Symptoms of depression and anxiety over time in chronic hemodialysis patients
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ORIGINAL ARTICLE JNEPHROL 2012; 25 ( 05 ) : 689-698
DOI:10.5301/jn.5000042
Symptoms of depression and anxiety over
time in chronic hemodialysis patients
Maurizio Bossola 1, Claudia Ciciarelli 2, Dialysis Service, Department of Surgery, Catholic Univer-
1
Enrico Di Stasio 3, Gian Luigi Conte 2, sity of the Sacred Heart, Rome - Italy
Manuela Antocicco 4, Fausto Rosa 3, Luigi Tazza 1 Institute of Psychiatry, Catholic University of the Sacred
2
Heart, Rome - Italy
Department of Clinical Chemistry, Catholic University of
3
the Sacred Heart, Rome - Italy
Institute of Geriatrics, Catholic University of the Sacred
4
Heart, Rome - Italy
Abstract At multivariate analysis the relationship between BDI
changes and MMSE and serum CRP was statistically
Background: Little is known about the course of the significant. In 25 patients, the HARS decreased/re-
symptoms of depression/anxiety and the factors pre- mained stable, while in 13 it increased. Characteristics
dictive of such courses in hemodialysis (HD) patients. of the 2 groups of patients did not differ significantly.
This study aimed at evaluating the possible changes of Conclusions: In a meaningful proportion of HD pa-
Beck Depression Inventory (BDI) and Hamilton Anxiety tients, symptoms of depression worsen over time,
Rating Scale (HARS) over time, and factors associated and CRP and MMSE are independent predictors of
with such changes in HD patients. such change.
Methods: We screened 110 patients for study partici-
pation. Of these, 30 were excluded because of dialytic Key words: Anxiety, Depression, Hemodialysis, Longi-
vintage 14 and 38
60%, respectively (1, 2). There is evidence of an association
patients ≤14. In patients with BDI ≤14, the BDI de-
between depression and/or anxiety and some demograph-
creased/remained stable in 19 and increased in 19.
ic, clinical and laboratory variables (3-13). Depression and
Patients with increased BDI had lower baseline MMSE
(22.6 ± 2.6 vs. 25.9 ± 2.7, p=0.004) and higher base- anxiety impair significantly the quality of life of HD patients (3,
line serum CRP (6.07 ± 4.2 vs. 1.64 ± 1.59, p=0.003). 4, 14-17). In addition, numerous studies have clearly dem-
onstrated that depression or symptoms of depression are
© 2011 Società Italiana di Nefrologia - ISSN 1121-8428 689Bossola et al: Depression and anxiety over time in hemodialysis
associated with increased hospitalization rate and reduced Study design
survival (18-26). Interestingly, Hedayati et al have shown that
depression diagnosed through the Diagnostic and Statisti- Patients were evaluated at baseline through the BDI and the
cal Manual of Mental Disorders, 4th edition (DSM-IV)–based HARS. Those with baseline BDI >14 and those with base-
SCID (Structured Clinical Interview for DSM Disorders), was line HARS >13 were referred to psychiatric counseling and
associated with time to death or hospitalization with a haz- excluded from the study. Patients with baseline BDI ≤14
ard ratio of 2.11 (26). were included in the study. They were reevaluated after 18
Unfortunately, little is known in HD patients about the course months through the BDI and the HARS.
of depression and anxiety or of the course of symptoms of
depression and anxiety, or about the factors predictive of Hemodialysis
development of depression or of its worsening (27, 28). Re-
cently, we conducted a cross-sectional study to evaluate the All patients were receiving conventional 4-hour HD, 3 times a
factors associated with symptoms of depression or anxiety week. The blood flow ranged from 250 to 300 ml/min with a
in chronic HD patients in a single HD center of a Mediter- dialysis flow rate of 500 ml/min. All patients were treated with
ranean country (9). Patients included in that study were fol- low-permeability membranes. Most patients were taking re-
lowed for 18 months with the aim to evaluate the course of combinant human erythropoietin, antihypertensive medica-
the symptoms of depression and anxiety through the Beck tions (β-blockers, calcium channel blockers and/or angioten-
Depression Inventory (BDI) and the Hamilton Anxiety Rating sin-converting enzyme inhibitors) and other commonly used
Scale (HARS) and to identify factors predictive of changes of drugs such as phosphate binders and vitamin D.
