA
| | - Duu‐Jian Tsai
- Center for Bioethics and Social MedicinePingtung Christian Hospital Pingtung Taiwan
- Graduate Institute of Health & Social PolicyNational Yang‐Ming University Taipei Taiwan
| | - Jun‐Cheng Weng
- Department of Psychiatry, Chang Gung Medical FoundationChiayi Chang Gung Memorial Hospital Puzi Taiwan
- Department of Medical Imaging and Radiological SciencesChang Gung University Taoyuan Taiwan
| | - Yi‐Lung Chen
- Department of Psychiatry, Chang Gung Medical FoundationChiayi Chang Gung Memorial Hospital Puzi Taiwan
- Department of Healthcare AdministrationAsia University Taichung Taiwan
- Department of PsychologyAsia University Taichung Taiwan
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Zhang W, Mei C, Chen N, Ding X, Ni Z, Hao C, Zhang J, Zhang J, Wang N, Jiang G, Guo Z, Yu C, Deng Y, Li H, Yao Q, Marshall MR, Wolley MJ, Qian J. Outcomes and practice patterns with hemodiafiltration in Shanghai: a longitudinal cohort study. BMC Nephrol 2019; 20:34. [PMID: 30709342 PMCID: PMC6359843 DOI: 10.1186/s12882-019-1219-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 01/17/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally, there is increased clinical interest and uptake of hemodiafiltration (HDF) for increased removal of uremic toxins. To date, there has been no epidemiological analysis of HDF in China. We present HDF practice patterns and associated mortality risk in Shanghai. METHODS This is an observational, prospectively collected, retrospective analysis of 9351 Chinese patients initiating hemodialysis in Shanghai from 2007 to 2014. The primary exposure was hemodialysis sub-modality at inception, classified into hemodiafiltration (HDF) and hemodialysis (HD), with adjustment for concommitant hemoperfusion. The primary outcome was patient mortality. We used Cox proportional hazards regression and Fine and Gray's proportional subhazards regression, with multiple imputation of missing co-variates by the chained equation method, adjusting for demographic and clinical variables. RESULTS Overall, patients in the cohort were younger, with a more males, and with a lower body mass index when compared to corresponding non-Asian cohorts. Mortality rate was low although it doubled over the period of observation. HDF utilization increased from 7% of patients in 2007 to 42% of patients in 2014. The majority of patients received HDF once a week. The adjusted hazard ratio of death (95% confidence intervals) for HDF versus HD was 0.85 (0.71-1.03), and corresponding sub-hazard ratio 0.86 (0.71-1.03). There was strong effect modification by age. In those aged 40-60 years, the hazard ratio (95% confidence intervals) was 0.65 (0.45-0.94), and sub-hazard ratio also 0.65 (0.45-0.95). CONCLUSIONS Our study has certain limitations resulting from the limited number of co-variates available for modelling, missing data for some co-variates, and the lack of verification of data against source documentation. Notwithstanding, there is evidence of clinical benefit from HDF in China, and potential to improve patient outcomes through the greater removal of middle and larger uremic solutes.
