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Zhang X, Ma L, Mu S, Yin Y. The Hidden Burden-Exploring Depression Risk in Patients with Diabetic Nephropathy: A Systematic Review and Meta-Analysis. Diabetes Ther 2023:10.1007/s13300-023-01436-y. [PMID: 37368150 PMCID: PMC10363103 DOI: 10.1007/s13300-023-01436-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/13/2023] [Indexed: 06/28/2023] Open
Abstract
INTRODUCTION Diabetic nephropathy is a common complication among patients with diabetes mellitus, and it has been linked to a higher risk of depression. However, the magnitude of this association remains unclear. This study aimed to systematically review and meta-analyse the risk of depression in patients with diabetic nephropathy compared to diabetes patients without nephropathy. METHODS We conducted a systematic literature review, searching multiple databases from January 1964 to March 2023, and included randomized controlled trials, non-randomized controlled trials, and observational studies. We assessed the risk of bias using the Newcastle Ottawa scale for observational studies. The statistical analysis was performed using STATA version 14.2, and pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated. A total of 60 studies were included. RESULTS The pooled OR for the risk of depression among patients with diabetic nephropathy was 1.78 (95% CI 1.56-2.04; I2 = 83%; n = 56), indicating a significantly higher risk compared to diabetes patients without nephropathy (p < 0.001). Pooling the effect size across these studies showed that the pooled OR was 1.15 (95% CI 1.14-1.16; I2 = 88%; n = 32). Subgroup analyses based on the type of diabetes and study region revealed no significant differences in the pooled estimates. CONCLUSION This study demonstrates that patients with diabetic nephropathy have a significantly higher risk of depression compared to diabetes patients without nephropathy. These findings highlight the importance of assessing and addressing the mental health of patients with diabetic nephropathy as part of their overall healthcare management.
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Affiliation(s)
- Xiaoli Zhang
- The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, 16369 Jingshi Road, Jinan, 250014, Shandong, China
| | - Liang Ma
- The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, 16369 Jingshi Road, Jinan, 250014, Shandong, China
| | - Shumin Mu
- The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, 16369 Jingshi Road, Jinan, 250014, Shandong, China
| | - Yonghui Yin
- The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, 16369 Jingshi Road, Jinan, 250014, Shandong, China.
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Li K, Zhao J, Yang W, Ye Z. Sleep traits and risk of end-stage renal disease: a mendelian randomization study. BMC Med Genomics 2023; 16:76. [PMID: 37029366 PMCID: PMC10080763 DOI: 10.1186/s12920-023-01497-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 03/23/2023] [Indexed: 04/09/2023] Open
Abstract
BACKGROUND Epidemiological evidence relating sleep disorders to end-stage renal disease (ESRD) has been obscure. The present study is sought to examine the association between sleep traits and ESRD. METHODS For this analysis, we selected genetic instruments for sleep traits from published genome-wide association studies (GWAS). As instrumental variables, independent genetic variations linked with seven sleep-related features (sleep duration, getting up in the morning, daytime napping, chronotype of morning/evening person, sleeplessness/insomnia, non-snoring, and daytime dozing) were chosen. A two-sample Mendelian randomization (TSMR) study was conducted to assess the causal relationship between sleep traits and ESRD (N = 33,061). The reverse MR analysis subsequently determined the causal relationship between ESRD and sleep traits. The causal effects were estimated using inverse variance weighted, MR-Egger, weighted median. To conduct sensitivity studies, Cochran's Q test, MR-Egger intercept test, MR-PRESSO, leave-one-out analysis, and funnel plot were used. To study the potential mediators, multivariable mendelian randomization analyses were undertaken further. RESULTS Genetically predicted sleeplessness/ insomnia (OR = 6.11, 95%CI 1.00-37.3, P = 0.049, FDR = 0.105), getting up in the morning easily(OR = 0.23, 95%CI 0.063-0.85; P = 0.0278, FDR = 0.105), non-snoring (OR = 4.76E-02, 95%CI 2.29E-03-0.985, P = 0.0488, FDR = 0.105) was suggestively associated with the risk of ESRD. However, we found no evidence favoring a causal association between other sleep traits and ESRD through the IVW method. CONCLUSION The present TSMR found no strong evidence of a bidirectional causal association between genetically predicted sleep traits and ESRD.