such scores over time. The results of this longitudinal study
are here presented. Beck Depression Inventory
Subjects and methods We used a validated Italian version of the BDI (29) to assess
the presence and severity of symptoms of depression. The
Between January 2007 and April 2009, patients with BDI is a self-administered questionnaire comprising 21 items
ESRD on chronic HD at the Catholic University Outpatient that evaluates a broad spectrum of depressive symptoms.
Dialysis Clinic were preliminarily screened. Exclusion cri- Of these 21 items, 15 refer to psychological-cognitive symp-
teria were age 90 years; dialysis vintage 17 points.
690 © 2011 Società Italiana di Nefrologia - ISSN 1121-8428JNEPHROL 2012; 25 ( 05 ) : 689-698
Charlson Comorbidity Index minutes, and samples were kept frozen at –70°C if not ana-
lyzed immediately. Laboratory parameters were measured
Each patient was evaluated for the presence of the follow- by routine methods at the Department of Laboratory Medi-
ing comorbidities included in the Charlson Comorbidity In- cine, Catholic University of Rome. CRP serum levels were
dex and according to the guidelines of the Index itself (35): measured using a high-sensitivity immunonephelometric
myocardial infarction, congestive heart failure, peripheral method (Nephelometric 100 Analyzer; Behring, Scoppito,
vascular disease, cerebrovascular disease, hemiplegia, de- Italy), the lowest detection limit of which was 0.05 mg/L.
mentia, chronic obstructive pulmonary disease, peptic ul- Plasma IL-6 was measured by a commercially available
cer disease, mild liver disease, diabetes without end-organ photometric enzyme-linked immunosorbent assay (ELISA)
damage, diabetes with end-organ damage, malignant tumor (Boehringer Mannheim, Mannheim, Germany).
without metastases (exclude if >5 years from diagnosis),
malignant tumor with metastases, acute or chronic leuke- Statistical analysis
mia, moderate or severe liver disease or AIDS. The Charlson
Comorbidity Index was then calculated in each patient. Statistical analysis was performed by SYSTAT 7.0 software
(SPSS Inc., Chicago, IL, USA). All data were expressed as
SF-36 Vitality Scale means ± SD, unless otherwise specified. All data were first
analyzed for normality of distribution using the Kolmogorov-
The Italian version of the SF-36 questionnaire (36) was of- Smirnov test of normality. When comparing differences in
fered to the patients by the attending physician. Patients the groups, the Kruskal-Wallis nonparametric test was used
completed the questionnaire at home and returned it during for non-normally distributed continuous variables, and anal-
the next dialysis session. The participants were screened ysis of variance was used for normally distributed variables.
for fatigue status using the Vitality Scale of the SF-36 (36). Categorial variables were compared using the chi-square
Standardized Vitality Scale scores range from 0 to 100, with test. Multivariate logistic regression analysis was performed
higher scores indicating better functioning (i.e., higher lev- to study the relationship between BDI changes and patients’
els of energy). Scores above the midpoint of 50 represent characteristics: the covariates introduced in the model were
well-being (nonfatigued group), whereas scores below 51 variables significantly different at the univariate analysis be-
represent limitations or disability related to fatigue (fatigued tween the 2 groups. To determine the diagnostic accuracy of
group) (37). serum CRP for the identification of patients with increased
BDI, we analyzed receiver operating characteristic (ROC)
Mini-Mental State Examination curves and calculated the areas under the curves (AUCs).