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Affiliation(s)
- Weiming Zhang
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127 China
| | - Changlin Mei
- Department of Nephrology, Changzheng Hospital, Second Military Medical University, Shanghai, 200003 China
| | - Nan Chen
- Department of Nephrology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200025 China
| | - Xiaoqiang Ding
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200032 China
| | - Zhaohui Ni
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127 China
| | - Chuanming Hao
- Division of Nephrology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, 200040 China
| | - Jinghong Zhang
- Department of Nephrology, 85 Hospital of People’s Liberation Army, Shanghai, 200052 China
| | - Jinyuan Zhang
- Department of Nephrology, 455 Hospital of People’s Liberation Army, Shanghai, 200052 China
| | - Niansong Wang
- Department of Nephrology, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai, 200233 China
| | - Gengru Jiang
- Department of Nephrology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 202150 China
| | - Zhiyong Guo
- Department of Nephrology, Changhai Hospital, Second Military Medical University, Shanghai, Shanghai, 200433 China
| | - Chen Yu
- Department of Nephrology, Tongji Hospital, Tongji University, Shanghai, 200092 China
| | - Yueyi Deng
- Department of Nephrology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032 China
| | - Haiming Li
- Baxter China Investment Co Ltd, Medical Affairs, Shanghai, 200031 China
| | - Qiang Yao
- Baxter China Investment Co Ltd, Medical Affairs, Shanghai, 200031 China
| | - Mark R. Marshall
- Baxter Healthcare (Asia) Pte Ltd, Medical Affairs, Singapore, 189673 Singapore
- School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, 1142 New Zealand
- Department of Renal Medicine, Counties Manukau Health, Auckland, 1640 New Zealand
| | - Martin J. Wolley
- Department of Renal Medicine, Royal Brisbane and Women’s Hospital, Brisbane, Queensland 4029 Australia
- School of Medicine, University of Queensland, Brisbane, Queensland 4072 Australia
| | - Jiaqi Qian
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127 China
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Wang YY, Zhang WW, Feng L, Gao D, Liu C, Zhong L, Ren JW, Wu YZ, Huang L, Fu LL, He YN. Development and Preliminary Validation of a Depression Assessment Tool for Maintenance Hemodialysis Patients. Ther Apher Dial 2018; 23:49-58. [PMID: 30239119 DOI: 10.1111/1744-9987.12749] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 06/11/2018] [Accepted: 07/19/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Yun-yan Wang
- Department of Nephrology, Daping Hospital; Third Military Medical University; Chongqing China
| | - Wei-wei Zhang
- Department of Nephrology, Daping Hospital; Third Military Medical University; Chongqing China
| | - Lei Feng
- Department of Nephrology, Daping Hospital; Third Military Medical University; Chongqing China
| | - Dong Gao
- Department of Sleep and Psychology, Institute of Surgery Research, Daping Hospital; Third Military Medical University; Chongqing China
| | - Chun Liu
- Department of Nephrology; The Third People's Hospital of Chongqing; Chongqing China
| | - Ling Zhong
- Department of Nephrology, The Second Affiliated Hospital; Chongqing Medical University; Chongqing China
| | - Jiang-wen Ren
- Department of Nephrology; The First People's Hospital of Jiulongpo District; Chongqing China
| | - Ya-zhou Wu
- Department of Statistics, Preventive Medicine; Third Military Medical University; Chongqing China
| | - Long Huang
- Department of Nephrology, Daping Hospital; Third Military Medical University; Chongqing China
| | - Li-li Fu
- Department of Nephrology, Daping Hospital; Third Military Medical University; Chongqing China
| | - Ya-ni He
- Department of Nephrology, Daping Hospital; Third Military Medical University; Chongqing China
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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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Wang J, Wu X, Lai W, Long E, Zhang X, Li W, Zhu Y, Chen C, Zhong X, Liu Z, Wang D, Lin H. Prevalence of depression and depressive symptoms among outpatients: a systematic review and meta-analysis. BMJ Open 2017; 7:e017173. [PMID: 28838903 PMCID: PMC5640125 DOI: 10.1136/bmjopen-2017-017173] [Citation(s) in RCA: 239] [Impact Index Per Article: 34.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Depression and depressive symptoms are common mental disorders that have a considerable effect on patients' health-related quality of life and satisfaction with medical care, but the prevalence of these conditions varies substantially between published studies. The aim of this study is to conduct a systematic review and meta-analysis to provide a precise estimate of the prevalence of depression or depressive symptoms among outpatients in different clinical specialties. DESIGN Systematic review and meta-analysis. DATA SOURCES AND ELIGIBILITY CRITERIA The PubMed and PsycINFO, EMBASE and Cochrane Library databases were searched to identify observational studies that contained information on the prevalence of depression and depressive symptoms in outpatients. All studies included were published before January 2016. Data characteristics were