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Affiliation(s)
- Kaixin Li
- Department of Nephrology, Shanghai Key Laboratory of Clinical Geriatric Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China
| | - Jiaxi Zhao
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Wenjing Yang
- Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China
| | - Zhibin Ye
- Department of Nephrology, Shanghai Key Laboratory of Clinical Geriatric Medicine, Huadong Hospital Affiliated to Fudan University, Shanghai, 200040, China.
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Shen Y, Chen Y, Huang S, Yao X, Kanwar YS, Zhan M. The Association between Symptoms of Depression and Anxiety, Quality of Life, and Diabetic Kidney Disease among Chinese Adults: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:475. [PMID: 36612797 PMCID: PMC9819882 DOI: 10.3390/ijerph20010475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/23/2022] [Accepted: 12/25/2022] [Indexed: 06/17/2023]
Abstract
Depression and anxiety are common comorbid symptoms among patients with diabetic kidney disease (DKD). Little is known about the influence of poor psychological conditions on the disease progression and quality of life (QOL) in DKD patients. This study aimed to investigate the prevalence of, and risk factors for, depression and anxiety in Chinese DKD patients, and to analyze their impact on the renal function, proteinuria, and QOL. A total of 620 adult patients with Type 2 diabetes and DKD being treated at a tertiary hospital in East China were recruited. Depression and anxiety symptoms were assessed by the Zung Self-Rating Depression Scale and Anxiety Scale. Among the DKD participants, 41.3% had symptoms of depression and 45.0% had anxiety symptoms. A poor education, physical inactivity, stroke, low serum albumin, CKD stage 3-4, macroalbuminuria, and a poor QOL were independent risk factors for depression in the DKD patients. Whereas a higher education, physical inactivity, diabetic retinopathy and neuropathy, low hemoglobin, CKD stage 3-4, and a poor QOL were risk factors for anxiety. Depression and anxiety scores among the DKD patients were negatively correlated with the eGFR and QOL scores. Moreover, depression and anxiety symptoms were independent risk factors for DKD patients with CKD stage 3-4 and a poor QOL. Our findings suggest a high prevalence of depression and anxiety among Chinese DKD patients, and the severity of psychological symptoms is closely linked to the deterioration of renal function and the QOL. The early screening and intervention of psychopathological disorders is thus strongly recommended for improving the QOL and clinical outcomes among DKD patients.
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Affiliation(s)
- Yan Shen
- School of Medicine, Ningbo University, Ningbo 315000, China
| | - Yi Chen
- School of Medicine, Ningbo University, Ningbo 315000, China
| | - Shichun Huang
- School of Medicine, Ningbo University, Ningbo 315000, China
| | - Xuejie Yao
- Department of Medicine, Ningbo First Hospital, Zhejiang University, Ningbo 315000, China
| | - Yashpal S. Kanwar
- Department of Pathology, Northwestern University, Chicago, IL 60611, USA
- Department of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Ming Zhan
- Department of Medicine, Ningbo First Hospital, Zhejiang University, Ningbo 315000, China
- China Health Institute, University of Nottingham Ningbo China, Ningbo 315100, China
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Fang T, Zhang Q, Wang Z, Liu JP. Bidirectional association between depression and diabetic nephropathy by meta-analysis. PLoS One 2022; 17:e0278489. [PMID: 36538528 PMCID: PMC9767359 DOI: 10.1371/journal.pone.0278489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 11/16/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Studies suggested that the association between depression and diabetic nephropathy may be bi-directional, but this hypothesis remains investigating. In this meta-analysis, the bi-directional relationship between depression and diabetic nephropathy was investigated. METHODS A search for the publications on depression and diabetic nephropathy in the databases of PubMed, Web of science, and Embase from the earliest available to