A p value of less than 0.05 was considered statistically
Cognitive function was assessed with the Mini-Men- significant.
tal State Examination (MMSE) (38). The MMSE is a brief
30-point questionnaire test that is used to screen for cogni- Results
tive impairment. It is also used to estimate the severity of
cognitive impairment at a given point in time and to follow A total of 110 patients were screened for study participation.
the course of cognitive changes in an individual over time, Of these, 30 were excluded because of dialytic vintageBossola et al: Depression and anxiety over time in hemodialysis
BDI over time level of depression, anxiety and functional and occupational
impairment did not remit spontaneously in HD patients. The
At baseline, 42 patients had BDI >14 and 38 patients ≤14. finding that the BDI increased over time in 48.1% of pa-
Patients with BDI >14 were referred to psychiatric counsel- tients included in the present study may suggest the need
ing, while patients with baseline BDI ≤14 were followed over for strict monitoring of chronic HD patients for symptoms of
time. In 19 patients, the BDI decreased or remained stable, depression, to avoid the risk of underrecognition and under-
and in 19 it increased. The characteristics of these 2 groups treatment of depression.
of patients are shown in Table I. When compared with pa- We also found that CRP was as an independent predictive
tients with stable or decreased BDI at month 18, patients factor of BDI increase in chronic HD patients. These results
with increased BDI at month 18 had lower baseline MMSE are in accordance with those of the study of Pasco et al that
and higher baseline serum CRP levels. Multivariate logistic showed that C-reactive protein is an independent risk marker
regression analysis showed that the relationship between for de novo major depressive disorders in women (39). In 3
BDI changes and MMSE and serum CRP level was statisti- other longitudinal studies, raised markers of systemic inflam-
cally significant (Tab. II). The AUC for the predictive value of mation have been shown to predate the onset of depressive
CRP for the change of BDI over time was 0.87 (95% con- symptoms (40-42). The fact that depression or symptoms
fidence interval, 0.74-1.00, pJNEPHROL 2012; 25 ( 05 ) : 689-698
TABLE I
DEMOGRAPHIC, CLINICAL AND LABORATORY CHARACTERISTICS OF ALL PATIENTS AND OF PATIENTS STRATI-
FIED ACCORDING TO CHANGE OF BDI OVER TIME
Whole group BDI stable/decreased BDI increased at
p Value
(n=38) at month 18 (n=19) month 18 (n=19)
Marital status
Married/living with partner 23 11 12
Divorced/separated - - -
Widowed 2 1 1
Single 13 7 6
0.982
Work
Yes 16 8 8
No or retired 22 11 11 1.000
Age, years 58.4 ± 17.1 53.2 ± 15.8 64.1 ± 17.1 0.099
Duration of dialysis, months 65.2 ± 11.7 80.5 ± 86.7 48.7 ± 28.4 0.212
Body mass index 25.1 ± 3.9 25.5 ± 3.8 24.8 ± 4.1 0.639
BDI baseline 7.9 ± 4.1 8.6 ± 3.4 7.2 ± 4.6 0.379
BDI month 18 11.2 ± 10.1 5.1 ± 3.6 17.9 ± 10.6Bossola et al: Depression and anxiety over time in hemodialysis
TABLE II
MULTIVARIATE LOGISTIC REGRESSION ANALYSIS OF RELATIONSHIP BETWEEN BDI CHANGES AND PATIENT
CHARACTERISTICS
Variable β SE p Value Odds ratio (95% CI)
MMSE 0.512 0.261 0.046 1.67 (1.00-2.78)
C-reactive protein -0.652 0.330 0.048 0.52 (0.27-0.99)
The covariates introduced in the model were those variables significantly different at the univariate analysis between the 2
groups.
BDI = Beck Depression Inventory; MMSE = Mini-Mental State Examination; SE = standard error.