extracted independently by two investigators. The point prevalence of depression or depressive symptoms was measured using validated self-report questionnaires or structured interviews. Assessments were pooled using a random-effects model. Differences in study-level characteristics were estimated by meta-regression analysis. Heterogeneity was assessed using standard χ2 tests and the I2 statistic. The study protocol has been registered with PROSPERO under number CRD42017054738. RESULTS Eighty-three cross-sectional studies involving 41 344 individuals were included in this study. The overall pooled prevalence of depression or depressive symptoms was 27.0% (10 943/41 344 individuals; 95% CI 24.0% to 29.0%), with significant heterogeneity between studies (p<0.0001, τ2=0.3742, I2=96.7%). Notably, a significantly higher prevalence of depression and depressive symptoms was observed in outpatients than in the healthy controls (OR 3.16, 95% CI 2.66 to 3.76, I2=72.0%, χ 2 =25.33). The highest depression/depressive symptom prevalence estimates occurred in studies of outpatients from otolaryngology clinics (53.0%), followed by dermatology clinics (39.0%) and neurology clinics (35.0%). Subgroup analyses showed that the prevalence of depression and depressive symptoms in different specialties varied from 17.0% to 53.0%. The prevalence of depression and depressive symptoms was higher among outpatients in developing countries than in outpatients from developed countries. Moreover, the prevalence of depression and depressive symptoms in outpatients slightly decreased from 1996 to 2010. Regarding screening instruments, the Beck Depression Inventory led to a higher estimate of the prevalence of depression and depressive symptoms (1316/4702, 36.0%, 95% CI 29.0% to 44.0%, I2=94.8%) than the Hospital Anxiety and Depression Scale (1003/2025, 22.0%, 95% CI 12.0% to 35.0%, I2=96.6%). CONCLUSION Our study provides evidence that a significant proportion of outpatients experience depression or depressive symptoms, highlighting the importance of developing effective management strategies for the early identification and treatment of these conditions among outpatients in clinical practice. The substantial heterogeneity between studies was not fully explained by the variables examined.
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Affiliation(s)
- Jinghui Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Xiaohang Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Weiyi Lai
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Erping Long
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Xiayin Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Wangting Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Yi Zhu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
- Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Chuan Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
- Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Xiaojian Zhong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Zhenzhen Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Dongni Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Haotian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
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Chilcot J, Friedli K, Guirguis A, Wellsted D, Farrington K, Davenport A. C reactive protein and depressive symptoms in hemodialysis patients: A questionable association. Hemodial Int 2016; 21:542-548. [PMID: 27678345 DOI: 10.1111/hdi.12500] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 08/31/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Patients with advanced chronic kidney disease (CKD) on haemodialysis (HD) may have increased C reactive protein (CRP) values and depressive symptoms. There is debate about the strength and nature of previously reported associations. We investigated these issues in a cohort of patients on HD. METHODS We screened for depressive symptoms using two valadiated depression screening tools: the Beck Depression Inventory-II (BDI-II), Patient Health Questionnaire (PHQ-9). Demographic and clinical correlates of depression symptoms were eveluated in adjusted linear and logistic regression models, which included extra renal comorbidity and high CRP (>5 mg/L). FINDINGS Three hundred and ninety-six HD patients were studied; 63.1% male, mean age 63.1 ± 16.4 years, median CRP 6 (5-15) mg/L. Depression scores were similar in those with normal and high CRP (BDI-II (9(5-17) vs. 11(6-20)) or PHQ (4(2-9) vs. 6(2-10)). In adjusted multivariable regression BDI-II scores were associated with previous history of depression (β 10.8, P < 0.001), serum albumin (β 0.41, P < 0.001), anuria (β 2.4, P < 0.037), diabetes (β 2.7, P = 0.033), and age (β -0.10, P = 0.009). High CRP was not independently associated with BDI-II (β 2.20, P = 0.057), though was with PHQ-9 (β 1.20, P = 0.046). In logistic regression those with high CRP were 1.9 times more likely to score ≥16 on BDI-II screening (P = 0.016), but did not relate significantly to a PHQ-score ≥10. DISCUSSION A relationship was observed between CRP and depression symptoms, though the effect was small, of unlikely clinical significance, and inconsistent between depression measures. Previous reports of this association may reflect overlap between symptoms of depression and advanced CKD.