August 2022 was conducted. Two sets of pooled risk estimates were calculated using random effects models: diabetic nephropathy predicting depression and depression predicting diabetic nephropathy. Cross-sectional studies were assessed using Agency for Healthcare Research and Quality (AHRQ), cohort and case-control studies were assessed using Newcastle-Ottawa Scale (NOS). RESULT Of the 974,121 patients in 30 clinical studies, 24 studies met eligibility for diabetic nephropathy predicting onset of depression, representing 28,438 incident cases. The other 6 studies met criteria for depression predicting onset of diabetic nephropathy, representing 945,683 incident cases. The pooled odds ratio (OR) of diabetic nephropathy predicting depression was 1.46 (95% CI 1.27-1.67). The OR of depression predicting diabetic nephropathy was 1.22 (95% CI 1.13-1.31). CONCLUSION This meta-analysis shows that the relationship between depression and diabetic nephropathy may be bidirectional. Diabetic nephropathy may be a predictor of depression, and depression may also be an indicator of diabetic nephropathy. The mechanisms underlying the bidirectional relationship need to be further investigated and interventions of the comorbidity of depression and diabetic nephropathy need be studied in clinical practice.
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Affiliation(s)
- Tingting Fang
- Institute of Ageing Research, Hangzhou Normal University, School of Basic Medicine, Hangzhou, Zhejiang Province, China
- School of Public Health, Hangzhou Normal University, Hangzhou, Zhejiang Province, China
- * E-mail: (TF); (JPL)
| | - Qiuling Zhang
- Department of Endocrinology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang Province, China
| | - Zhiguo Wang
- Institute of Ageing Research, Hangzhou Normal University, School of Basic Medicine, Hangzhou, Zhejiang Province, China
| | - Jun-Ping Liu
- Institute of Ageing Research, Hangzhou Normal University, School of Basic Medicine, Hangzhou, Zhejiang Province, China
- Monash University Department of Immunology and Pathology, Central Clinical School, Faculty of Medicine, Prahran, Victoria, Australia
- Hudson Institute of Medical Research, Clayton, Victoria, Australia
- * E-mail: (TF); (JPL)
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Takaike H, Miura J, Ishizawa K, Babazono T. High prevalence of depressive symptoms among people with pediatric-onset and adolescent-onset type 1 diabetes: A cross-sectional analysis of the Diabetes Study from the Center of Tokyo Women's Medical University. J Diabetes Investig 2022; 13:1626-1632. [PMID: 35587633 PMCID: PMC9434570 DOI: 10.1111/jdi.13835] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/19/2022] [Accepted: 05/05/2022] [Indexed: 01/09/2023] Open
Abstract
AIMS To investigate the prevalence of depressive symptoms by the age of onset of type 1 diabetes and its association with the condition of individuals with pediatric- and adolescent-onset type 1 diabetes. MATERIALS AND METHODS This single-center cross-sectional study enrolled Japanese participants with type 1 diabetes. All participants completed a questionnaire about their diabetes-related condition and the Patient Health Questionnaire-9, which was used to evaluate depression. Individuals with a Patient Health Questionnaire-9 score of ≥10 points were defined as having moderate depressive symptoms. RESULTS A total of 1,267 participants (mean age, 40 years; mean duration of type 1 diabetes, 21 years; 68% female; mean glycated hemoglobin, 7.8%) were included and classified according to the age of onset of type 1 diabetes to identify the proportion of moderate depressive symptoms in each group: 21% (0-12 years), 18% (13-19 years), and 13% (20-40 years). The prevalence of moderate depressive symptoms was significantly higher among participants with pediatric-onset type 1 diabetes (p<0.05). Moderate depressive symptoms were associated with increased glycated hemoglobin, neuropathy, and hypoglycemia unawareness. CONCLUSIONS Regular screening for depressive symptoms and hypoglycemia awareness is important. Healthcare professionals should provide appropriate psychosocial care for people with pediatric-onset and adolescent-onset type 1 diabetes from childhood through to adulthood.