TABLE III
DEMOGRAPHIC, CLINICAL AND LABORATORY CHARACTERISTICS OF PATIENTS STRATIFIED ACCORDING TO
CHANGE OF HARS OVER TIME
HARS stable/decreased HARS increased
at month 18 at month 18 p Value
(n=25) (n=13)
Age (years) 58.1 ± 16.3 59.2 ± 19.7 0.877
Duration of dialysis (months) 64.6 ± 63.8 66.7 ± 64.2 0.940
Body mass index 25.1 ± 3.8 25.1 ± 4.5 0.986
BDI baseline 7.4 ± 4.1 9.1 ± 3.8 0.347
HARS baseline 8.7 ± 3.4 8.5 ± 3.9 0.910
HARS month 18 5.5 ± 4.2 14.1 ± 4.1JNEPHROL 2012; 25 ( 05 ) : 689-698
Noteworthy is the fact that baseline vitamin D levels were a bias for this kind of study if we consider the differences in
not predictive of BDI increase at month 18. Recently, we diagnostic and therapeutic procedures and in the patient–
found a significant negative correlation between the BDI physician relationship. Finally, to the best of our knowledge,
and 25-hydroxyvitamin D levels in chronic HD patients (9). this is one of the largest longitudinal studies evaluating the
Hoogendijk et al reported the results of a large population- course of symptoms of depression and anxiety in chronic
based study showing an association of depression status HD patients. Second, we used a depressive inventory such
and severity with decreased serum 25-hydroxyvitamin D as BDI for the assessment of the presence and severity of
levels and increased serum parathyroid hormone levels (66). depression. Indeed, we choose the BDI just because it was
Other cross-sectional studies have led to similar conclu- originally created as an instrument for measuring the sever-
sions in the general population (67, 68) and in chronic dis- ity of depression, although it is sometimes used by health
eases (69). care providers to reach a quick diagnosis (71).
Interestingly, the mean and the median HARS did not change In summary, the present study showed that in a significant
significantly at month 18, and in less than one third of the proportion of chronic HD patients, the symptoms of depres-
patients, the HARS score increased over time. In addition, sion worsen over time and that in such patients CRP and
we did not find differences in the demographic, clinical and MMSE are independent predictors of the increase of the
laboratory characteristics of patients in whom the HARS at BDI score. These results suggest the importance of carefully
month 18 decreased or remained stable, with respect to monitoring chronic HD patients to avoid underrecognition
those in which the HARS increased. As suggested by Cukor and undertreatment of depression. However, further stud-
et al, it is possible that the difference between the course of ies in diverse populations are needed to confirm or not our
depression and anxiety is due to the fact that the “effect of results and to establish generalizability.
depression is more robust and easily detectable and that,
to observe the effect for anxiety, a large sample would be Financial support: None.
required” (27).
The present study has some limitations. First, the sample Conflict of interest statement: None.
of the patient population was relatively small. However, the
sample was representative of the HD patients of the city Address for correspondence:
of Rome and of Lazio, a central region of Italy. In fact, our Maurizio Bossola, MD
Istituto di Clinica Chirurgica
population had characteristics similar to the overall popula-
Università Cattolica Sacro Cuore
tion of Lazio region derived from the Lazio Dialysis Register Largo A. Gemelli, 8
(Registro Dialisi Lazio [RDL]) (70). In addition, we believe IT-00168 Rome, Italy
that the inclusion of cohorts from different centers could be maubosso@tin.it
ety in urban hemodialysis patients. Clin J Am Soc Nephrol.
References 2007;2(3):484-490.
4. Cukor D, Coplan J, Brown C, et al. Anxiety disorders in adults
1. Hedayati SS, Finkelstein FO. Epidemiology, diagnosis, and treated by hemodialysis: a single-center study. Am J Kidney
management of depression in patients with CKD. Am J Kid- Dis. 2008;52(1):128-136.
ney Dis. 2009;54(4):741-752. 5. Drayer RA, Piraino B, Reynolds CF III, et al. Characteristics of
2. Kimmel PL, Cukor D, Cohen SD, Peterson RA. Depression depression in hemodialysis patients: symptoms, quality of life
in end-stage renal disease patients: a critical review. Adv and mortality risk. Gen Hosp Psychiatry. 2006;28(4):306-312.
