The purpose of this study was to examine the association between uremic toxins, inflammation, depression and anxiety among hemodialysis patients in Montenegro.
Method
The cross-sectional study included 88 patients undergoing hemodialysis. Depression symptoms were assessed by Patient Health Questionnaire (PHQ-9), and anxiety symptoms were measured by the Beck Anxiety Inventory (BAI). Standard laboratory methods were used to measure uremic toxins and systemic inflammation (C-reactive protein, Neutrophil-to-Lymphocyte Ratio [NLR] and Platelet-to-Lymphocyte Ratio [PLR]).
Results
Clinically significant depression (PHQ-9 ≥ 10) and anxiety (BAI ≥16) were found in 55.7% and 27.2%, respectively. Logistic regression analyses revealed that serum urea, beta 2-microglobulin (B2M), and systemic inflammation (CRP, NLR, PLR) were significantly and independently associated with depressive symptoms, whereas serum urea, creatinine, uric acid, B2M, and systemic inflammation (CRP nad NLR) were associated with anxiety symptoms.
Conclusions
Depressive symptoms and anxiety are common among hemodialysis patients in Montenegro, and are associated with increased levels of systematic inflammation, serum urea, and beta 2-microglobulin.
JagerKJKovesdyCLanghamRRosenbergMJhaVZoccaliC. A single number for advocacy and communication-worldwide more than 850 million individuals have kidney diseases. Kidney Int. 2019;96(5):1048-1050.
2.
InkerLAAstorBCFoxCH, et al.KDOQI US commentary on the 2012 KDIGO clinical practice guideline for the evaluation and management of CKD. Am J Kidney Dis. 2014;63(5):713-735.
3.
Silva JuniorGBDaherEFBuosiAP, et al.Depression among patients with end-stage renal disease in hemodialysis. Psychol Health Med. 2014;19(5):547-551.
4.
MurtaghFEAddington-HallJHigginsonIJ. The prevalence of symptoms in end-stage renal disease: a systematic review. Adv Chron Kidney Dis. 2007;14(1):82-99.
5.
TanakaSOkusaMD. Crosstalk between the nervous system and the kidney. Kidney Int. 2020;97(3):466-476.
6.
QawaqzehDTAMasa'dehRHamaidehSHAlkhawaldehAAlbashtawyM. Factors affecting the levels of anxiety and depression among patients with end-stage renal disease undergoing hemodialysis. Int Urol Nephrol. 2023;55(11):2887-2896.
7.
WangHHuangBWangW, et al.High urea induces depression and LTP impairment through mTOR signalling suppression caused by carbamylation. EBioMedicine. 2019;48:478-490.
8.
CoboGLindholmBStenvinkelP. Chronic inflammation in end-stage renal disease and dialysis. Nephrol Dial Transplant. 2018;33:iii35-iii40.
9.
ZhangPZengDYiYL, et al.β2-microglobulin induces depressive- and anxiety-like behaviors in rat. PLoS One. 2018;13(5):e0198027.
10.
LamersFBotMJansenR, et al.Serum proteomic profiles of depressive subtypes. Transl Psychiatry. 2016;6(7):e851.
11.
ZhangJSokalIPeskindER, et al.CSF multianalyte profile distinguishes Alzheimer and Parkinson diseases. Am J Clin Pathol. 2008;129(4):526-529.
12.
McArthurJCNance-SprosonTEGriffinDE, et al.The diagnostic utility of elevation in cerebrospinal fluid beta 2-microglobulin in HIV-1 dementia. Multicenter AIDS Cohort Study. Neurology. 1992;42(9):1707-1712.
13.
FosterMCCoreshJHsuCY, et al.Serum β-trace protein and β2-microglobulin as predictors of ESRD, mortality, and cardiovascular disease in adults with CKD in the chronic renal insufficiency cohort (CRIC) study. Am J Kidney Dis. 2016;68(1):68-76.