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Affiliation(s)
- Hiroko Takaike
- Division of Diabetology and Metabolism, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Junnosuke Miura
- Division of Diabetology and Metabolism, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Kaya Ishizawa
- Division of Diabetology and Metabolism, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Tetsuya Babazono
- Division of Diabetology and Metabolism, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
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Pan J, Li H, Shi J. Clinical Application of the Classical Theory of Traditional Chinese Medicine in Diabetic Nephropathy. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:4066385. [PMID: 35495881 PMCID: PMC9045989 DOI: 10.1155/2022/4066385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/02/2022] [Accepted: 03/10/2022] [Indexed: 12/03/2022]
Abstract
Objective To explore the clinical application of the classical theory of traditional Chinese medicine (TCM) in diabetic nephropathy (DN). Methods A total of 100 patients with DN treated in our hospital from May 2019 to June 2021 were included. The patients were randomly assigned to the control group and the study group. The control group received routine treatment, and the study group was treated with the classical theory of TCM. The efficacy, TCM syndrome score, urine proteinuria (UTP), urine albumin-creatinine ratio (UACR), plasma albumin (ALB), hemoglobin A1c (HbA1C), fasting blood glucose (FBG), blood urea nitrogen (BUN), creatinine (Cr), and treatment safety were compared between the two groups. Results In comparison to the curative effect, the study group was significantly effective in 34 cases, effective in 12 cases, and ineffective in 4 cases, and the effective rate was 92.00%; the control group was significantly effective in 16 cases, effective in 18 cases, and ineffective in 16 cases, and the effective rate was 68.00%. The effective rate in the study group was higher compared to the control (P < 0.05). In comparison to the TCM syndrome scores, there exhibited no significant difference before treatment (P > 0.05), but after treatment, the TCM syndrome scores of the two groups decreased, and the TCM syndrome scores of the study group were lower compared to the control at 6 weeks, 12 weeks, 24 weeks, and 36 weeks of treatment (P < 0.05). There exhibited no significant difference in the indexes of UTP and UACR before treatment, but the indexes of UTP and UACR in the two groups decreased after treatment, and the indexes of UTP and UACR in the study group were lower compared to the control at 6 and 12 weeks after treatment. There was no significant difference in the indexes of ALB, HbA1C, and FBG before treatment, but after treatment, the indexes of ALB increased, the indexes of HbA1C and FBG decreased in both groups, and the indexes of HbA1C and FBG i4n the study group were lower compared to the control, while the index of ALB in the study group was higher. The indexes of BUN and Cr were compared, and there was no significant difference before treatment, but after treatment, the indexes of BUN and Cr in the two groups decreased, and the indexes of BUN and Cr in the study group were lower compared to the control (P < 0.05). In terms of the treatment safety of the two groups, there was no abnormality in blood, urine, stool routine, and liver and kidney function examination in the study group. No obvious adverse reactions were found in all patients. There were 1 case of abnormal liver function and 2 cases of rash in the control group, and there exhibited no significant difference (P > 0.05). Conclusion Under the guidance of classical theory, the optimization scheme of comprehensive treatment of TCM may improve renal function by improving metabolic disorders, vascular lesions, neurotrophic disorders, antioxidant stress, and other ways to repair nerve injury, improving the changes of TCM syndromes, signs, and indicators of patients, and delay the progress of DN.
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Affiliation(s)
- Jintong Pan
- Hubei Province Hospital of Traditional Chinese Medicine, Nephropathy, China
| | - Huihui Li
- Guangzhou Weimi Biological Technology Company, China
| | - Junhua Shi
- Hubei Province Hospital of Traditional Chinese Medicine, Nephropathy, China
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