Chronic Kidney Dis. 2007;14(4):328-334. 6. Jadoulle V, Hoyois P, Jadoul M. Anxiety and depression in
3. Cukor D, Coplan J, Brown C, et al. Depression and anxi- chronic hemodialysis: some somatopsychic determinants.
© 2011 Società Italiana di Nefrologia - ISSN 1121-8428 695Bossola et al: Depression and anxiety over time in hemodialysis
Clin Nephrol. 2005;63(2):113-118. 22. Kimmel PL, Peterson RA, Weihs KL, et al. Psychosocial fac-
7. Davison SN, Jhangri GS. The impact of chronic pain on tors, behavioral compliance and survival in urban hemodialy-
depression, sleep, and the desire to withdraw from di- sis patients. Kidney Int. 1998;54(1):245-254.
alysis in hemodialysis patients. J Pain Symptom Manage. 23. Peterson RA, Kimmel PL, Sacks CR, Mesquita ML, Simmens
2005;30(5):465-473. SJ, Reiss D. Depression, perception of illness and mortal-
8. Kalender B, Ozdemir AC, Koroglu G. Association of depres- ity in patients with end-stage renal disease. Int J Psychiatry
sion with markers of nutrition and inflammation in chronic Med. 1991;21(4):343-354.
kidney disease and end-stage renal disease. Nephron Clin 24. Troidle L, Watnick S, Wuerth DB, Gorban-Brennan N, Kliger
Pract. 2006;102(3-4):c115-c121. AS, Finkelstein FO. Depression and its association with peri-
9. Bossola M, Ciciarelli C, Di Stasio E, et al. Correlates of symp- tonitis in long-term peritoneal dialysis patients. Am J Kidney
toms of depression and anxiety in chronic hemodialysis pa- Dis. 2003;42(2):350-354.
tients. Gen Hosp Psychiatry. 2010;32(2):125-131. 25. Hedayati SS, Grambow SC, Szczech LA, Stechuchak KM,
10. Hung KC, Wu CC, Chen HS, et al: Serum IL-6, albumin and Allen AS, Bosworth HB. Physician-diagnosed depression as
co-morbidities are closely correlated with symptoms of de- a correlate of hospitalizations in patients receiving long-term
pression in patients on maintenance haemodialysis. Nephrol hemodialysis. Am J Kidney Dis. 2005;46(4):642-649.
Dial Transplant 2010 Jul 14. 26. Hedayati SS, Bosworth HB, Briley LP, et al. Death or hospi-
11. Dogan E, Erkoc R, Eryonucu B, Sayarlioglu H, Agargun talization of patients on chronic hemodialysis is associated
MY. Relation between depression, some laboratory param- with a physician-based diagnosis of depression. Kidney Int.
eters, and quality of life in hemodialysis patients. Ren Fail. 2008;74(7):930-936.
2005;27(6):695-699. 27. Cukor D, Coplan J, Brown C, Peterson RA, Kimmel PL.
12. Santoro A, Mancini E. Hemodialysis and the elderly patient: Course of depression and anxiety diagnosis in patients treat-
complications and concerns. J Nephrol. 2010;23(Suppl 15): ed with hemodialysis: a 16-month follow-up. Clin J Am Soc
S80-S89. Nephrol. 2008;3(6):1752-1758.