14.
YeZKappelmannNMoserS, et al.Role of inflammation in depression and anxiety: tests for disorder specificity, linearity and potential causality of association in the UK Biobank. EClinicalMedicine. 2021;38:100992.
15.
Kidney disease: Improving global outcomes (KDIGO) CKD work group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2012;3(1):1-150.
16.
BellCC. DSM-IV: diagnostic and statistical manual of mental disorders. JAMA. 1994;272(10):828-829.
17.
BeckATEpsteinNBrownGSteerRA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol. 1998;56(6):893-897.
18.
YeWWangLWangYWangCZengJ. Depression and anxiety symptoms among patients receiving maintenance hemodialysis: a single center cross-sectional study. BMC Nephrol. 2022;23(1):417.
19.
NgHJTanWJMooppilNNewmanSGrivaK. Prevalence and patterns of depression and anxiety in hemodialysis patients: a 12-month prospective study on incident and prevalent populations. Br J Health Psychol. 2015;20(2):374-395.
20.
KimD-SKimS-WGilH-W. Emotional and cognitive changes in chronic kidney disease. Korean J Intern Med. 2022;37:489-501.
21.
AndersonBMQasimMCorreaG, et al.Depression is associated with frailty and lower quality of life in haemodialysis recipients, but not with mortality or hospitalization. Clin Kidney J. 2022;16(2):342-354.
22.
SchoutenRWNadortEHarmseV, et al.Symptom dimensions of anxiety and their association with mortality, hospitalization and quality of life in dialysis patients. J Psychosom Res. 2020;133:109995.
23.
ShatzCJ. MHC class I: an unexpected role in neuronal plasticity. Neuron. 2009;64(1):40-45.
24.
HsuHJYenCHChenCK, et al.Association between uremic toxins and depression in patients with chronic kidney disease undergoing maintenance hemodialysis. Gen Hosp Psychiatr. 2013;35(1):23-27.
25.
LiYPiHCYangZKDongJ. Associations between small and middle molecules clearance and the change of cognitive function in peritoneal dialysis. J Nephrol. 2020;33(4):839-848.
26.
HamedSA. Neurologic conditions and disorders of uremic syndrome of chronic kidney disease: presentations, causes, and treatment strategies. Expet Rev Clin Pharmacol. 2019;12(1):61-90.
FussJBen AbdallahNMHensleyFWWeberKJHellwegRGassP. Deletion of running-induced hippocampal neurogenesis by irradiation prevents development of an anxious phenotype in mice. PLoS One. 2010;5(9):e12769.
29.
SmithLKHeYParkJS, et al.β2-microglobulin is a systemic pro-aging factor that impairs cognitive function and neurogenesis. Nat Med. 2015;21(8):932-937.
30.
WatanabeKSatoEMishimaE, et al.Effect of uremic toxins on hippocampal cell damage: analysis in vitro and in rat model of chronic kidney disease. Heliyon. 2021;7(2):e06221.
31.
KaminskiTWPawlakKKarbowskaMMysliwiecMPawlakD. Indoxyl sulfate—the uremic toxin linking hemostatic system disturbances with the prevalence of cardiovascular disease in patients with chronic kidney disease. BMC Nephrol. 2017;18(1):35.
32.
RhieSJJungEYShimI. The role of neuroinflammation on pathogenesis of affective disorders. J Exerc Rehabil. 2020;16(1):2-9.
33.
MilaneschiYKappelmannNYeZ, et al.Association of inflammation with depression and anxiety: evidence for symptom-specificity and potential causality from UK Biobank and NESDA cohorts. Mol Psychiatr. 2021;26(12):7393-7402.
34.
FengJLuXLiHWangS. High neutrophil-to-lymphocyte ratio is a significant predictor of depressive symptoms in maintenance hemodialysis patients: a cross-sectional study. BMC Psychiatr. 2022;22(1):313.