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Affiliation(s)
- Joseph Chilcot
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Karin Friedli
- Department of Psychology, Centre for Lifespan and Chronic Illness Research, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Ayman Guirguis
- Renal Unit, Lister Hospital, East & North Herts NHS Trust, Stevenage, UK.,Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, UK.,Postgraduate Medical School, University of Hertfordshire, Hatfield, UK
| | - David Wellsted
- Department of Psychology, Centre for Lifespan and Chronic Illness Research, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Ken Farrington
- Renal Unit, Lister Hospital, East & North Herts NHS Trust, Stevenage, UK.,Postgraduate Medical School, University of Hertfordshire, Hatfield, UK
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Najafi A, Keihani S, Bagheri N, Ghanbari Jolfaei A, Mazaheri Meybodi A. Association Between Anxiety and Depression With Dialysis Adequacy in Patients on Maintenance Hemodialysis. IRANIAN JOURNAL OF PSYCHIATRY AND BEHAVIORAL SCIENCES 2016; 10:e4962. [PMID: 27803725 PMCID: PMC5087286 DOI: 10.17795/ijpbs-4962] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Revised: 12/25/2015] [Accepted: 02/05/2016] [Indexed: 01/18/2023]
Abstract
Background Depression and anxiety are common among hemodialysis patients and affect their treatment outcomes. Dialysis adequacy also affects the hemodialysis patients’ survival rates. Objectives This study aimed to evaluate the correlation between anxiety and depression with dialysis adequacy. Patients and Methods In this cross-sectional study, 127 hemodialysis patients (73 males, 57.5%) with the mean age of 55.7 ± 17.5 were enrolled. Demographic and recent laboratory data were collected using self-administered questionnaires and by reviewing medical records. Dialysis adequacy measures including the Kt/V and urea reduction rate (URR) were calculated using standard formulas. The Hospital Anxiety and Depression Scale (HADS) was used to diagnose depression and anxiety. Independent sample t-test and Chi-square test were used to compare the values in different groups. Pearson correlations and linear regression were used to analyze the data using SPSS version 21. Results The prevalence rates of depression and anxiety (HADS score ≥ 8) were 31.5% and 41.7%, respectively. The prevalence of both conditions was significantly higher in women than in men (P < 0.05). The mean values of Kt/V and URR were not different in patients with and without depression or anxiety. The anxiety scores were correlated with age (P = 0.007, r = -0.24) and parathyroid hormone (P = 0.04, r = -0.19). Younger age and lower parathyroid hormone were the only factors that predicted higher scores of anxiety in linear regression. The Kt/V or URR were not significantly correlated with depression and anxiety scores. Conclusions Depression and anxiety are common among hemodialysis patients. There are no statistically significant correlation between depression and anxiety and dialysis adequacy.