13. Andrade CP, Cruz MC, Urrutia M, et al. Evaluation of de- 28. Soykan A, Boztas H, Kutlay S, et al. Depression and its
pressive symptoms in patients with chronic renal failure. J 6-month course in untreated hemodialysis patients: a pre-
Nephrol. 2010;23(2):168-174. liminary prospective follow-up study in Turkey. Int J Behav
14. Park HC, Yoon HB, Son MJ, et al. Depression and health- Med. 2004;11(4):243-246.
related quality of life in maintenance hemodialysis patients. 29. Sica C, Ghisi M. The Italian versions of the Beck Anxiety
Clin Nephrol. 2010;73(5):374-380. Inventory and the Beck Depression Inventory-II: psycho-
15. Tentori F, Mapes DL. Health-related quality of life and de- metric properties and discriminant power. In: Lange MA,
pression among participants in the DOPPS: predictors and ed. Leading-edge psychological tests and testing research.
associations with clinical outcomes. Semin Dial. 2010;23(1): Hauppauge, New York: NOVA; 2007:27-50.
14-16. 30. Chilcot J, Wellsted D, Farrington K. Screening for depres-
16. Son YJ, Choi KS, Park YR, Bae JS, Lee JB. Depression, sion while patients dialyse: an evaluation. Nephrol Dial Trans-
symptoms and the quality of life in patients on hemodialy- plant. 2008;23(8):2653-2659.
sis for end-stage renal disease. Am J Nephrol. 2009;29(1): 31. Watnick S, Wang PL, Demadura T, Ganzini L. Validation of 2
36-42. depression screening tools in dialysis patients. Am J Kidney
17. Dogan E, Erkoc R, Eryonucu B, Sayarlioglu H, Agargun MY. Dis. 2005;46(5):919-924.
Relation between depression, some laboratory parameters, 32. Hamilton M. The assessment of anxiety states by rating. Br J
and quality of life in hemodialysis patients. Ren Fail. 2005; Med Psychol. 1959;32(1):50-55.
27(6):695-699. 33. Nifosì F, Violato E, Pavan C, et al. Psychopathology and clini-
18. Shulman R, Price JD, Spinelli J. Biopsychosocial aspects cal features in an Italian sample of patients with myofascial
of long-term survival on end-stage renal failure therapy. Psy- and temporomandibular joint pain: preliminary data. Int J
chol Med. 1989;19(4):945-954. Psychiatry Med. 2007;37(3):283-300.
19. Wai L, Richmond J, Burton H, Lindsay RM. Influence of 34. Cassano GB, Pancheri P. Trattato Italiano di Psichiatria. Mi-
psychosocial factors on survival of home-dialysis patients. lan, Italy: Masson; 1993.
Lancet. 1981;2(8256):1155-1156. 35. Di Iorio B, Cillo N, Cirillo M, De Santo NG. Charlson Comor-
20. Burton HJ, Kline SA, Lindsay RM, Heidenheim AP. The re- bidity Index is a predictor of outcomes in incident hemodialy-
lationship of depression to survival in chronic renal failure. sis patients and correlates with phase angle and hospitaliza-
Psychosom Med. 1986;48(3-4):261-269. tion. Int J Artif Organs. 2004;27(4):330-336.
21. Ziarnik JP, Freeman CW, Sherrard DJ, Calsyn DA. Psycho- 36. Mingardi G, Cornalba L, Cortinovis E, Ruggiata R, Mosconi
logical correlates of survival on renal dialysis. J Nerv Ment P, Apolone G; DIA-QOL Group. Health-related quality of life
Dis. 1977;164(3):210-213. in dialysis patients: a report from an Italian study using the
696 © 2011 Società Italiana di Nefrologia - ISSN 1121-8428JNEPHROL 2012; 25 ( 05 ) : 689-698
SF-36 Health Survey. Nephrol Dial Transplant. 1999;14(6): sociation between major depression and levels of soluble in-
1503-1510. tercellular adhesion molecule 1, interleukin-6, and C-reactive
37. Jhamb M, Weisbord SD, Steel JL, Unruh M. Fatigue in pa- protein in patients with recent acute coronary syndromes.
tients receiving maintenance dialysis: a review of defini- Am J Psychiatry. 2004;161(2):271-277.
tions, measures, and contributing factors. Am J Kidney Dis. 52. Loftis JM, Huckans M, Ruimy S, Hinrichs DJ, Hauser P. De-
2008;52(2):353-365. pressive symptoms in patients with chronic hepatitis C are
38. Tombaugh TN, McIntyre NJ. The Mini-Mental State Examina- correlated with elevated plasma levels of interleukin-1beta
tion: a comprehensive review. J Am Geriatr Soc. 1992;40(9): and tumor necrosis factor-alpha. Neurosci Lett. 2008;430(3):
922-935. 264-268.
39. Pasco JA, Nicholson GC, Williams LJ, et al. Association of 53. Dervisoglu E, Kir HM, Kalender B, Eraldemir C, Caglayan C.
high-sensitivity C-reactive protein with de novo major de- Depressive symptoms and proinflammatory cytokine levels
pression. Br J Psychiatry. 2010;197(5):372-377. in chronic renal failure patients. Nephron Clin Pract. 2008;
40. Milaneschi Y, Corsi AM, Penninx BW, Bandinelli S, Guralnik 108(4):c272-c277.
JM, Ferrucci L. Interleukin-1 receptor antagonist and incident 54. Taskapan H, Ates F, Kaya B, et al. CRP and depression in pa-
depressive symptoms over 6 years in older persons: the In- tients on chronic dialysis. Clin Nephrol. 2003;60(6):443-444.
CHIANTI study. Biol Psychiatry. 2009;65(11):973-978. 55. Sonikian M, Metaxaki P, Papavasileiou D, et al. Effects of
41. van den Biggelaar AH, Gussekloo J, de Craen AJ, et al. In- interleukin-6 on depression risk in dialysis patients. Am J
flammation and interleukin-1 signaling network contribute to Nephrol. 2010;31(4):303-308.
depressive symptoms but not cognitive decline in old age. 56. Howren MB, Lamkin DM, Suls J. Associations of depression
Exp Gerontol. 2007;42(7):693-701. with C-reactive protein, IL-1, and IL-6: a meta-analysis. Psy-
42. Gimeno D, Kivimäki M, Brunner EJ, et al. Associations of C- chosom Med. 2009;71(2):171-186.
reactive protein and interleukin-6 with cognitive symptoms of 57. Maes M. Depression is an inflammatory disease, but cell-me-
depression: 12-year follow-up of the Whitehall II study. Psy- diated immune activation is the key component of depres-
chol Med. 2009;39(3):413-423. sion. Prog Neuropsychopharmacol Biol Psychiatry. 2011;
43. Dantzer R, O’Connor JC, Freund GG, Johnson RW, Kelley 35(3):664-675.
KW. From inflammation to sickness and depression: when 58. Jehn CF, Kühnhardt D, Bartholomae A, et al. Association of IL-
the immune system subjugates the brain. Nat Rev Neurosci. 6, hypothalamus-pituitary-adrenal axis function, and depres-
2008;9(1):46-56. sion in patients with cancer. Integr Cancer Ther. 2010;9(3):
44. Adler UC, Marques AH, Calil HM. Inflammatory aspects of 270-275.
depression. Inflamm Allergy Drug Targets. 2008;7(1):19-23. 59. Pyter LM, Pineros V, Galang JA, McClintock MK, Prendergast
45. Irwin MR, Miller AH. Depressive disorders and immunity: BJ. Peripheral tumors induce depressive-like behaviors and
20 years of progress and discovery. Brain Behav Immun. cytokine production and alter hypothalamic-pituitary-adrenal
2007;21(4):374-383. axis regulation. Proc Natl Acad Sci U S A. 2009;106(22):
46. Alesci S, Martinez PE, Kelkar S, et al. Major depression is 9069-9074.
associated with significant diurnal elevations in plasma in- 60. Tsirpanlis G, Bagos P, Ioannou D, et al. The variability and
terleukin-6 levels, a shift of its circadian rhythm, and loss accurate assessment of microinflammation in haemodialysis
of physiological complexity in its secretion: clinical implica- patients. Nephrol Dial Transplant. 2004;19(1):150-157.