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Affiliation(s)
- Afshan Najafi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Sorena Keihani
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Nazila Bagheri
- Department of Nephrology, Taleghani Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Atefeh Ghanbari Jolfaei
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Azadeh Mazaheri Meybodi
- Department of Psychiatry, Taleghani Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
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Jean G, Hurot JM, Deleaval P, Mayor B, Lorriaux C. Online-haemodiafiltration vs. conventional haemodialysis: a cross-over study. BMC Nephrol 2015; 16:70. [PMID: 25956949 PMCID: PMC4429419 DOI: 10.1186/s12882-015-0062-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 04/30/2015] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The main short-term advantages of haemodiafiltration (HDF) are supposedly better removal of Beta2-microglobulin (ß2-m) and phosphate, and better haemodynamic stability. The main disadvantage is higher costs. The aim of the study was to compare the clinical and biological parameters associated with HDF and high-flux haemodialysis (HD), using a cross-over design, while maintaining the same dialysis parameters. METHODS All patients on a 3 × 4 hours schedule were observed during 3 identical 6-months periods: HDF1 - HD - HDF2. The mean values for the 2 last months of each period were compared. RESULTS A total of 51 patients (76 % males, 45 % diabetic) with a mean age of 74 ± 15 years, and who had been on dialysis for 49 ± 60 months were included. The mean blood flow (329 ± 27 ml/min), dialysate flow (500 ml/min), and convection volumes (21.6 ± 3.2 L) were recorded. Patient medications were not changed. Predialysis blood pressure, phosphataemia, calcaemia, iPTH, Kt/V, nPNA and intradialytic events were similar throughout the 3 periods. Only serum albumin (34. 4 ± 3.6, 35.9 ± 3.4, 34.1 ± 4 g/L, p < 0. 0001) and ß2-m serum levels (26.1 ± 5.4, 28 ± 6, 26.5 ± 5 mg/L, p < 0.001, values shown for HDF1, HD, HDF2, respectively) were significantly lower during the HDF periods. Factor associated with higher delta serum albumin levels between HD and HDF periods was mainly a lower convection volume. CONCLUSION Comparing HDF and HD, we did not observe any differences in haemodynamic stability or in serum phosphate levels. Only serum ß2-m (-6% vs. HD) and albumin (-5% vs. HD) levels changed. The long-term clinical consequences of these biochemical differences should be prospectively assessed.
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Affiliation(s)
- Guillaume Jean
- NEPHROCARE Tassin-Charcot, 7 avenue Maréchal FOCH, 69110, Sainte Foy-les-lyon, France.
| | - Jean-Marc Hurot
- NEPHROCARE Tassin-Charcot, 7 avenue Maréchal FOCH, 69110, Sainte Foy-les-lyon, France.
| | - Patrik Deleaval
- NEPHROCARE Tassin-Charcot, 7 avenue Maréchal FOCH, 69110, Sainte Foy-les-lyon, France.
| | - Brice Mayor
- NEPHROCARE Tassin-Charcot, 7 avenue Maréchal FOCH, 69110, Sainte Foy-les-lyon, France.
| | - Christie Lorriaux
- NEPHROCARE Tassin-Charcot, 7 avenue Maréchal FOCH, 69110, Sainte Foy-les-lyon, France.
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Sekercioglu N, Curtis B, Murphy S, Barrett B. Sleep apnea in patients with chronic kidney disease: a single center experience. Ren Fail 2014; 37:83-7. [DOI: 10.3109/0886022x.2014.962408] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Taraz M, Taraz S, Dashti-Khavidaki S. Association between depression and inflammatory/anti-inflammatory cytokines in chronic kidney disease and end-stage renal disease patients: a review of literature. Hemodial Int 2014; 19:11-22. [PMID: 25040322 DOI: 10.1111/hdi.12200] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Depression is a common psychiatric disorder in patients with advanced chronic kidney diseases (CKDs). Strong correlation has been reported between depression and patients' morbidity and mortality among dialysis patients. On the contrary, chronic inflammation may be a major contributor to morbidity and mortality in these patients. Elevated plasma levels of proinflammatory cytokines, especially C-reactive protein and interleukin (IL)-6, have been correlated with cardiovascular events, hospitalization, and all-cause and cardiovascular-associated mortality in dialysis patients. Studies suggested that inflammation-mediated atherosclerotic cardiovascular diseases are the possible reasons for depression-induced mortality among patients without renal diseases. Several studies found significant elevations in circulating levels of proinflammatory cytokines, particularly IL-6 and tumor necrosis factor-α, in patients with major depression. Furthermore, depressive mood and behaviors, including sadness and suicidal ideation, were observed in patients who received repeated injections of recombinant cytokines. A thorough literature review indicates that while depressive symptoms and elevated inflammatory cytokine levels coexist in CKD and dialysis patients, their association is uncertain. Depression seems to be more associated with elevated serum levels of IL-6 than other cytokines in these patients. Further studies are needed to clarify the possibility of a causal relationship between inflammation and depressive symptoms in CKD and dialysis patients.
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Affiliation(s)
- Mohammad Taraz
- Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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