tions. J Clin Endocrinol Metab. 2005;90(5):2522-2530. 61. Alesci S, Martinez PE, Kelkar S, et al. Major depression is
47. Marques-Deak AH, Neto FL, Dominguez WV, et al. Cytokine associated with significant diurnal elevations in plasma in-
profiles in women with different subtypes of major depres- terleukin-6 levels, a shift of its circadian rhythm, and loss
sive disorder. J Psychiatr Res. 2007;41(1-2):152-159. of physiological complexity in its secretion: clinical implica-
48. Christian LM, Franco A, Glaser R, Iams JD. Depressive tions. J Clin Endocrinol Metab. 2005;90(5):2522-2530.
symptoms are associated with elevated serum proinflamma- 62. Bossola M, La Torre G, Giungi S, Tazza L, Vulpio C, Luciani
tory cytokines among pregnant women. Brain Behav Immun. G. Serum albumin, body weight and inflammatory parame-
2009;23(6):750-754. ters in chronic hemodialysis patients: a three-year longitudi-
49. Zautra AJ, Yocum DC, Villanueva I, et al. Immune activation nal study. Am J Nephrol. 2008;28(3):405-412.
and depression in women with rheumatoid arthritis. J Rheu- 63. Ciaccio M, Bivona G, Di Sciacca R, et al. Changes in serum
matol. 2004;31(3):457-463. fetuin-A and inflammatory markers levels in end-stage renal
50. Musselman DL, Miller AH, Porter MR, et al. Higher than nor- disease (ESRD): effect of a single session haemodialysis.
mal plasma interleukin-6 concentrations in cancer patients Clin Chem Lab Med. 2008;46(2):212-214.
with depression: preliminary findings. Am J Psychiatry. 2001; 64. Martins C, Mazza do Nascimento M, Pecoits-Filho R, et al.
158(8):1252-1257. Insulin resistance is associated with circulating fibrinogen
51. Lespérance F, Frasure-Smith N, Théroux P, Irwin M. The as- levels in nondiabetic patients receiving peritoneal dialysis. J
© 2011 Società Italiana di Nefrologia - ISSN 1121-8428 697Bossola et al: Depression and anxiety over time in hemodialysis
Ren Nutr. 2007;17(2):132-137. 68. Wilkins CH, Sheline YI, Roe CM, Birge SJ, Morris JC. Vitamin
65. Djernes JK. Prevalence and predictors of depression in D deficiency is associated with low mood and worse cog-
populations of elderly: a review. Acta Psychiatr Scand. 2006; nitive performance in older adults. Am J Geriatr Psychiatry.
113(5):372-387. 2006;14(12):1032-1040.
66. Hoogendijk WJ, Lips P, Dik MG, Deeg DJ, Beekman AT, 69. Armstrong DJ, Meenagh GK, Bickle I, Lee AS, Curran ES, Finch
Penninx BW. Depression is associated with decreased MB. Vitamin D deficiency is associated with anxiety and de-
25-hydroxyvitamin D and increased parathyroid hormone pression in fibromyalgia. Clin Rheumatol. 2007;26(4):551-554.
levels in older adults. Arch Gen Psychiatry. 2008;65(5): 70. Agency for Public Health, Lazio Region. Registro Dialisi del
508-512. Lazio. Rome, Italy: Agency for Public Health; 2008.
67. Jorde R, Waterloo K, Saleh F, Haug E, Svartberg J. Neuro- 71. Hersen M, Turner SM, Beidel DC. Adult psychopathology
psychological function in relation to serum parathyroid hor- and diagnosis. 5th ed. Wiley; New York, NY. 2007:301-302.
mone and serum 25-hydroxyvitamin D levels: the Tromsø
study. J Neurol. 2006;253(4):464-470. Accepted: September 5, 2011
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